Defiant Behavior: Discussing the Full Array of Treatment Options with Families

by Allison Hall, MD

Alisson Hall, MD

Behavioral and emotional problems, like some other health conditions such as diabetes, are often best treated with a package of interventions.  Because families may sometimes expect a quick fix, it is helpful to have a strategy

to discuss the importance of several treatment features.   Russell Barkley, a psychologist who is one of the leading experts in ADHD and behavioral problems, has a model concerning defiant behavior which is helpful in discussing many child psychiatric problems.   

Dr. Barkley describes four contributors to child defiance.  These include

1)      Child characteristics.  These are genetically influenced aspects of the child including temperament (such as being prone to irritability or a very high activity level) and also cognitive factors (such as language disability) which affect how a child interacts with the world,

2)      Parent characteristics.  These are similar temperamental and cognitive factors in the parent and include mental health problems, such as depression, substance misuse or ADHD, which affect how the parent responds to situations and the child.

3)      The parent child relationship which includes parenting style with issues such as the degree of attention, permissiveness, monitoring limit setting.

4)      And finally contextual factors such as the couple’s relationship, trauma, the neighborhood environment and similar issues.

When one looks at a behavioral or emotional problem in this way, one can see that there are several levels on which to intervene.  By treating the child with medication or individual therapy one may be able to modify child characteristics.  But it may also be important to treat a parent individually to address the parent characteristics.  One might recommend a parent training intervention to address the parent child relationship and one might address contextual factors by making recommendations for the school or by accessing neighborhood and larger social resources such as The Boys and Girls Club. 

A conversation concerning this model can help parents understand the opportunities to address a problem in a variety of ways.  It also encourages families to become aware of their own strengths and resources.

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