Residential Care for Children and Adolescents with Oppositional Defiant Disorder and Conduct Disorder

Abstract

The practice of placing children and adolescents with severe conduct problems (e.g., Oppositional Defiant Disorder {ODD} and Conduct Disorder {CD}) in residential settings is expanding. In 1983, estimates were that more than 19,000 such youngsters were in residential care. By 1986, the number had increased 32% to more than 25,000 (Select Committee on Children, Youth, and Families, 1990). These data are surely an underestimate in that they exclude those placed in for-profit residential treatment centers. The American Public Welfare Association estimated that approximately 70% of the total funding for children’s mental health services was used for residential services. Yet little research exists on either the short-term effectiveness or long-term benefits of these placements (Burns & Freidman, 1990). In commenting on the effectiveness of various components of the system of care for children and adolescents, Burns, Hoagwood, and Maultsby (1998) noted that “A dominant observation is that the least evidence of effectiveness exists for residential services, where the vast majority of dollars are spent” (p. 690). Moreover, there is some indication in the literature that children and adolescents who have disruptive behavior problems with antisocial and aggressive symptoms are among the most difficult population to treat in residential settings and that they tend to benefit the least when compared to their nonantisocial counterparts in care (Zoccolillo & Rogers, 1991).