The Parent–Child Relationship and Posttreatment Child Outcomes Across Two Treatments for Oppositional Defiant Disorder

Abstract

This study examined the degree to which the parent–child relationship uniquely predicted clinical outcomes in externalizing problems and adaptive skills in children meeting diagnostic criteria for oppositional defiant disorder and whether facets of this relationship moderated the effects of two unique psychosocial treatments. We recruited 134 children and their parents (38.06% female; M age = 9.52 years, range = 7–14; 83.58% White). Families were randomly assigned to 1 of 2 treatments: Parent Management Training (PMT) and Collaborative and Proactive Solutions (CPS). We formed principal components from pretreatment reports and behaviors of the parent–child relationship to predict within- and between-family outcomes in children’s externalizing problems and adaptive skills. Four principal components were supported (parental warmth, parental monitoring, family hostility, and family permissiveness). Parental monitoring predicted fewer externalizing problems, whereas family permissiveness predicted more externalizing problems. Parental warmth predicted greatest improvements in children’s adaptive skills among families receiving PMT. Family hostility predicted more externalizing problems and poorer adaptive skills for children; however, families receiving CPS were buffered from the negative effect of family hostility on adaptive skills. The parent–child relationship can uniquely inform posttreatment outcomes following treatment for oppositional defiant disorder. Certain treatment approaches may better fit unique relationships that emphasize warmth and/or hostility, allowing clinicians to anticipate and tailor treatments to families.

Disclosure statement

RWG received royalties related to work concerning Collaborative and Proactive Solutions. The remaining authors have no conflicts of interest.

Ethics Statement

All procedures performed in this study were in accordance with the ethical standards of the overseeing Institutional Review Board and with the 1964 Helsinki declaration and its later amendments.

Informed Consent Statement

All families completed informed consent and informed assent before participating.

Statement of Each Author’s Contributions

JAB conducted the data analyses and contributed to writing the paper. NNC-H proposed the research question and contributed to writing the paper. RWG codesigned the study and contributed to writing and editing the paper. THO was the PI of the grant supporting this research, codesigned and executed the study, and contributed to writing and editing the paper.

Notes

¹ Bivariate correlations tests associations of child age, child gender, anxiety disorder comorbidity (i.e., generalized anxiety disorder, social anxiety disorder, separation anxiety), and ADHD comorbidity with pretreatment reports of externalizing problems and adaptive skills. Only age and ADHD were significantly correlated with one or more outcome.

Additional information

Funding

Funding was provided by R01 MH076141 from the National Institute of Mental Health and by the Institute for Society, Culture, and Environment at Virginia Tech. We 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.