Recommendations from others
Two parent training interventions meet the American Psychological Association’s criteria for well-established treatments.9 These include programs based on Patterson and Gullion’s Living with Children, a short-term, behavioral parent training program, and programs based on WebsterStratton’s Videotape Modeling parent training program. Two additional treatments, Anger Coping Therapy and Problem Solving Skills Training, meet the criteria for “probably efficacious.”
According to the International Consensus Statement on ADHD and Disruptive Behavior Disorders, “pharmacological treatment of pure ODD should not be considered except in cases where aggression is a significant, persistent problem.”10
CLINICAL COMMENTARY
Psychological interventions for parent and child are essential
Richard C. Fulkerson, MD
Anita R. Webb, PhD
John Peter Smith Family Medicine Residency Program, Fort Worth, Tex
Oppositional and defiant behaviors are a family problem requiring a family solution. Frustrated parents often request a “quick fix,” so this literature review is helpful in defining when medications are not indicated. Psychological interventions for the parents and for the child are essential. An important role for the family physician is to convince parents that their participation is critical in treating this problem. In addition to encouraging referrals to psychological resources in the community and occasionally prescribing medication, another role for the physician is to model parenting skills. The physician can demonstrate the “Tough Love” philosophy of holding the child responsible for unacceptable behavior without rejecting the child or blaming other people. An additional role could be to schedule brief checkup/counseling sessions with the family and child. These roles can be time consuming without necessarily having the assurance that all of them are evidence-based. However, the value of having multiple role options is that family physicians can develop an individualized approach for helping each family, as long as the emphasis remains on parental involvement.