Two Therapies Help Preschool Children's Disorder

CHICAGO -- Oppositional Defiant Disorder (ODD) is the most common psychiatric disorder among preschool children and sometimes leads to conduct disorder. Relatively few preschool children with ODD are treated in the mental health service system, and the need to extend treatment services to other settings is increasingly being recognized.

In two studies published in the June 2008 issue of Journal of Pediatric Psychology, John V. Lavigne, professor of psychiatry and behavioral sciences at Northwestern University's Feinberg School of Medicine, and colleagues tested two types of therapies for ODD in 24 primary care clinics, among the parents of 117 preschool children: minimal intervention bibliotherapy treatment (MIT), or a 12-session parenting program led by a nurse or psychologist.

The team found that MIT was as successful as therapist-led treatment unless parents attend a significant number of sessions. Treatment success depends on degree of pre-treatment dysfunction, gender of the child and other factors. More initial total life stress, parenting distress, internalizing problems, functional impairment, and difficult temperament are associated with more improvement. Girls did better than boys in the nurse-led group, while boys did better following MIT. Less well-educated mothers treated by psychologists showed the greatest change.

"These findings raise the possibility of developing brief but effective interventions for ODD that can be used by a large number of families, with more intensive treatment being reserved for situations in which the brief treatment is insufficient," said Lavigne, who also is chief psychologist in child and adolescent psychiatry at Children's Memorial Hospital.

The studies were conducted with the Pediatric Practice Research Group (PPRG) of the Mary Ann & J. Milburn Smith Child Health Research Program of Children's Memorial Research Center.

The studies were supported by a National Institute of Mental Health grant.