Oppositional defiant disorder, treatment

Greene, R.W. and Doyle, A.E. (1999). Toward a transactional conceptualization of oppositional defiant disorder implications for treatment and assessment. Clin Child Pam Psychol Rev 2 129-148. 

FIGURE 53.1 Cumulative distribution curves of final ADHD scores by treatment group in the MTA Study. The SNAP rating is average score of the 18 items corresponding to the DSMTV defining symptoms for attention-deficit-hyperactivity disorder and oppositional defiant disorder (range 0, not present to 3 very much). Beh, Behavior... 

A trial published by Gillberg et al. (1997) comprised 62 children (52 males, 10 females), aged 6 11 years and meeting DSM-HI-R criteria for ADHD. The children suffered from severe attention deficits and 42% had comorbid diagnoses including mild mental retardation, autistic features, oppositional defiant disorder and tic disorder. They were included in a parallel-group, randomized, double-blind, place bo-cont ro 1 led study of amphetamine treatment. 

Clinical outcomes before, during and after treatments were assessed in six multiple domains represented by 19 separate measures. The domains were ADHD symptoms aggression-oppositional defiant disorder internalizing symptoms social skills parent child relations and cognitive performance (measured with three subscales of the Wechsler Individual Achievement test readmg, mathematics, spelling). 

ADHD is rarely encountered without comorbid conditions and often is underdiagnosed. Between 40% and 75% of patients with ADHD will have one or more comorbidities (e.g., learning disabilities, oppositional defiant conduct, anxiety, or depressive disorders).10 It is important to identify other coexisting conditions in patients with ADHD to assist in initial and ongoing selection of treatment. 

Like ADHD, the disruptive behaviors also require a multidimensional approach to treatment. Social workers must include medication therapy, cognitive behavioral techniques, parent management training, and family therapy in order to successfully treat oppositional defiant and conduct disorders. 

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