Treating oppositional defiant disorder in primary care: a comparison of three models

J Pediatr Psychol. 2008 Jun;33(5):449-61. doi: 10.1093/jpepsy/jsm074. Epub 2007 Oct 23.


Objective: To determine if a nurse-led or psychologist-led parent-training program was more successful than a minimal intervention in treating early childhood Oppositional Defiant Disorder (ODD) in pediatric primary care.

Methods: Twenty-four practices were randomized to conditions in which parents of 117, 3- to 6.11-year-olds with ODD received the 12-session Webster-Stratton Incredible Years program led by primary care nurses or clinical psychologists, or to a minimal intervention group in which parents received only the companion book to the treatment program.

Results: There was improvement across posttreatment and 12-month follow-up for all groups, but no overall treatment group effects. There was a dose effect, with a reliable, clinically significant gain after seven sessions on the Eyberg intensity scale, and nine sessions on the Child Behavior Checklist externalizing scale.

Conclusions: There is little advantage to the therapist-led treatment over bibliotherapy unless parents attend a significant number of sessions.

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Attention Deficit and Disruptive Behavior Disorders / diagnosis
  • Attention Deficit and Disruptive Behavior Disorders / psychology
  • Attention Deficit and Disruptive Behavior Disorders / therapy*
  • Behavior Therapy*
  • Bibliotherapy*
  • Child
  • Child, Preschool
  • Combined Modality Therapy
  • Education*
  • Female
  • Humans
  • Male
  • Outcome and Process Assessment, Health Care
  • Parent-Child Relations
  • Personality Assessment
  • Primary Health Care*
  • Referral and Consultation