NDSU Department of Child Development and Family Science
North Dakota Department of Human Services
June 1998
Our parent training serves one group of parents each spring in the tradition developed by Patterson (1973) and refined by Forehand and McMahon (1981). Five sets of parents meet for ten weekly sessions which last an hour and a half. Since our clinic follows the Forehand and McMahon model regarding attending, ignoring, and issuing specific commands, those aspects of the clinic will not be discussed. However, we deviate from this model in the following ways.
The first parent training session begins with an overview of the etiology of ODD. The parents are told that three factors usually operate when a child develops ODD. First, the child is born with a fussy, easily upset, irritable temperament. Second, family functioning is usually compromised due to such things as maternal depression, single-parenting, substance abuse, and marital stress. Third, the parents do not have the requisite parenting skills to deal with a child who has a difficult temperament.
As part of the pre-therapy assessments and interviews, parents complete the Parenting Stress Index (Abidin, 1983). This instrument provides an index of the stress attributable to the child's characteristics and dimensions of the parent's functioning. Every mother seen in our clinic scored at or above the 98th percentile on their total stress index. We believe it is important for the parents to receive confirmation and acknowledgment of their stress. We point out that the research has not determined whether family dysfunction causes the child to develop ODD, or whether the child's temperament compromises family functioning. After reviewing the Parenting Stress Index, the parent discusses his/her stress level with the group. This gives the parents permission to tell their stories, and they do. We have learned that the majority of mothers feel alienated from their spouses. They often feel devalued by their in-laws and sometimes by their parents. They feel that preschools and schools have labeled them as "poor parents." In short, everyone has given them the message that they are the cause of their child's ODD. They feel they have failed as parents. It is important for the parents, particularly the mothers, to have this catharsis.
Since parenting skills are the most malleable component of this tripartite etiology, it becomes the focus of treatment. We incorporate Webster-Straton's concept of videotape training to teach seven vital parenting skills. Parents learn the skills of labeling, praising, requesting positive behavior, ignoring, ignoring and redirecting, implementing logical consequences, and avoiding punishment. The skills are taught one at a time over a period of seven weeks. The parents first watch the video tape, which defines the concept and shows the skill being applied and misapplied. The following week, the parents practice the use of the skill, with feedback from the clinician, in the clinic with their child. After successfully using the skill in the clinic, the parents use the skill at home with their child. In the future, the clinic plans to furnish the parents with portable tape recorders and lapel microphones to record parent-child interactions.
In contrast to Forehand & McMahon (1981), we do not teach parents to use time-out. As Forehand & McMahon (1981) noted, teaching parents to use TO is risky. Some parents become abusive in implementing the spanking called for when the child refuses to remain in TO. If punishment is defined as doing things designed to make the child feel fearful, humiliated, or guilty (Hall & Braun, 1988), then time-out is punishment. Punishment undermines the development of the solidarity that we consider essential in a healthy parent-child relationship (McGee et al., 1987). In lieu of teaching TO, parents learn the concepts of routines, foreshadowing, ignoring, ignoring and redirecting, and logical consequences.
Parents are given training about how to establish routines. Each set of parents selects a particularly difficult time of the day and then develops a routine to implement at that time. One family identified bedtime as problematic. Their child delayed bedtime. He refused to quit watching television, to take his bath, or to brush his teeth. With the child's input, his parents developed the following routine:
7:00 – Homework
7:30 – Television
8:00 – Pick up room
8:10 – Bath
8:30 – Computer
9:00 – Bedtime snack
9:15 – Brush teeth
9:20 – Study time
Routines are built around the Premack Principle, (Premack, 1959), also called "Grandma's rule"— "You have to eat your peas before you eat the ice cream." In their child's schedule, watching television follows completing homework, and enjoying computer time and a bedtime snack follows picking up his room and bathing. Likewise, reading a favorite story with Mom follows brushing his teeth. The Premack Principle leads to logical consequences, which is defined as missing a privilege for failing to fulfill a responsibility. If the child does not pick up his room and take his bath by 8:30, then no computer time is provided at 8:30. If the child tantrums about not getting to use the computer, the parent need only say, "You can either tantrum, or you can take a bath and then use the computer for the remaining time. You decide." It is important that parents choose only those privileges over which they have control. For example, the privilege of watching a TV show after completion of homework will not work if the child does not accept parental control of the television.
Charting is another component of a successful routine. Parents should involve the child in developing the chart. Some children create the chart on the computer. Younger children find magazine pictures that represent activities in the routine, such as brushing teeth. The parent and child paste the pictures on the chart.
The child should be involved in developing the routine, making the chart, and then monitoring his performance. Self-monitoring raises the child's awareness of the desired behavior. A checkmark gives the parent an opportunity to praise the child for appropriate behavior. The absence of a checkmark allows the parent to avoid bantering, which is a succession of beta commands often given with increased emotional intensity. At this point, we tell the parents to "let the chart work for you." Meaning, if it is snack time and the child has not yet picked up his room, the parent says, "Please check your chart and see if you are ready for a snack." If the child has not picked up his room, this is often the only prompt needed to elicit the desired behavior. If the child refuses to pick up his room, the parent needs to be sufficiently steeled to ignore the pouting and possible temper tantrum that will follow. We help the parents anticipate how their child might challenge the integrity of the chart and help them role play their response to that challenge. There are two bottom line messages. First, it is imperative that the parents not raise the intensity of their emotions to match the child's emotions. Secondly, it is important that the parents do not give in. The parents are told that if they uphold this first challenge to the chart, it will likely be the last. If they give in bring some peace to the moment, then they can forget about the chart being effective.
It is our experience that children with ODD have a particularly difficult time with change. For them, change needs to be foreshadowed. For example, rather than tell the child, "It's time to go to bed," it works better to say, "It will be bedtime in five minutes." Rather than tell the child, "Come in for supper," it works better to say, "Take three more shots (with the basketball), and then come in for supper."
Forehand & McMahon (1981) teach parents to ignore inappropriate behaviors. Ignoring in their model is somewhat akin to parent time-out. The parent looks away from the child and stops all interaction. Through ignoring, the parents convey to the child their disapproval, i.e., punishment. To avoid punishment, we teach the parent to ignore the behavior but not the child. In our model, ignoring means giving no indication that the parent is aware of the behavior.
Behavior that does not endanger anyone's health, safety, property, or basic rights can be ignored (Hall, 1992). For example, the child who tantrums when requested to eat certain foods is not endangering health, safety, property, or basic rights. It can be ignored.
Not all behavior can be ignored. If the child's behavior portends injury to himself or to others, an adult must intervene. The best intervention is a combination of ignoring and redirecting. For example, Justin, a kindergarten child, is pushing another student in the lunch line. Seeing this, the teacher asks Justin to count the students who want milk with their lunch. Since Justin cannot simultaneously push students and count them, he stops pushing. The teacher immediately reinforces his counting.
Dreikurs and Soltz (1964) recommend using logical consequences as an alternative to punishment. A logical consequence is the relationship between how one behaves and what then happens, either naturally or by necessity, as a result of those behaviors. A logical consequence can be positive, such as when responsible behavior leads to an increase in privileges. Or, a logical consequence can be negative, such as when irresponsible behavior leads to loss of privileges to the extent necessary to protect health, safety, welfare, or basic rights (Hall, 1992). This definition of logical consequences has two key components: (1) irresponsible behavior leads to a loss of privileges (not to punishment); and (2) privileges are lost to the extent necessary to protect. For example, if a child throws things in a classroom, he needs to be removed from the classroom so that he does not hurt anyone. If the child is reminded that people should not hurt other people, then he can accept having to leave the classroom until he calms down.
We empower the parents to become problem solvers by asking them to apply the skills they have learned. One parent's difficulty with her daughter in a grocery store is an example. Every time Mom took her daughter, Sarah, into the grocery store, they were unable to go down any aisle without the four-year-old spotting some item she wanted. If Mom did not put the item into the cart, Sarah had a tantrum. At best, Mom left the store with a dozen unnecessary items. At worse, Sarah's tantrum forced Mom to abandon the cart mid-aisle and carry the kicking, screaming girl out of the store.
Mom considered using a routine. With help from another parent, Mom determined that Sarah had to help her find ten things on "her" grocery list. When Sarah found the tenth item, which was always in the last aisle, She was permitted to select one item, a treat, out of three acceptable choices. Sarah's mom presented this idea to her. Together, they planned their next trip to the grocery store. As part of the planning, Mom and Sarah looked in magazines for pictures of the ten items she was to find. These items were cut out and pasted on a chart. Beside each picture was space for a check mark. Sarah was given the choice of three possible treats that she could then buy. As part of this planning, Mom told Sarah that if she insisted on getting a treat before all ten items were found, they would immediately leave the store. These rules were reviewed just prior to going into the store. The outing was successful. Follow-up a year later revealed that all subsequent "planned" grocery outings had gone smoothly. A couple of unplanned, last minute trips to the store without Sarah's list had been disasters.
At the parent's request, we consult with the child's teachers and school staff. For example, Sammy was a kindergarten student who was physically removed daily from the classroom. When he was removed, he was forcibly taken to the principal's office. The aide restrained Sammy while the secretary phoned his parents. If Dad came to remove Sammy, he got a spanking when they got home. If Mom came, Sammy was confined to his room for the rest of the school day. Little wonder that the aide sported bruised shins and threatened to resign.
In our clinic, Sammy was asked to explain why he was removed from the classroom; he did not know why. The teacher was asked why Sammy was removed; she related, "That's obvious. He is removed when he misbehaves." The graduate student, who had been observing in the classroom, felt that Sammy's removal depended more on the time of day than on his behavior. Sammy was removed when the teacher reached the "end of her rope." That usually happened about 10:30. Behaviors that were tolerated earlier in morning were no longer tolerated.
After consultation with the teacher, it was decided that Sammy would be removed when he threw things, took things, or hit someone. These rules were reviewed with Sammy. He understood why these behaviors could not be allowed. With Sammy's input, a logical consequence was developed. If Sammy threw things, took things, or hit anyone he would need to leave the room. To facilitate leaving the room, the aide would hand Sammy a puzzle piece, and he and the aide would go to another room to put a puzzle together. The precipitating behaviors and intervention were role played with Sammy and his aide in the clinic and then in the classroom. Sammy was asked to explain his plan, in turn, to his mother, the school counselor, and the principal. Sammy never again engaged in these inappropriate behaviors. He finished the school year without once being asked to leave the room.
Our individual work with the child is considerably different from that undertaken in other clinics. Patterson, believing that ODD was the result of poor parenting skills, did not work with the child. Forehand & McMahon coached the development of parenting skills as they watched the parent-child interaction. Webster-Stratton presented parent-child vignettes followed by discussion of the skills.
Oppositional behavior is the result of dysfunctional dynamics between the parent and the child. Parents need to learn more effective parenting skills, and the child needs to learn relationship skills. The child does not know how to enter into equitable relationships. Lacking relationship skills, the child has not experienced the enjoyment or benefitted from the nurturing inherent in equitable relationships.
First, the child is taught to accept labeling of his behavior. He is taught to look forward to being praised. He learns to accept getting control and then giving up control, i.e., turn taking, and he is taught the skill of losing within the context and camaraderie that develops during a competitive game.
The child is taught these relationship skills in the care-giving posture that McGee et al. (1987) call Gentle Teaching. Gentle Teaching eschews punishment in favor of providing an emotionally safe environment in which to build an equitable relationship through the vehicle of shared tasks. This care-giving posture is facilitated through the use of Structured Teaching (Mesibov, Schopler, & Hearsay, 1994). Structured Teaching was developed as a method of teaching children with autism. Among other things, Structured Teaching uses visual cues as opposed to oral directions to communicate demands and expectations. In our clinic, the child with ODD is presented with three "work baskets" holding developmentally appropriate tasks. A card system signals which basket he should chose next. All of the tasks in the baskets have a clear "finish." After the child finishes the tasks in the three baskets, he goes to a clearly defined play area.
Not only must the child learn equitable relationship skills, he must also learn that he can engage in an equitable relationship with his parent. In practice, when Mom first enters the clinic room it is common for the child to turn his back on her, to attempt to push her off her chair, or to hit her. The child has learned to enjoy participating in the relationship skills with the clinician, and he does not want his mother to interfere. It takes time for both child and parent to learn the skills of participating in equitable, nurturing relationships.
We are still refining our clinic procedures and have not finished designing our data collection battery. Nonetheless, we are mindful of treatment efficacy and have routinely collected outcome data at three months, six months, and one year post-treatment. At three months post-treatment, 95% of the children are doing very well. At six months post-treatment, 60% of the children are doing very well. At one year post-treatment, 40% of the children are doing very well.
Case by case analysis revealed that the gains from treatment last until the first unexpected crisis. Kenny, for example, did great for six months. Then his teacher, was diagnosed with breast cancer. With no foreshadowing, a new teacher took over the class. Kenny immediately regressed to oppositional behavior. When the substitute teacher attempted to "straighten Kenny out," he became aggressive. Before noon of the first day, Kenny was in the principal's office. The principal phoned Mom and informed her that Kenny was no longer wanted at the private school. Another boy, Jason, did well following treatment until his dad lost his job. We are currently investigating a mechanism for providing periodic, post-treatment checkups so that the setbacks experienced in the face of unanticipated crises can be mitigated.
Abidin, R. R. (1983). Parenting Stress Index. Odessa , FL: Psychological Assessment Resources.
Barkley, R. A. (1990). Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment. New York: Guildford.
Beardslee, W.R., Bemporad, J., Keller, M.B., & Klermar, G.L. (1983). Children of parents with major affective disorder: A review. American Journal of Psychiatry, 140, 825-832.
Biederman, J., Munir, K., & Knee, D. (1987). Conduct and oppositional disorder in clinically referred children with attention deficit disorder: A controlled family study. Journal of the American Academy of Child and Adolescent Psychiatry, 26, 724-727.
Bird, H.R., Camino, G., Rubio-Stipe, M., Gould, M.S., Rivera, J, Seaman, M., Woodbury M, Hairdos-Goldman, S., Pagan, A., Sanchez-Lacy, A., & Miscast, H. (1988) Estimates of the prevalence of childhood maladjustment in a community survey in Puerto Rico. Archives of General Psychiatry, 45, 1120-1126.
Bronfenbrenner, U. (1979). The Ecology of Human Development: Experiments by Nature and Design. Cambridge: Harvard University Press.
Dreikurs, R., & Soltz, V. (1964). Children the Challenge. New York, NY: Hawthorn Books, Inc.
Emery, R.E. (1982). Interparental conflict and the children of discord and divorce. Psychological Bulletin, 92, 310-330.
Forehand, R.L., & McMahon, R.J. (1981). Helping the Noncompliant Child: A Clinician's Guide to Parent Training. New York: Guilford.
Frick, P.J., Lahey, B.B., Loeber, R., Stouthamer-Loeber, M., Christ, M.A.G., & Hanson, K. (1992). Familial risk factors to oppositional defiant disorders and conduct disorder: Parental psychopathology and maternal parenting. Journal of Consulting and Clinical Psychology, 60, 49-55.
Goodenough, F.L. (1931). Anger in Young Children. Minneapolis: University Press.
Hall, P.S., & Braun, V.R. (1988). Punishment: A consumer's perspective. TASH Newsletter, June.
Hall, P.S. (1992). Applied humanism: A model for normalized behavior programming. Journal of Humanistic Education and Development, 31, 22-32.
Lahey, B.B., Loeber, R., Quay, H.C., Frick, P.J., & Grimm, J. (1992). Oppositional defiant and conduct disorders: Issues to be resolved by DSM-IV. Journal of American Academy of Child Adolescent Psychiatry, 31, 539-546.
Loeber, R., Keenan, K., Lahey, B.B., Green, S.M., & Thomas, C. (1993). Evidence for developmentally based diagnosis of oppositional defiant disorder and conduct disorder. Journal of Abnormal Child Psychology, 21 (4), 377-410.
McGee, J.J., Menolascino, F. J., Hobbs, D.C., & Menousek, P.E. (1987). Gentle Teaching: A Nonaversive Approach for Helping Persons with Mental Retardation. New York: Human Service Press, Inc.
McGee R., Feehan M., Williams S., Partridge F., Silva PA., & Kelly J. (1990). DSM-III disorders in a large sample of adolescents. Journal of American Academy of Child and Adolescent Psychiatry, 29, 611-619.
Mesibov, G.B., Schopler, E., & Hearsay, K. (1994). Structured Teaching. In E. Schopler & G.B. Mesibov, Eds., Behavioral Issues in Autism: Current Issues in Autism. New York, NY: Plenum Press, 1994.
Patterson, G.R. (1976). The aggressive child: Victim and architect of a coercive system. In E. Mash, L. Hamerlynck, & L. Hardy, Eds., Behavior Modification and Families. New York: Brunner/Mazel, 1976.
Patterson, G.R., Cobb, J.A., & Ray, R.S. (1973). A social engineering technology for retaining families of aggressive boys. In H. E. Adams & I. P. Unikel, Eds., Issues and Trends in Behavior Therapy. Springfield, IL: Charles C. Thomas.
Premack, D. (1959). Toward empirical behavior laws: I. Positive reinforcement. Psychological Review, 66, 219-233.
Rey, J.M. (1993). Oppositional defiant disorder. American Journal of Psychiatry, 150 (12), 1769-1778.
Schroeder, C.S., & Gordon, B.N. (1991). Assessment and Treatment of Childhood Problems. New York: Guildford..
Shaffer, D., Schwab-Stone M., Fisher, P., Davies M., Piacentini, J., & Gioia, P. (1988). A revised version of the Diagnostic Interview Schedule for Children (DISC-R): Results of a field trial and proposals for a new instrument (DISC-2). Washington, DC: National Institute of Mental Health.
Shepherd, M., Oppenheim, B., & Mitchell S., Eds., (1971). Childhood Behavior and Mental Health. London: University of London Press.
Webster-Stratton, C. (1981a). Modification of mothers' behaviors and attitudes through a videotape modeling group discussion program. Behavior Therapy, 12, 634-642.
Webster-Stratton, C. (1981b). Videotape modeling: A method of parent education. Clinical Child Psychology, 10, 93-98.
Webster-Stratton, C. (1982). Long term effects of a videotape modeling parent education program: Comparison of immediate and one year follow-up results. Behavior Therapy, 13, 702-714.
Wenning, K., Nathan, P., & King, S. (1993). Mood disorders in children with oppositional defiance disorder: A pilot study. American Journal of Orthopsychiatry, 63 (2), 295-299.
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Book by One Author
Morgenstern, S. (1992). No sweat desktop publishing. New York: AMACOM.
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Cone, J.D., & Foster, S.L. (1993). Dissertations and theses from start to finish:
Psychology and related fields. Washington, DC: American Psychological Association.
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Gibbs, J.T. , & Huang, L.N. (Eds.). (1991). Children of color: Psychological
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Community Psychiatry. 28. 451-458.
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of 1990, 42 U.S.C.A. _ 2101 et seq.m (West 1993).
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Fedor, L. (1995, April 1). Domestic violence needs attention. Grand Forks Herald,
p.4.
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Osgood, D.W., & Willson, J.K. (1990). Covariation of adolescent health problems.
Lincoln: University of Nebraska. (NTIS No. PB 91-154 377/AS)
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Bower, D.L. (1993). Employee assistant programs supervisory referrals: Characteristics of
referring and nonreferring supervisors. Dissertation Abstracts International.
54(01), 534B. (University Microfilms No. AAD93-15947)
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Wilficy, D.E. (1989). Interpersonal analyses of bulimia: Normal-weight and obese.
Unpublished doctoral dissertation, University of Missouri, Columbia.
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The North Dakota Journal of Human Services, June 1998