Parenting styles for children with oppositional defiant disorder: Scope review

Abstract

Behavioral and emotional problems are the most common form of child psychiatric pathology. Parenting styles are one of the factors affecting the formation of children's personality and the use of inefficient styles can lead to several negative consequences such as behavioral problems. The aim of the present article is to describe a variety of parenting styles and their relationship with children behavioral problems. The present study reviews a variety of parenting styles including Kazdin's Parent Management Education Model, Barclay's Parent Training Program, Adler and Dreikurs Approach, and Positive Parenting Program. Finally, based on reality theory, parenting is neglected to be one of those styles. Therefore, it is imperative to do a research based on reality theory with existential psychotherapy and with the view that everyone chooses to behave, external pressure is always an imposition, the children learn from their mistakes, and everyone is responsible for his own happiness.

Introduction

Children's defiance occurs as an inevitable stage in their growth. The most striking oppositional behaviors appear in children aged 18 and 24 months and reach its peak in age 3. This disorder appears as a pathological phenomenon that finds abnormal status in terms of continuity or severity and its frequency becomes more significant. In other words, this disorder becomes pathological when it is not associated with children's age and growth conditions.[1] When these behaviors are repeated and overwhelming, they become a kind of disorder called oppositional defiant disorder (ODD).[2,3] ODD is one of the most common clinical disorders appearing in children and adolescents.[4] This disorder is categorized in disruptive behavior disorder group that those suffering from are one of the largest groups of patients referring to children's mental health clinics.[5,6] Based on the definition of the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM5), Barclay (2013) stated that ODD is a negative consistent pattern, disobedience, stalking, hostility, and rebellion against owners of power.[7] Psychologists believe that several factors contribute to the formation of consistent patterns of ODD, including biological, mood (intrinsic, in-kind), learned factors. In addition, psychologic risk factors (risk factors) for aggressive behaviors in adolescents include childhood abusive behaviors such as physical abuse and sexual abuse, negligence, emotional abuse, and over-rigorous, punishment-oriented training.[6] The American Psychiatric Association's DSM-5 has divided ODD into three types: angry/irritable mood, argumentative/defiant behavior, and vindictiveness.[8]

Methods

The present study reviewed papers and books addressing different parenting styles, symptoms, and prevalence rate for ODD children and briefly described the Kazdin, Adler and Dreikurs, Barkely, and positive parenting approaches. Finally, the issue of the position of parenting based on the choice theory among these parenting approaches for children with ODD was dealt with.

Oppositional defiant disorder symptoms

ODD symptoms can also be partly addressed in people without this disorder; several important points whether behaviors are ODD symptoms are as follows: first, the diagnostic threshold of four or more symptoms within 6 months must be met and second, the continuity and frequency of symptoms must go beyond what is normal in terms of age, sex, or culture.[8] Symptoms of this disorder are often part of a pattern of problematic interactions with others. In addition, individuals with this disorder often do not consider themselves angry, defiant, or disobedient.[9] Related characteristics that confirm the ODD diagnosis is that in the ODD is more common in children and adolescents living in families in which caring for the children is disrupted by the substitution of caregivers, or in families with violent childcare, instability, or negligence.[10,11] Individuals with ODD show symptoms only in relation to family members; younger children consider their parents as owners of power, while older ones usually view parents, teachers, and other adults as owners of power. However, the incidence of symptoms is an indicator of the severity of this disorder.[8,9] ODD symptoms may be limited to a limited position which is often referred to as home. Individuals who show enough symptoms to meet the diagnosis threshold, even if they are at home, may be very disadvantaged in their social function. However, in more severe cases, the symptoms of this disorder are present in many situations. Considering the fact that symptoms are an indicator of the severity of this disorder, it is important that the individual's behaviors are assessed in different situations; since those behaviors are common among siblings, they should be observed during interactions with persons other than the siblings. Moreover, since ODD symptoms are usually more obvious when children interact with adults or peers who are well known to them, they may not be apparent at a clinical examination.[8] ODD, if chronic, is almost always problematic in interpersonal relationships and academic performance. Children with ODD are usually rejected by peers and classmates, and they may be isolated and alone. In spite of their intelligence, the children with ODD may not have good academic skills at school because they do not cooperate and participate in classroom work and cannot accept help from others. These problems, in turn, cause children's self-esteem to fall; they cannot tolerate failure, become depressed, and show anger explosions.[3,6] ODD is also predictive of a wide range of compatibility problems.[12] Compatibility is a change in behaviors or cognitive processes, enabling individuals to adaptively cope with the changes in their abilities.[13]

Prevalence rate

According to the some researchers the prevalence of ODD among children and adolescents is between 3% and 6%, according.[14,15] In addition, evaluations and reports indicate that the prevalence rate of ODD ranges 2%–16% for males who have not yet reached maturity, but and after puberty, the prevalence rate for girls and boys is the same. The prevalence rate of ODD decreases in boys and girls over the age of 12 years.[6] Research on the etiology of ODD shows a combination of characteristics of children's genetic or biological biases, inadequate parenting practices, and environmental conditions which have been described.[16,17] Research results have illustrated that children with ODD are largely lacking in cognitive, social, and emotional skills needed to handle elderly demands,[18,19,20] do not have good progress at school,[21] are inefficient in making interpersonal relationships,[22] and have significant problems and impairment in executive functions.[23,24] which may result in low self-esteem, low tolerance for failure, depression, and anger.[25] In addition, in children with ODD, ethical judgment may be adversely affected.[26] The prognosis of this disorder is undesirable and the children are at high risk of juvenile delinquency, anti-social behavior, substance abuse, and school dropout and disorders such as behavior, antisocial behavior, mood disorders, and anxiety.[27,28,29,30] Children with ODD have emotional regulations, poor self-regulation, and behavioral problems. They also have more hostile interactions with their peers and show anger and aggression.[31] Emotional regulation strategies are among the psychological components having led to extensive research on the issues of childhood and adolescent disorders.[32,33,34] Emotional regulation refers to strategies by which individuals affect what emotions they experience, when they experience emotions, and how they express them.[35] Emotional regulation strategies are an intrinsic part of trends related to emotional responses. According to Garanefski, the strategies of emotional regulation are actions that indicate ways to cope with stressful situations or unpleasant events.[36] Various studies have shown that children and adolescents with extraneous disorders and behaviors such as aggression, disobedience, and hyperactivity are more likely to use maladaptive regulation strategies[37,38] and are defective in applying adaptive emotional regulation strategies.[39] ODD is directly related to the way children and adolescents regulate their emotional processing (aged 6–11 years). A child with ODD behaved less well in their emotional regulation and processing than their normal counterparts.[40] The results of studies have shown that students with behavioral problems experience more emotions than their peers, have more difficulties in adapting emotions to social problems than their peers, are more likely to watch an anger triggering program, feel angry, use symptoms to identify their feelings, do not respond to the peers' answers, and not only tend to focus on negative aspects of the location but focus on exciting their emotions.[41,42] According to researchers, there is a link between parenting styles and the ability of children to express and excite their emotions.[43] Instead of working directly with children, psychologists can provide more help to children if they provide parents with counseling or direct education; the way parents and careers interact with children depends on the stress and flexibility available in each particular family.[31] Parents interact with children; focus on direct education, selective empowerment, and expressive expression; affect the children's growth of emotion regulation through modeling and analogy; control the children's environment to limit or extend the opportunities for experiential experience; and teach children to control their emotions.[31] Due to the number and variety of problems among those children in different areas, different educational and therapeutic approaches have been proposed.[44,45] Research on the teaching of ODD in children confirms the view that parents' appropriate and contingent responses to child behaviors are an important factor in the establishment and continuation of positive child behaviors.[16] Different studies have shown that many homosexuals play a role in causative disorder/coping disorder. These factors include childbearing or parenting practices, parent's mental harm, marital problems, and differences between brothers and sisters.[45,46,47] In this regard, Costin and Chambers state that among the family factors explaining ODD in children, most studies are related to inefficient parenting styles.[47] The most important educational programs for ODD are interventions based on cognitive and social skills training for children, behavioral parent training, behavior parent management, and parent–child interaction training for parents.[48,49,50,51] Parent management training simply means experiencing a new way of learning to influence and modify parent–child behaviors. Those changes in behaviors can bring us closer to the goal of treatment.[52] This method focuses its attention entirely on the clinical causes of the problem, and the conceptual model emphasizes children's behaviors to know “what to do for treatment.”[45] Parent management training can be employed to neutralize and quit certain behaviors and start some other behaviors in parents. The challenge of training is that a therapist, while doing things, also takes into account the views of the parents, maintains their respect, and does not discourage them from training children.[52] Kazdin designed a parent–child management program for children aged 2–14 years.[52] The program is presented individually and collectively, the method of presentation is determined by the severity and type of the problem of children and the insufficiency of family functioning. The training consists of 12 sessions and each session lasts from 45 to 60 min. Between the sessions, therapists ask parents to provide assistance and support for practicing parenting skills at home. An ongoing assessment of the progress of the child and parents is important by using the role-play method taken by parents and children. Optional sessions are also held to strengthen the skills that children or parents have weakened.[52] There are many approaches to parent's training; in some approaches, cognitive and interactive management is proposed. Those approaches oppose principally the use of behavioral techniques such as punishment, reward, and reinforcement. On the other hand, the principles of learning and training psychology are used in behavioral parent approaches, such as Kazdin and Russell Barclay's programs and the parent management program that addresses the problems at home and school; in fact, behavioral parent programs are theoretically constructive of behaviors and learning and use learning techniques based on task analysis and operant conditioning.[7,52] Reality theory is a process emphasizing the choice, accountability, and evaluation of an individual. This theory considers the individual responsible for choices and implicating them and tries to inform he/she about his/her needs by focusing on external factors and moves him/her from the disclaimer against him/her toward self-focus on his/her abilities and greater accountability.[53] Generally speaking, the theory of choice is based on the view that every individual's behaviors are his/her choices to satisfy his/her needs. These purposive behaviors are rooted more in internal stimuli and motivations than the external factors and motives. This view is doubtful that the individual's behaviors are at any time the best attempt to control the world around him/her and also himself/herself as part of this world. Therefore, the individual should always behave in a way and choose to best meet his/her needs. According to this theory, the individual's attitude at any time is his/her best attempt to satisfy his/her needs. This effort may not actually be effective or useful. However, they are his/her best efforts; therefore, reality theory attempts to help patients to evaluate their behavior from this aspect whether the behaviors they have now respond to their needs or whether their wishes have come true or not.[54] According to reality theory, the reason for people's different perceptions of reality is related to a desirable world specific to each individual which involves individuals, objects, and systems of beliefs that most of all represent the best way to meet the individual's needs. This theory considers that behavior includes four components of function, thinking, emotion, and physiology. Its underlying emphasis is on thinking and function because of individuals' ability of direct control and on emotion and physiology because of their indirect control. The fundamental principle of reality theory is that “The only person whose behavior we can control is our own.”[53] Reality theory focuses on the improvement of current relationships. Its success depends on the relationship between the patient and counselor. Reality theory is a system helping individuals to identify specific demands related to their own needs, also called genetic structures, to evaluate their behaviors, and to design objective designs to satisfy their needs.[55] In reality theory, training process is employed more than treatment, in which counseling is essentially a learning-training process. This is one of the most important features of reality theory that distinguishes it from other approaches.[54] So far, different methods have been employed for training ODD, including the “Kazdin” training model;[45,52] the overall effectiveness rate of training for children whose parents are involved in the training was ranged from 0.80 to 1, i.e., approximately 85% better than those whose parents did not participate in the training.[52] It seems that the great effectiveness of behavioral parent training for is generalized to children's classroom behaviors and parent personal adherence. According to Kazdin, “perhaps there is no other method has been confirmed more precisely and experientially than parent management training about the treatment of ODD.”[45]

Barclay's approach relates a few children's characteristics to the effectiveness of parent training programs. One of the relatively stable predictors of reducing the effectiveness of parent education is children's age.[1,7,56] Compared to schoolchildren with a lower probability of their improvement (50%–64%) and compared to adolescents (25%–35%), it seems that preschool children (under 6 years of age) have the highest positive response rates to behavioral parent training programs.[56] Adler and Dreikurs Approach[57,58,59] and the effectiveness of psychosocial therapy have been examined and the effectiveness rate was estimated as 0.69.[60] the effectiveness of Sanders' Positive Parenting Program; for ODD children has estimated the effectiveness of this educational method in the range from 0.35 to 0.48.[61,62,63,64,65,66]

Discussion

Reviewing the findings of other studies confirms that the research conducted on children with ODD has a high effectiveness. There are many approaches to parent training, cognitive-management and interactive approaches which are fundamentally opposed to behavioral techniques such as punishment, rewards, and incentives. On the other hand, behavioral parenting approaches, such as Kazdin and Barclay, and the parent management program that help the solution of the problems at home and school use the principles of psychology of learning and education.[7,45] Basically, behavioral parent programs have a theoretical basis for behavior and learning and employ learning techniques based on task analysis and operant conditioning. Since one of the goals of reality theory is to help parents to achieve a sense of internal control, and in this theory, the training process is more emphasized than the treatment, as well as parenting is really preventive using the theory, and if this theory is used from a younger age, educational problems requiring external control are rarely seen, what these parents really need is to look at their children's problem in a completely different way. They need a view that strengthens family relationships and leads to greater happiness and merit of their children. They should find a better choice.

Conclusion

Thus it is mandatory that some research be conducted based on reality theory with an existential psychotherapy and with the view that everyone chooses how to behave, external pressure is always an imposition, children learn from their mistakes, and everyone is responsible for his/her happiness. Finally, the type of parent communication with each other, as well as how they interact with their children, can also affect the children's characters and their behaviors; parents' behaviors with children are often done according to a particular cultural model in which the community is located. The development of a parenting model based on reality theory can be employed for designing caring programs for families of children with behavioral problems.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.