Perceived Parent–Child Relations, Conduct Problems, and Clinical Improvement Following the Treatment of Oppositional Defiant Disorder

Our objective in this study was to examine the moderating influence of parent–child relationship quality (as viewed by the child) on associations between conduct problems and treatment responses for children with oppositional defiant disorder (ODD). To date, few studies have considered children’s perceptions of relationship quality with parents in clinical contexts even though extant studies show the importance of this factor in children’s behavioral adjustment in non-clinical settings. In this study, 123 children (ages 7–14 years, 61.8 % male, 83.7 % white) who fulfilled DSM-IV criteria for ODD received one of two psychosocial treatments: Parent Management Training or Collaborative and Proactive Solutions. In an earlier study, both treatments were found to be effective and equivalent in treatment outcomes. In the current study, pre-treatment maternal reports of conduct problems and pre-treatment child reports of relations with parents were used to predict outcomes in ODD symptoms and their severity following treatment. Elevated reports of children’s conduct problems were associated with attenuated reductions in both ODD symptoms and their severity. Perceived relationship quality with parents moderated the ties between conduct problems and outcomes in ODD severity but not the number of symptoms. Mother reports of elevated conduct problems predicted attenuated treatment response only when children viewed relationship quality with their parents as poorer. When children viewed the relationship as higher quality, they did not show an attenuated treatment response, regardless of reported conduct problems. The current findings underscore the importance of children’s perspectives in treatment response and reductions in externalizing child behaviors.