Defiant Children, Second Edition: A Clinician's Manual for Assessment and Parent Training [Paperback]

Dr. Barkley's book (and the recently-published "Defiant Teens") is the current state-of-the-art treatment for oppositional-defiant children. I have used Dr. Barkley's methods with many families struggling to cope positively with an OD child. Our community frequently requests parenting workshops, and I always find myself turning to Barkley's works as a way to focus my presentations. There are many books for clinicians on this subject. For a research-based, instantly useable, positively-focused reference, buy this one.

Barkley's book describes a 10-week behavior manageent program to teach parents how to get better compliance to their directives. I'll describe Barkley's program first, then compare it to the "Collaborative Problem Solving" (CPS) approach. The Explosive Child: A New Approach for Understanding and Parenting Easily Frustrated, Chronically Inflexible Children. In my view, CPS is much more effective, and more respectful, because CPS identifies and treats the root deficits that trigger the inflexible, hostile, explosive patterns.

Barkley's "Parent Training" model consists of the following instructional modules: (1)(assumed) causes of children's defiant behavior (2) positive attending through "special time"; (3) attending for increasing compliant behavior;(4) more effective commands; (5) contingency management (i.e. rewards and punishments); (6) time-outs; (7) managing behavior in public places; (7) using a daily school-home report card.

Unfortunately, a recent meta-analysis of 63 peer-reviewed studies showed that for such parent training programs:
- the immediate effects were "small to moderate", and
- longer-term "follow-up effects were small in magnitude".
(Lundahl, 2006, "A meta-analyisis of parent training: moderators and follow-up effects", in Clinical Psychology Review 26(1))

And, there are many children, reportedly 40-50% (Dishion '91) or more (see below), for whom Parent Training just doesn't help, or even makes things worse, no matter how long, how consistently parents use it. The flaw of PT is to assume that the key cause of the defiance "inept parenting"; and that children disobey to get attention or to get power.

In contrast, Drs. Greene and Ablon (Dept. of Psychiatry, Massachusetts General Hospital and Harvard Medical School) present a compelling and research-based alternative, based on the premise that "children do well if they can"; that defiance is a symptom of identifiable thinking/emotion-management-skill deficits in the child. Just like we no longer shame or punish a dyslexic for not reading well, we shouldn't punish an inflexible child who doesn't know how to manage emotions for the behaviors that stem from their developmental deficits. It's more effective to help them articulate their concerns, describe your concern, and teach them the skills they lack within a collaborative problem-solving (CPS) process.

Greene, Ablon et. al. argue that these children lack one or more cognitive skills: emotion regulation, frustration tolerance, problem solving, language use, or adaptability. These kids do know how they "should" behave, and are motivated to. However, due to the missing emotional/cognitive skills, their plans easily go wrong. Simple transitions, expectations for adapting, embarrassment, or commands can overwhelm their ability to cope and trigger emotional flooding. When flooded, a person can't think well, calm down, or problem solve.

The CPS approach teaches adults to examine child's predictable triggers for the challenging behaviors, and figure out the deficits these point to. Then, the adults coach the lagging emotion-management and flexibility skills, in the context of PROACTIVE adult-child problem-solving around a predictable conflict. ... Since these children usually have numerous lagging skills, CPS helps adults decide where to focus, and which expectations to set aside (temporarily), which to enforce, and which problem situations to select for the collaborative problem solving.

Given these two very different approaches, how is a person to choose? Barkley's Parent Training (PT) is certainly the more popular one. If you are drawn to it, you can try it. But first consider this:
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In a randomized head-to-head comparison trial of children (aged 4-12) diagnosed with Oppositional-Defiant Disorder, CPS came out much better than PT.

1. At the end of the 10-14wk treatment, CPS was only a bit better at reducing oppositional behavior (37% improved after PT; 46% with CPS)
2. HOWEVER at 4-months post-treatment, 60% of children whose parents were taught CPS had clinical benefit, vs. 37% of children whose parents were taught PT.
3. The contrast was even larger when comparing "excellent responders" on another measure (the CGI): at 4 months post-treatment, 80% of children in CPS condition were "much improved" or "very much improved", vs. only 44% of those in the PT condition.

The authors did have PT-experienced behavioral therapists teach PT using this manual; and ognitive-behavioral therapists teach CPS using a manual of CPS, and had independent reviewers check audiotaped sessions for treatment-adherence (Greeene et. al., "Effectiveness of Collaborative Problem Solving in Affectively Dysregulated Children with Oppositional Defiant Disorder: Initial Findings" Journal of Consulting and Clinical Psychology, 2004, 72(6);

I'm not a clinician, but I research things thoroughly before deciding on something as important as this. And, based on my reading of the literature, and personal experience with both, I suggest that parents and teachers don't rely on Parent Training as taught here, but instead check out the excellent book The Explosive Child: A New Approach for Understanding and Parenting Easily Frustrated, Chronically Inflexible Children, by Ross W. Greene, Ph.D. (145 reviews on Amazon as of 2/008; 4.5/5 stars)

Read the reviews. They'll confirm that Greene's book and the CPS approach is caring, insightful, and effective; even with the very, very diffcult, angry, explosive, out-of-control children or teens.

And, for clinicians, there is also a well-written, clear, motivated and very useful textbook:

Treating Explosive Kids: The Collaborative Problem-Solving Approach by Ross W. Greene and J. Stuart Ablon (Hardcover - Oct 18, 2005)

Prior to purchasing this book, I had read some excellent techniques that Dr. Barkley had recommended when working with children with ADHD. I then purchased this book and began implementing the books training program with the families that I work with. The thing that I appreciated about this book is the care the Dr. Barkely takes in educating the parents on ADHD, helping to improve the relationship between parent and child and then looking to implement a behavior plan to improve the childs acting out behaviors. By doing this, it provided a more comprehensive parent training plan rather than solely implementing a behavior modification plan. At times Dr. Barkley's explainations can be a little blunt which may put off some parents who are reading this as a self help guide. Otherwise, it is an exellent resource for those therapists needing clinical guidance in implementing an effective parental training program.

› Go to Amazon.com to see all 7 reviews  4.3 out of 5 stars