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

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

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.

Russell A. Barkley, PhD

• Title: Retired Clinical Neuropsychologist
• Website: http://russellbarkley.org
• Email: drbarkley@russellbarkley.org

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

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

Recommended Intensity

Once per week for 1 hour of individual parent training or 2 hours of group parent training

Recommended Duration

10 weeks

Delivery Settings

This program is typically conducted in a(n):

• Community-based Agency / Organization / Provider
• Hospital
• Outpatient Clinic
• School Setting (Including: Day Care, Day Treatment Programs, etc.)

Homework

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 the following languages 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 in 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

Prerequisite/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.

Manual Information

There is a manual that describes how to deliver this program.

Program Manual(s)

Manual details:

• Barkley, R. (2013). Defiant Children: A clinician's manual for assessment and parent training (3rd ed.). Guildford Press. https://www.guilford.com/books/Defiant-Children/Russell-Barkley/9781462509508

Training Information

There is training available for this program.

Training Contact

Training Type/Location:

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

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.

Established Psychometrics

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

Fidelity Measures Required

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

Implementation Guides or Manuals

There is implementation information in the manual:

• Barkley, R. (2013). Defiant Children: A clinician's manual for assessment and parent training (3rd ed.). Guildford Press. https://www.guilford.com/books/Defiant-Children/Russell-Barkley/9781462509508

Implementation Cost

There are no studies of the costs of Defiant Children: A Clinician’s Manual for Assessment and Parent Training.

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.

Child Welfare Outcome: Child/Family Well-Being

"What is included in the Relevant Published, Peer-Reviewed Research section?"

• Anastopoulos, A. D., Shelton, T. L., 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(5), 581–596. https://doi.org/10.1007/BF00916320

  Type of Study: Pretest–posttest study with a nonequivalent control group (Quasi-experimental)

  Number of participants: 34

  Population:

  • Age — 75–123 months (approx. 6–10 years)
  • Race/Ethnicity — Not specified
  • Gender — 25 Male and 9 Female
  • 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:

  The purpose of the study was to examine changes in parent functioning resulting from parental participation in the Defiant Children program [now called, Defiant Children: A Clinician's Manual for Assessment and Parent Training] specifically designed for school-aged children with attention-deficit hyperactivity disorder (ADHD). Participants were assigned either to Defiant Children or to the wait list control condition. Measures utilized include 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 indicate that 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 controlled postintervention follow-up: 2 months.

• Barkley, R. A., Shelton, T. L., Crosswait, C., Moorehouse, M., Fletcher, K., Barrett, S., Jenkins, L., & Metevia, L. (2000). Multi-method psycho-educational intervention for preschool children with disruptive behavior: Preliminary results at post-treatment. Journal of Child Psychology and Psychiatry, 41(3), 319–332. https://doi.org/10.1111/1469-7610.00616

  Type of Study: Randomized controlled trial

  Number of participants: 158

  Population:

  • Age — 75–123 months (approx. 6–10 years)
  • Race/Ethnicity — Not specified
  • Gender — No Treatment Group: 23 Male and 19 Female; Intervention-Only Group: 29 Male and 10 Female; Treatment Classroom Only: 27 Male and 10 Female; Combination of Intervention/Treatment Classroom: 26 Male and 14 Female
  • Status — Participants were children and their parents who were referred to a university clinic for treatment of ADHD.

  Location/Institution: Worcester, Massachusetts

  Summary:

  The purpose of the study was to examine four treatment conditions lasting the kindergarten school year. Participants were randomly assigned to one of four groups: no treatment, Defiant Children [now called, Defiant Children: A Clinician's Manual for Assessment and Parent Training] 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 indicate 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 the inability to generalize to non-school populations.

  Length of controlled postintervention follow-up: None.

• Note: The following study was not included in rating Defiant Children: A Clinician’s Manual for Assessment and Parent Training on the Scientific Rating Scale.

  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(3), 275–281. https://doi.org/10.1046/j.1440-1819.2003.01117.x

  Type of Study: One-group pretest–posttest study

  Number of participants: 23

  Population:

  • Age — 3–6 years
  • Race/Ethnicity — 100% Taiwanese
  • Gender — 20 Male and 3 Female
  • 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:

  The purpose of the study was to describe implementation of Defiant Children [now called, Defiant Children: A Clinician's Manual for Assessment and Parent Training] in a Confucian environment and examine 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). Results indicate 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 controlled postintervention follow-up: None.

• Suess, G., Erickson, M. F., Egeland, B., Scheurer-Englisch, H., & Hartmann, H-P. (2017). Attachment-based preventive intervention: Lessons from 30 years of implementing, adapting and evaluating the STEEP™ Program. In H. Steele & M. Steele (Eds.), Handbook of Attachment-based Interventions. Guilford Publications.

• 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(4), 210-218. https://doi.org/10.1177/002221949102400405

• Barkley, R. A., & Murphy, J. G. (1991). Treating attention deficit hyperactivity disorder: Medication and behavior management training. Pediatric Annals, 20(5), 256-266. https://doi.org/10.3928/0090-4481-19910501-09