A transactional model of oppositional behavior: underpinnings of the Collaborative Problem Solving approach.

Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
Journal of Psychosomatic Research (Impact Factor: 2.74). 08/2003; 55(1):67-75.
Source: PubMed


Oppositional defiant disorder (ODD) refers to a recurrent pattern of developmentally inappropriate levels of negativistic, defiant, disobedient, and hostile behavior toward authority figures. ODD is one of the most common (and debilitating) comorbid disorders within Tourette's disorder (TD). Diverse psychosocial treatment approaches have been applied to children's ODD-related behaviors. In this paper, the authors articulate a transactional developmental conceptualization of oppositional behavior and describe a cognitive-behavioral model of intervention-called collaborative problem solving (CPS)-emanating from this conceptualization. The specific goals of the CPS approach are to help adults (1). understand the specific adult and child characteristics contributing to the development of a child's oppositional behavior; (2). become cognizant of three basic strategies for handling unmet expectations, including (a). imposition of adult will, (b). CPS, and (c). removing the expectation; (3). recognize the impact of each of these three approaches on parent-child interactions; and (4). become proficient, along with their children, at CPS as a means of resolving disagreements and defusing potentially conflictual situations so as to reduce oppositional episodes and improve parent-child compatibility. Summary data from an initial study documenting the effectiveness of the CPS approach (in comparison to the standard of care) are also presented.

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    • "Le modèle d'intervention Collaborative Problem Solving (CPS) se base sur la prémisse que la réponse parentale peut exacerber la frustration de l'enfant (p. ex., une réponse de type autocratique) (Greene et al., 2003). L'objectif est d'aider l'adulte à prendre conscience de l'effet des interactions parent/enfant dans le maintien des comportements agressifs. "
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    ABSTRACT: For children with Tourette syndrome (TS), explosive outbursts (EO) can be more disruptive than tics to the child's functioning. This study evaluated the effectiveness of an innovative cognitive-behavioral intervention for decreasing frequency and intensity of EO. Five boys and one girl ranging in age from 9 to 12 years took part in the study. EO frequency and intensity were measured by systematic observation of events and by questionnaire, while tics and child's psychosocial functioning were measured by questionnaires. The children showed trends towards decreased EO frequency post treatment but no changes in EO intensity. Statistical analysis and questionnaires results revealed no significant change. Qualitative information indicated a benefit to the families following therapy.
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    • "In short, the CPS model is posited on the idea that children's capacities for complying with caregivers directives or expectations are unique to each child and if caregivers demands exceed these capacities, children responses deviate from the responses expected by those caregivers. These deviations may increase frustration levels for both parties, and may result in response biases on the part of both (Greene et al., 2003). The CPS model assumes that children " do well if they can. "
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    ABSTRACT: Many residential treatment facilities and child inpatient units in the United States have been structured by way of motivational programming such as the point and/or level systems. On the surface, they appear to be a straightforward contingency management tool that is based on social learning theory and operant principles. In this article, the authors argue that the assumptions upon which point and level systems are based do not hold up to close empirical scrutiny or theoretical validity, and that point and level system programming is actually counterproductive with some children, and at times can precipitate dangerous clinical situations, such as seclusion and restraint. In this article, the authors critique point and level system programming and assert that continuing such programming is antithetical to individualized, culturally, and developmentally appropriate treatment, and the authors explore the resistance and barriers to changing traditional ways of "doing things." Finally, the authors describe a different approach to providing treatment that is based on a collaborative problem-solving approach and upon which other successful models of treatment have been based.
    Preview · Article · Feb 2009 · American Journal of Orthopsychiatry
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    • "Several such intervention models have been identified as probably efficacious. However, it has been argued that neither of the above categories of intervention directly addresses the reciprocal adult– child processes giving rise to oppositional behavior in a child (Greene, Ablon, & Goring, 2002). PT programs, by concentrating on altering patterns of inept parental discipline, focus primarily on only one component (the parent) of parent– child transactions. "
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    ABSTRACT: Oppositional-defiant disorder (ODD) refers to a recurrent pattern of negativistic, defiant, disobedient, and hostile behavior toward authority figures. Research has shown that children with ODD and comorbid mood disorders may be at particular risk for long-term adverse outcomes, including conduct disorder. In this study, the authors examined the effectiveness of a cognitive-behavioral model of intervention--called collaborative problem solving (CPS)--in comparison with parent training (PT) in 47 affectively dysregulated children with ODD. Results indicate that CPS produced significant improvements across multiple domains of functioning at posttreatment and at 4-month follow-up. These improvements were in all instances equivalent, and in many instances superior, to the improvements produced by PT. Implications of these findings for further research on and treatment selection in children with ODD are discussed.
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