Parents´ experience of living with a child displaying oppositional defiant disorder. Top-down and bottom-up approaches to gain a deeper understanding of the complexity

Abstract

Clinical levels of oppositional defiant disorder (ODD) during childhood are considered a significant marker of risk to develop mental illness later in life. If serious behavior problems begin as early as preschool years and persist through childhood and adolescence, there is a risk that the behaviors will turn into more severe behavior problems and develop into criminality and antisocial behavior in adulthood. The overall purpose of this thesis was to gain a deeper insight into the complexity in families with children who exhibit ODD behaviors and get a deeper understanding of the risk factors and conditions that may complicate the impact of a comprehensive parent training (PT) program for parents with children displaying symptoms of ODD. Fifty-seven children with clinical levels of ODD participated in study I, 19 of those in study II and, 30 of those in study III. The result from study I showed that the diagnostic criteria for ODD helped to identify and distinguish commonly occurring oppositional behavior from disruptive behavior problems (DBPs), but the accepted diagnostic criteria did not cover the entire range of problematic behaviors, especially those behaviors that constitute a risk for later antisocial behavior. Study II focused on the parents´ descriptions of the complexity in the family and parenting situation. The parents highlight the need to address parents´ own mental health problems, parental alliance, lack of parental strategies, capacity for emotional regulation, parents´ perceived helplessness, parental stress, sense if isolation and absence of supportive social networks. A careful assessment before parents join a parent training (PT) program should lead to a better adaptation of the PT program to the parents´ situation. Study III showed that it is neither risk factors alone, nor protective factors alone, that lead to different outcomes for children whose parents participated in a PT program; rather, a combination of risk and protective factors determine the outcome. Study III has led to hypotheses about combinations of factors leading to different outcomes. Aggressiveness in combination with either ADHD or negative emotionality (NE) in children, when parents simultaneously have mental health problems, or a lower education level, seems to constitute risks for families and lead to a negative outcome after intervention with a PT program. In all three studies, it has been shown that a subgroup of children displaying ODD in preschool and early school age, exhibit serious disruptive behavior problems. Early detection and early interventions are most important for families with children displaying ODD, to prevent the development of more serious behavior problems and antisocial behaviors in adulthood. Keywords: ODD, parenting training program, aggression, negative emotionality