Defiant Children: A Clinician’s Manual for Assessment and Parent Training

Scientific Rating:
3
Promising Research Evidence
See scale of 1-5
Child Welfare System Relevance Level:
Medium
See descriptions of 3 levels

About This Program

The information in this program outline is provided by the program representative and edited by the CEBC staff. Defiant Children: A Clinician’s Manual for Assessment and Parent Training has been rated by the CEBC in the areas of: Disruptive Behavior Treatment (Child & Adolescent) and Parent Training Programs that Address Behavior Problems in Children and Adolescents.

Target Population: Parents of children ages 4-12 years who are defiant or who may qualify for a diagnosis of oppositional defiant disorder (ODD)

For parents/caregivers of children ages: 4 – 12

Brief Description

Defiant Children: A Clinician’s Manual for Assessment and Parent Training provides clinicians with a scientifically based behavioral paradigm and set of methods in which to train parents in the management of defiant/ oppositional defiant disorder (ODD) children. The program involves training parents in 10 steps through weekly sessions that have proven effectiveness in reducing defiance and ODD symptoms in children ages 4-12 years. The manual also provides information on the assessment of these children prior to intervention and with rating scales to use to monitor changes that occur during treatment. The manual further provides the parent handouts that are to be given by the therapist at each step. Therapists are granted limited permission to photocopy the assessment tools and rating scales as well as the parent handouts for use with families undergoing treatment in their practice.


Program Goals:

The goals of Defiant Children: A Clinician’s Manual for Assessment and Parent Training are:

  • Increase the value of the parents’ attention generally, and its particular worth in motivating and reinforcing their child’s positive behavior
  • Increase the positive attention and incentives the parents provide for compliance while decreasing the inadvertent punishment they provide for occasional compliance
  • Decrease the amount of inadvertent positive attention the parents provide to negative child behavior
  • Increase the use of immediate and consistent mild punishment for occurrences of child noncompliance
  • Ensure that escape from the activity being imposed upon the child does not occur (i.e., the command is eventually complied with by the child)
  • Reduce the frequency of repeat commands the parents employ so as to avoid delays to consequences (act, don’t yak)
  • Recognize and rapidly terminate escalating and confrontational negative interactions with the child
  • Ensure that the parents do not regress to a predominantly punitive child management strategy once training has been completed

Essential Components

The essential components of Defiant Children: A Clinician’s Manual for Assessment and Parent Training include:

  • Program Lessons:
    • Step 1: Explain to parents why children misbehave
    • Step 2: Teach parents to pay attention to appropriate child behavior and improve the value of their attention for doing so
    • Step 3: Teach parents ways to increase compliance and independent play in their defiant child
    • Step 4: Train parents to construct and implement a home poker chip program or point system (token economy)
    • Step 5: Instruct parents in the use of a highly effective paradigm for implementing time out and other disciplinary methods contingent on child misbehavior
    • Step 6: Work with parents to extend the use of time out to additional misbehavior
    • Step 7: Show parents how to anticipate behavior problems, such as in public places, and how to implement a transition plan to reduce the likelihood of such misbehavior
    • Step 8: Teach parents how to implement a daily school behavior report card for improving school behavior from home
    • Step 9: Review with parents all prior procedures and then how to handle future misbehavior using such methods
    • Step 10: Conduct a booster session and follow-up meetings with parents
    • Can be conducted in individual sessions or group sessions with 6 to 8 parent couples

Parent/Caregiver Services

Defiant Children: A Clinician’s Manual for Assessment and Parent Training directly provides services to parents/caregivers and addresses the following:

  • Inability to effectively parent children with defiant behavior

Delivery Settings

This program is typically conducted in a(n):

  • Community Agency
  • Hospital
  • Outpatient Clinic
  • School

Homework

Defiant Children: A Clinician’s Manual for Assessment and Parent Training includes a homework component:

At the end of sessions 2-8, parents are assigned homework that consists of implementing the procedures they were taught in that session and to keep notes of any problems they encounter for discussion with the therapist at the next session.

Languages

Defiant Children: A Clinician’s Manual for Assessment and Parent Training has materials available in a language other than English:

Spanish

For information on which materials are available in this language, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

Office space for individual parent training or conducting a parent group

Minimum Provider Qualifications

Masters Degree or Doctorate in Clinical, school, or counseling psychology, social work, or an MD in child psychiatry, developmental and behavioral pediatrics, or child behavioral neurology.

Education and Training Resources

There is a manual that describes how to implement this program, and there is training available for this program.

Training Contact:
Training is obtained:

Can be provided through a workshop for clinicians onsite on request

Number of days/hours:

6-hour workshop

Additional Resources:

There currently are additional qualified resources for training:

  • Arthur Anastopoulos, PhD, Department of Psychology, University of North Carolina at Greensboro
  • George DuPaul, PhD, Department of School Psychology, Lehigh University, Bethlehem, PA
  • Karen Wells, PhD, Department of Psychiatry, Duke University Medical School, Durham, NC
  • Robert McMahon, PhD, Department of Psychology, University of Washington, Seattle

Implementation Information

Since Defiant Children: A Clinician’s Manual for Assessment and Parent Training is rated on the Scientific Rating Scale, information was requested from the program representative on available pre-implementation assessments, implementation tools, and/or fidelity measures.

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Pre-Implementation Materials

There are no pre-implementation materials to measure organizational or provider readiness for Defiant Children: A Clinician’s Manual for Assessment and Parent Training.

Formal Support for Implementation

There is no formal support available for implementation of Defiant Children: A Clinician’s Manual for Assessment and Parent Training.

Fidelity Measures

There are no fidelity measures for Defiant Children: A Clinician’s Manual for Assessment and Parent Training.

Implementation Guides or Manuals

There are implementation guides or manuals for Defiant Children: A Clinician’s Manual for Assessment and Parent Training as listed below:

There is a published manual, Defiant Children, via Guilford Press.

Research on How to Implement the Program

Research has not been conducted on how to implement Defiant Children: A Clinician’s Manual for Assessment and Parent Training.

Relevant Published, Peer-Reviewed Research

This program is rated a "3 - Promising Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The practice must have at least one study utilizing some form of control (e.g., untreated group, placebo group, matched wait list study) establishing the practice's benefit over the placebo, or found it to be comparable to or better than an appropriate comparison practice. Please see the Scientific Rating Scale for more information.

Child Welfare Outcome: Child/Family Well-Being

Show relevant research...

Anastopoulos, A. D., Shelton, T., DuPaul, G. J., & Guevremont, D. C. (1993). Parent training for attention-deficit hyperactivity disorder: Its impact on parent functioning. Journal of Abnormal Child Psychology, 21, 581-596.

Type of Study: Nonequivalent control group design
Number of Participants: 34

Population:

  • Age — 75-123 months (approx. 6-10 years)
  • Race/Ethnicity — Predominantly Caucasian
  • Gender — 25 Male and 9 Females
  • Status — Participants were children and their parents who were referred to a university clinic for treatment of attention-deficit hyperactivity disorder (ADHD).

Location/Institution: Not specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The present study examined changes in parent functioning resulting from parental participation in the Defiant Children program specifically designed for school-aged children with attention-deficit hyperactivity disorder (ADHD). Measures utilized the Child Behavior Checklist for Ages 4-18 (CBCL), the Home Situations Questionnaire-Revised (HSQ-R), the Parenting Stress Index (PSI), the Parenting Sense of Competence Scale (PSCS), and the Symptom Checklist 90-Revised (SCL 90-R). Results show parents reported improvements in the overall severity of their child's ADHD symptomatology. These reported changes in child behavior were accompanied by improvements in parent functioning, in terms of reduced parenting stress and enhanced parenting self-esteem. These changes did not appear to be due to extraneous factors (e.g., child medication status, life stress). Limitations include the small sample size, lack of randomization, and reliance on maternal report on outcomes.

Length of postintervention follow-up: 2 months.

Barkley, R. A., Shelton, T. L., Crosswait, C., Moorehouse, M., Fletcher, K., Barrett, S., & Metevia, L. (2000). Early psycho-educational intervention for children with disruptive behavior: Preliminary post-treatment outcome. Journal of Child Psychology and Psychiatry, 41, 319-332.

Type of Study: Randomized controlled trial
Number of Participants: 158

Population:

  • Age — 75-123 months (approx. 6-10 years)
  • Race/Ethnicity — Predominantly Caucasian
  • Gender — No-treatment Group: 23 Males and 19 Females; Intervention-Only Group: 29 Males and 10 Females; Treatment Classroom Only: 27 Males and 10 Females; Combination of Intervention with the Treatment Classroom: 26 Males and 14 Females
  • Status — Participants were children and their parents who were referred to a university clinic for treatment of ADHD.

Location/Institution: Worcester, Massachusetts

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The present study examined four treatment conditions lasting the kindergarten school year: no treatment, Defiant Children training only, treatment classroom only, and the combination of Defiant Children training with the treatment classroom. Measures utilized include the Diagnostic Interview Schedule for Children-Parent (DISC-P) version 2, the Child Behavior Checklist for Ages 6-18 (CBCL), the Normative Adaptive Behavior Checklist, Home Situations Questionnaire (HSQ), Parenting Stress Index-Short Form (PSI), Parenting Sense of Competence Scale, Parenting Practices Scale, the Social Skills Rating Scale (SSRS), and the Woodcock Johnson Psychoeducational Test. Results showed that Defiant Children produced no significant treatment effects; however, many parents assigned to the Defiant Children condition did not attend or attended erratically. The treatment classroom produced improvement in multiple areas: parent ratings of adaptive behavior, teacher ratings of attention, aggression, self-control, and social skills, as well as direct observations of externalizing behavior in the classroom. Neither treatment improved academic achievement skills or parent ratings of home behavior problems. Limitations include generalization to non-school populations and attrition.

Length of postintervention follow-up: None.

Huang, H., Chao, C., Tu, C., & Yang, P. (2003). Behavioral parent training for Taiwanese parents of children with attention-deficit/hyperactivity disorder. Journal of Psychiatry and Neurosciences, 57, 275-281.

Type of Study: One group pretest-posttest design
Number of Participants: 23

Population:

  • Age — 3-6 years
  • Race/Ethnicity — 100% Taiwanese
  • Gender — 20 Males and 3 girls
  • Status — Participants were children and their parents who were referred by child psychiatrists at the Developmental Delay Clinic of Kaohsiung Medical University Hospital.

Location/Institution: Taiwan

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The present study describes implementation of Defiant Children in a Confucian environment and examines its effectiveness. Measures utilized include the Disruptive Behavior Rating Scale-Parent Form (DBRS-PF), The Child Attention Profile (CAP), and the Home Situations Questionnaire (HSQ). The results showed that both attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) symptoms and home behaviors of these 14 children improved significantly after the parent training. There was also a significant decline in the severity of symptoms and problem behaviors at home with the progression of training. Limitations include lack of control group and small sample size.

Length of postintervention follow-up: None.

Huang, H., Lu, C., Tsai, H., Chao, C., Ho, T., Chuang, S., ... Yang, P. (2009). Effectiveness of behavioral parent therapy in preschool children with attention-deficit hyperactivity disorder. Kaohsiung Journal Medical Science, 25(7), 357-365.

Type of Study: One group pretest-posttest design
Number of Participants: Children: 21

Population:

  • Age — Children: 48-74 months (approx. 4-6 years)
  • Race/Ethnicity — 100% Taiwanese
  • Gender — 100% Male
  • Status — Participants were children and their parents who referred by child psychiatrists at the Developmental Delay Clinic of Kaohsiung Medical University Hospital.

Location/Institution: Taiwan

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The purpose of this study was to assess the effectiveness of a modified version of Defiant Children in children with attention-deficit hyperactivity disorder (ADHD). Measures utilized include the Child Behavior Checklist for Ages 6-18 (CBCL/6-18), Child Behavior Checklist for Ages 1.5. to 5 (CBCL/1.5-5), Wechsler Preschool and Primary Scale of Intelligence-Revised, and the Teacher Report Form (TRF). The behavioral and emotional problems of the children showed improvement after the modified Defiant Children sessions.  On the TRF, the inattention syndrome improved significantly after the modified Defiant Children sessions, while other syndromes showed non-significant changes.  Limitations include lack of a control group and small sample size.

Length of postintervention follow-up: None.

References

Barkley, R. A. (2002). Psychosocial treatments for attention-deficit/hyperactivity disorder. Journal of Clinical Psychiatry, 63 (suppl.), 36-43.

Anastopoulos, A. D., DuPaul, G. J., & Barkley, R. A. (1991). Stimulant medication and parent training therapies for attention deficit hyperactivity disorder. Journal of Learning Disabilities, 24, 210-218.

Barkley, R. A., & Murphy, J. G. (1991). Treating attention deficit hyperactivity disorder: Medication and behavior management training. Pediatric Annals, 20, 256-266.

Contact Information

Name: Russell A. Barkley, PhD
Title: Clinical Professor of Psychiatry
Agency/Affiliation: Virginia Commonwealth University Medical Center
Department: Virginia Treatment Center for Children
Website: russellbarkley.org
Email:
Phone: (843) 971-8323
Fax: (843) 971-8323

Date Research Evidence Last Reviewed by CEBC: June 2017

Date Program Content Last Reviewed by Program Staff: May 2017

Date Program Originally Loaded onto CEBC: December 2012