Journal of Child and Family Studies

, Volume 25, Issue 5, pp 1623–1633 | Cite as

Perceived Parent–Child Relations, Conduct Problems, and Clinical Improvement Following the Treatment of Oppositional Defiant Disorder

  • Jordan A. BookerEmail author
  • Thomas H. Ollendick
  • Julie C. Dunsmore
  • Ross W. Greene
Original Paper


Our objective in this study was to examine the moderating influence of parent–child relationship quality (as viewed by the child) on associations between conduct problems and treatment responses for children with oppositional defiant disorder (ODD). To date, few studies have considered children’s perceptions of relationship quality with parents in clinical contexts even though extant studies show the importance of this factor in children’s behavioral adjustment in non-clinical settings. In this study, 123 children (ages 7–14 years, 61.8 % male, 83.7 % white) who fulfilled DSM-IV criteria for ODD received one of two psychosocial treatments: Parent Management Training or Collaborative and Proactive Solutions. In an earlier study, both treatments were found to be effective and equivalent in treatment outcomes. In the current study, pre-treatment maternal reports of conduct problems and pre-treatment child reports of relations with parents were used to predict outcomes in ODD symptoms and their severity following treatment. Elevated reports of children’s conduct problems were associated with attenuated reductions in both ODD symptoms and their severity. Perceived relationship quality with parents moderated the ties between conduct problems and outcomes in ODD severity but not the number of symptoms. Mother reports of elevated conduct problems predicted attenuated treatment response only when children viewed relationship quality with their parents as poorer. When children viewed the relationship as higher quality, they did not show an attenuated treatment response, regardless of reported conduct problems. The current findings underscore the importance of children’s perspectives in treatment response and reductions in externalizing child behaviors.


Oppositional defiant disorder Parent–child relationships Antisocial behavior 



Funding was provided by R01 MH59308 from NIMH and by the Institute for Society, Culture, and Environment at Virginia Tech. We wish to express appreciation to the graduate students and research scientists who assisted us with various aspects of this project, including data reduction, assessment, and treatment of these youth. We also wish to extend thanks to the many undergraduate students at Virginia Tech who assisted us with data coding, entry, and verification. Finally, we are grateful to the youth and families who participated in this clinical research.


  1. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington DC: American Psychiatric Association.Google Scholar
  2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington DC: American Psychiatric Association.Google Scholar
  3. Andersen, S. M., & Chen, S. (2002). The relational self: An interpersonal social-cognitive theory. Psychological Review, 109, 619–645. doi: 10.1037//0033-295X.109.4.619.CrossRefPubMedGoogle Scholar
  4. Anderson, S. R., & Ollendick, T. H. (2012). Diagnosing oppositional defiant disorder using the anxiety disorders interview schedule for DSM-IV: Parent version and the diagnostic interview schedule for children. Psychopathology and Behavioral Assessment, 34, 467–475.CrossRefGoogle Scholar
  5. Angold, A., Costello, E., & Erkanli, A. (1999). Comorbidity. Journal of Child Psychology and Psychiatry, 40, 57–97.CrossRefPubMedGoogle Scholar
  6. Arbunkle, J. L. (1996). Full information estimation in the presence of incomplete data. In G. A. Marcoulides & R. E. Schumacker (Eds.), Advanced structural equation modeling (pp. 243–277). Mahwah, NJ: Erlbaum.Google Scholar
  7. Barkley, R. A. (1997). Defiant children: A clinician’s manual for parent training (2nd ed.). New York: Guilford Press.Google Scholar
  8. Bauer, D. J., & Curran, P. J. (2005). Probing interactions in fixed and multilevel regression: Inferential and graphical techniques. Multivariate Behavioral Research, 40, 373–400.CrossRefPubMedGoogle Scholar
  9. Beauchaine, T. P., Webster-Stratton, C., & Reid, M. J. (2005). Mediators, moderators, and predictors of 1-year outcomes among children treated for early-onset conduct problems: A latent growth curve analysis. Journal of Consulting and Clinical Psychology, 73, 371–388. doi: 10.1037/0022-006X.73.3.371.CrossRefPubMedGoogle Scholar
  10. Beiderman, J., Faraone, S. V., Milberger, S., Jetton, J. G., Chen, L., Mick, E., et al. (1996). Is childhood oppositional defiant disorder a precursor to adolescent conduct disorder? Findings from a four-year follow-up study of children with ADHD. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 1193–1204. doi: 10.1097/00004583-199609000-00017.CrossRefGoogle Scholar
  11. Brestan, E. V., & Eyberg, S. M. (1998). Effective psychosocial treatments of conduct-disordered children and adolescents: 29 years, 82 studies, and 5,272 kids. Journal of Clinical Child Psychology, 27, 180–189.CrossRefPubMedGoogle Scholar
  12. Burke, J. D., Loeber, R., & Birmaher, B. (2000). Oppositional defiant disorder and conduct disorder: A review of the past 10 years, part II. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 1275–1293.CrossRefGoogle Scholar
  13. Burt, S. A., McGue, M., Krueger, R. F., & Iacono, W. G. (2005). How are parent-child conflict and childhood externalizing symptoms related over time? Results from a genetically informative cross-lagged study. Developmental Psychopathology, 17, 145–165.CrossRefGoogle Scholar
  14. Cooley, C. H. (1902). Human nature and the social order. New York: Scribner.Google Scholar
  15. Crick, N. R., & Dodge, K. A. (1996). Social information-processing mechanisms in reactive and proactive aggression. Child Development, 67, 993–1002.CrossRefPubMedGoogle Scholar
  16. Dodge, K. A., Lansford, J. E., Burks, V. S., Bates, J. E., Pettit, G. S., Fontaine, R., & Price, J. M. (2003). Peer rejection and social information-processing factors in the development of aggressive behavior problems in children. Child Development, 74, 374–393.CrossRefPubMedPubMedCentralGoogle Scholar
  17. Edens, J. F., Cavell, T. A., & Hughes, J. N. (1999). The self-systems of aggressive children: A cluster-analytic investigation. Journal of Child Psychology and Psychiatry, 40, 441–453.CrossRefPubMedGoogle Scholar
  18. Edwards, G., Barkley, R. A., Laneri, M., Fletcher, K., & Metevia, L. (2001). Parent–adolescent conflict in teenagers with ADHD and ODD. Journal of Abnormal Child Psychology, 29, 557–572.CrossRefPubMedGoogle Scholar
  19. Eisenberg, N., Zhou, Q., Spinrad, T. L., Valiente, C., Fabes, R. A., & Liew, J. (2005). Relations among positive parenting, children’s effortful control, and externalizing problems: A three-wave longitudinal study. Child Development, 76, 1055–1071.CrossRefPubMedPubMedCentralGoogle Scholar
  20. Enders, C. K., & Bandalos, D. L. (2001). The relative performance of full information maximum likelihood estimation for missing data in structural equation mdoels. Structural Equation Modeling, 8, 430–457.CrossRefGoogle Scholar
  21. Epstein, T., & Saltzman-Benaiah, J. (2010). Parenting children with disruptive behaviors: Evaluation of a collaborative problem solving pilot program. Journal of Clinical Psychology Practice, 2010, 27–40. doi: 10.1023/A:1021803005547.Google Scholar
  22. Eyberg, S. M., Nelson, M. M., & Boggs, S. R. (2008). Evidence-based psychosocial treatments for children and adolescents with disruptive behavior. Journal of Clinical Child & Adolescent Psychology, 37, 215–237. doi: 10.1080/15374410701820117.CrossRefGoogle Scholar
  23. Fergusson, D. M., John Horwood, L., & Ridder, E. M. (2005). Show me the child at seven: The consequences of conduct problems in childhood for psychosocial functioning in adulthood. Journal of Child Psychology and Psychiatry, 46, 837–849. doi: 10.1111/j.1469-7610.2004.00387.x.CrossRefPubMedGoogle Scholar
  24. Frick, P. J., Cornell, A. H., Barry, C. T., Bodin, S. D., & Dane, H. E. (2003). Callous-unemotional traits and conduct problems in the prediction of conduct problem severity, aggression, and self-report of delinquency. Journal of Abnormal Child Psychology, 31, 457–470.CrossRefPubMedGoogle Scholar
  25. Frick, P. J., & Ellis, M. (1998). Callous-unemotional traits and subtypes of conduct disorder. Clinical Child and Family Psychology Review, 2, 149–168.CrossRefGoogle Scholar
  26. Frick, P. J., & Loney, B. R. (1999). Outcomes of children and adolescents with oppositional defiant disorder and conduct disorder. In H. C. Quay & A. Hogan (Eds.), Handbook of disruptive behavior disorders (pp. 507–524). New York: Plenum.CrossRefGoogle Scholar
  27. Frick, P. J., & McMahon, R. J. (2008). Child and adolescent conduct problems. In J. Hunsley & E. J. Mash (Eds.), A Guide to assessments that work (pp. 41–66). New York: Oxford University Press.CrossRefGoogle Scholar
  28. Frick, P. J., Stickle, T. R., Dandreaux, D. M., Farrell, J. M., & Kimonis, E. R. (2005). Callous-unemotional traits in predicting the severity and stability of conduct problems and delinquency. Journal of Abnormal Child Psychology, 33, 471–487. doi: 10.1007/s10648-005-5728-9.CrossRefPubMedGoogle Scholar
  29. Gilman, R., Huebner, E. S., & Laughlin, J. E. (2000). A first study of the multidimensional students’ life satisfaction scale with adolescents. Social Indicators Research, 52, 135–160.CrossRefGoogle Scholar
  30. Greene, R. W. (1998). The explosive child. New York: Harper Collins.Google Scholar
  31. Greene, R. W. (2010). Collaborative problem solving. In R. C. Murrihy, A. D. Kidman, & T. H. Ollendick (Eds.), Clinical handbook of assessing and treating conduct problems in youth (pp. 193–220). doi: 10.1007/978-1-4419-6297-3_8
  32. Greene, R. W., Biederman, J., Zerwas, S., Monuteaux, M. C., Goring, J. C., & Faraone, S. V. (2002). Psychiatric comorbidity, family dysfunction, and social impairment in referred youth with oppositional defiant disorder. American Journal of Psychiatry, 159, 1214–1224.CrossRefPubMedGoogle Scholar
  33. Greene, R. W., & Ollendick, T. H. (2000). Behavioral assessment of children. In G. Goldstein & M. Hersen (Eds.), Handbook of psychological assessment (3rd ed., pp. 453–470). Oxford: Elsevier Science Ltd.CrossRefGoogle Scholar
  34. Hoza, B., Pelham, W. E, Jr, Dobbs, J., Owens, J. S., & Pillow, D. R. (2002). Do boys with attention-deficit/hyperactivity disorder have positive illusory self-concepts? Journal of Abnormal Psychology, 111, 268–278. doi: 10.1037//0021-843X.111.2.268.CrossRefPubMedGoogle Scholar
  35. Ingoldsby, E. M., Shaw, D. S., Winslow, E., Schonberg, M., Gilliom, M., & Criss, M. M. (2006). Neighborhood disadvantage, parent-child conflict, neighborhood peer relationships, and early antisocial behavior problem trajectories. Journal of Abnormal Child Psychology, 34, 293–309. doi: 10.1007/s10802-006-9026-y.CrossRefGoogle Scholar
  36. Kamphaus, R. W., & Frick, P. J. (2005). Clinical assessment of children and adolescent personality and behavior. Boston: Allyn & Bacon.Google Scholar
  37. Kazdin, A. E. (2005). Parent management training: Treatment for oppositional, aggressive, and antisocial behavior in children and adolescents. New York: Oxford University Press.Google Scholar
  38. Kimonis, E. R., & Frick, P. J. (2010). Oppositional defiant disorder and conduct disorder grown-up. Journal of Developmental and Behavioral Pediatrics, 31, 244–254.CrossRefPubMedGoogle Scholar
  39. Laursen, B., & Mooney, K. S. (2008). Relationship network quality. Adolescent adjustment and perceptions of relationships with parents and friends. American Journal of Orthopsychiatry, 78, 47–53. doi: 10.1037/0002-9432.78.1.47.CrossRefPubMedPubMedCentralGoogle Scholar
  40. Maughan, B., Rowe, R., Messer, J., Goodman, R., & Meltzer, H. (2004). Conduct disorder and oppositional defiant disorder in a national sample: Developmental epidemiology. Journal of Child Psychology and Psychiatry, 45, 609–621. doi: 10.1111/j.1469-7610.2004.00250.x.CrossRefPubMedGoogle Scholar
  41. Mead, G. H. (1934). Mind, self, and society. Chicago: University of Chicago Press.Google Scholar
  42. Murrihy, R. C., Kidman, A. D., & Ollendick, T. H. (2010). Clinical handbook of assessing and treating conduct problems in youth. New York: Springer.Google Scholar
  43. Nixon, R. D. V., Sweeney, L., Erickson, D. B., & Touyz, S. W. (2003). Parent-child interaction therapy: A comparison of standard and abbreviated treatments for oppositional defiant preschoolers. Journal of Counseling and Clinical Psychology, 71, 251–260. doi: 10.1037/0022-006X.71.2.251.CrossRefGoogle Scholar
  44. Olinsky, A., Chen, S., & Harlow, L. (2003). The comparative efficacy of imputation methods for missing data in structural equation modeling. European Journal of Operational Research, 151, 53–79.CrossRefGoogle Scholar
  45. Ollendick, T. H., Greene, R. W., Austin, K. E., Fraire, M. G., Halldorsdottir, T., Allen, K. B., et al. (in press). Parent management training and collaborative & proactive solutions: A randomized control trial for oppositional youth. Journal of Clinical Child and Adolescent Psychology. doi: 10.1080/15374416.2015.1004681
  46. Pasalich, D. S., Dadds, M. R., Vincent, L. C., Cooper, F. A., Jawes, D. J., & Brennan, J. (2012). Emotional communication in families of conduct problem children with high and low callous-unemotional traits. Journal of Clinical Child and Adolescent Psychology, 41, 302–313.CrossRefPubMedGoogle Scholar
  47. Pelham, W. E., Gnagy, E. M., Greenslade, K., & Milich, R. (1992). Teacher ratings of DSM-III-R symptoms for the disruptive behavior disorders. Journal of American Academy of Child and Adolescent Psychiatry, 31, 210–218. doi: 10.1097/00004583-199203000-00006.CrossRefGoogle Scholar
  48. Preacher, K. J., Curran, P. J., & Bauer, D. J. (2006). Computational tools for probing interactions in multiple linear regression, multilevel modeling, and latent curve analysis. Journal of Educational and Behavioral Statistics, 31, 437–448.CrossRefGoogle Scholar
  49. Rapee, R. M., & Lim, L. (1992). Discrepancy between self- and observer ratings of performance in social phobics. Journal of Abnormal Psychology, 101, 728–731.CrossRefPubMedGoogle Scholar
  50. Reid, M. J., Webster-Stratton, C., & Hammond, M. (2003). Follow-up of children who received the incredible years intervention for oppositional-defiant disorder: Maintenance and prediction of 2-year outcome. Behavior Therapy, 34, 471–491.CrossRefGoogle Scholar
  51. Reynolds, C. R., & Kamphaus, R. W. (2000). Behavior assessment system for children (2nd ed.). Circle Pines, MN: American Guidance Service.Google Scholar
  52. Rhodes, T. E., & Dadds, M. R. (2010). Assessment of conduct problems using an integrated, process-oriented approach. In R. C. Murrihy, A. D. Kidnman, & T. H. Ollendick (Eds.), Clinical handbook of assessing and treating conduct problems in youth (pp. 77–116). New York: Springer.Google Scholar
  53. Rosseel, Y. (2012). lavaan: An R package for structural equation modeling. Journal of Statistics Software, 48, 1–36.CrossRefGoogle Scholar
  54. Scott, S., Briskman, J., & O’Connor, T. G. (2014). Early prevention of antisocial personality: Long-term follow-up of two randomized controlled trials comparing indicated and selective approaches. American Journal of Psychiatry, 171, 649–657.CrossRefPubMedGoogle Scholar
  55. Shrauger, J. S., & Schoeneman, T. J. (1979). Symbolic interactionist view of self-concept: Through the looking glass darkly. Psychological Bulletin, 86, 549–573.CrossRefGoogle Scholar
  56. Silver, R. B., Measelle, J. R., Armstrong, J. M., & Essex, M. J. (2011). The impact of parents, child care providers, teachers, and peers on early externalizing trajectories. Journal of School Psychology, 48, 555–583. doi: 10.1016/j.jsp.2010.08.003.CrossRefGoogle Scholar
  57. Silverman, W. K., & Albano, A. M. (1996). The anxiety disorders interview schedule for children for DSM-IB: Child and parent versions. San Antonio: Psychological Corporation.Google Scholar
  58. South, S. C., Oltmanns, T. F., Johnson, J., & Turkheimer, E. (2011). Level of agreement between self and spouse in the assessment of personality pathology. Assessment, 18, 217–226. doi: 10.1177/1073191110394772.CrossRefPubMedPubMedCentralGoogle Scholar
  59. Stringaris, A., Maufhan, B., & Goodman, R. (2010). What’s in a disruptive disorder? Temperamental antecedents of oppositional defiant disorder: Findings from the Avon Longitudinal Study. Journal of the American Academy of Child and Adolescent Psychiatry, 49, 474–483.PubMedGoogle Scholar
  60. Tesser, A. (2002). Constructing a niche for the self: A bio-social, PDP approach to understanding lives (special issue: Self-concept, self-regulation, and psychological vulnerability). Self and Identity, 1, 185–190.CrossRefGoogle Scholar
  61. Urquiza, A. J., & Timmer, S. (2012). Parent-child interaction therapy: Enhancing parent-child relationships. Psychosocial Intervention, 21, 145–156. doi: 10.5093/in2012a16.CrossRefGoogle Scholar
  62. van Aken, M. A. G., & Asendorpf, J. B. (1997). Support by parents, classmates, friends and siblings in preadolescence: Covariation and compensation across relationships. Journal of Social and Personal Relationships, 14, 79–93.CrossRefGoogle Scholar
  63. Vickers, A. J., & Altman, D. G. (2001). Analyzing controlled trials with baseline and follow-up measurements. British Medical Journal, 323, 1123–1124. doi: 10.1136/bmj.323.7321.1123.CrossRefPubMedPubMedCentralGoogle Scholar
  64. Webster-Stratton, C., Reid, M. J., & Hammond, M. (2004). Treating children with early-onset conduct problems: Intervention outcomes for parent, child, and teacher-training. Journal of Clinical Child and Adolescent Psychology, 33, 105–124. doi: 10.1207/S15374424JCCP3301-11.CrossRefPubMedGoogle Scholar
  65. White, B. A., Jarrett, M. A., & Ollendick, T. H. (2013). Self-regulation deficits explain the deficits between reactive aggression and internalizing and externalizing behavior problems. Journal of Psychopathology and Behavioral Assessment, 35, 1–9.CrossRefGoogle Scholar
  66. Wolke, D., & Samara, M. M. (2004). Bullied by siblings: Association with peer victimization and behaviour problems in Israeli lower secondary children. Journal of Child Psychology and Psychiatry, 45, 1015–1029.CrossRefPubMedGoogle Scholar
  67. Wolke, D., Woods, S., Bloomfield, L., & Karstadt, L. (2000). The association between direct and relational bullying and behavior problems among primary school children. Journal of Child Psychology and Psychiatry, 41, 989–1002. doi: 10.1111/1469-7610.00687.CrossRefPubMedGoogle Scholar
  68. Woodworth, M., & Waschbusch, D. (2007). Emotional processing in children with conduct problems and callous/unemotional traits. Child: Care Health, and Development, 34, 234–244. doi: 10.1111/j.1365-2214.2007.00792.x.Google Scholar
  69. Wootton, J. M., Frick, P. J., Shelton, K. K., & Silverthorn, P. (1997). Ineffective parenting and childhood conduct problems: The moderating role of callous-unemotional traits. Journal of Consulting and Clinical Psychology, 65, 301–308.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Family Narratives Lab, Department of PsychologyEmory UniversityAtlantaUSA
  2. 2.Child Study Center, Department of PsychologyVirginia TechBlacksburgUSA
  3. 3.Social Development Lab, Department of PsychologyVirginia TechBlacksburgUSA

Personalised recommendations