Toward a transactional conceptualization of oppositional defiant disorder: implications for assessment and treatment.
The conceptualization and treatment of oppositional defiant disorder (ODD) has been characterized by surprising homogeneity. In this paper evidence is presented to underscore the heterogeneity within ODD, including research demonstrating (a) the distinction between reactive and proactive forms of aggression; (b) the importance of affective modulation and self-regulation, and associated cognitive skills, in the development of the skill of compliance; and (c) high levels of comorbidity between ODD and other disorders. The disparate pathways that give rise to oppositional behavior suggest that different children with ODD may require different forms of intervention. The necessity of a transactional conceptualization, of achieving a comprehensive understanding of the factors underlying the difficulties of individual children with ODD, and of matching intervention ingredients to the specific needs of different children and families is discussed.
Massachusetts General Hospital/Harvard Medical School, Boston 02114, USA.
R W
RW
Greene
A E
AE
Doyle
D000367:Age Factors; D000374:Aggression / Q000523:psychology*; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology / Q000628:therapy*; D002648:Child; D019955:Conduct Disorder / Q000209:etiology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D009341:Negativism; D019954:Neurobehavioral Manifestations; D010287:Parent-Child Relations; D011613:Psychotherapy / Q000379:methods*