Introduction
The research literature was reviewed to determine the effects of both parenting style and levels of gratification on children with ODD. Due to the exploratory nature of the research and the paucity of research specifically addressing the topic at hand, the literature review was conducted in a strategic manner. This involved definition of the problem, placement of the problem within a methodological context, and analysis of possible solutions to the problem which have already been developed through practical applications. The review was conducted with a preference for ethnic-centered studies where applicable, and research related to Mexican American families favored where available. Because the ultimate usefulness of the research will revolve around its ability to validly and reliably identify data to be analyzed for useful intervention strategies related to the variables at hand, studies with both methodological and practical implications were included in the review. Specifically this meant highlighting both the requirements for evaluation of ODD among children and possible interventions that have addressed problems such as parenting styles and levels of gratification in the past.
The literature review was drawn from a number of research databases including PubMed and the following EBSCO databases: Academic Search Premier, MasterFILE Premier, ERIC, PsycINFO, and PsycARTICLES. Keywords used in the search included either individually or in conjunction the following terms: children, parents, parenting, mothers, fathers, families, behavior, conduct, oppositional defiant disorder (ODD), delay of gratification, self-regulation, self-control, impulsivity, Mexican Americans, Latinos, Hispanics, culture, therapy, programs, and interventions. Through the compilation of research articles related to these topics, the researcher formed a foundation of support for the preset study. The presentation of the findings from the literature review will include a summary of the discussion regarding ODD as it relates to parenting styles and gratification issues, and will follow with methodological concerns regarding the development of a measurement instrument for assessing behavioral problems, as well as a summary of intervention strategies that have been designed for application in culturally-sensitive situations. Because the link between ODD, parenting styles and levels of gratification, and intervention strategies has not yet been made clear in this study, the remainder to this section will provide a brief overview of the general topics covered in this chapter.
Mastery of self-control has been described as “perhaps, the most formidable task facing the developing child” (Reitman & Gross, 1997, p. 279). The young child’s ability to delay gratification is a precursor of self-regulation that is central to competence in social situations. Difficulties with self-regulation are associated with a variety of problematic conditions in children including disruptive and aggressive behavior (Gordon, 2010; Rowe, Costello, Angold, Copeland, & Maughan, 2010; Supplee, Skuban, Shaw, & Prout, 2009), problems with social and academic adjustment at school (DaFonseca et al., 2010; Mayes & Calhoun, 2007; Wulfert, Block, Santa Ana, Rodriguez, & Colsman, 2002), and negative interactions with peers (Ramani, Brownell, & Campbell, 2010). In research adapting Mischel’s protocol for examining self-regulation in young children by offering adolescents a monetary incentive, Wulfert et al. (2002) found that compared to students who delayed gratification, students who chose immediate rewards tended to have lower self-esteem and poorer school grades, and tended to flout school rules and consume cigarettes, alcohol, and illicit drugs. Indeed, Wulfert et al. (2002) state that self-regulatory difficulties underlie many contemporary social problems including the failure to develop a capacity for self-regulation that has serious implications beyond the individual level. In view of the association between self-regulatory deficits and externalizing disorders such as ODD and conduct disorder (CD) — which in turn are often forerunners of delinquent and antisocial behavior — there is ample evidence supporting an assertion that personality development factors that lead to self-regulation are less likely to result in the development of ODD. For example according to Wall (2009) he state that there is a high likelihood that ODD is caused by integration of environmental and inherited factors plus a disproportion of some of brain chemicals like serotonin, deformity in a child’s feelings and thoughts maturity, therefore there is no connection between personality development factors that give rise to self-regulation and ODD. In fact retardation of these developmental factors is thought to be some of the causes of ODD. In addition, another vital factor of personal development is anger and its regulation. Anger is an emotion that is significant for aggressive actions. According to Garrison and Stolberg (1983) when training children using sentimental imagery, anger is reduced for children who are angry, however, this causes reduction of aggressive school behaviors thus making an increase in sadness. It has been found that there is a correlation between anger and aggression that is interceded by impulsivity. Hence, the reasons why when children are anger-roused they are much likely to have aggressive behaviors (Matthys & Lochman, 2010). But contrary to Quiggle et al. (1992) he found out that children who were depressed showed more anger relative to controls, results that were opposite of results of aggressive children who were found to have difficulties in becoming angry. Moreover, according to Orobio et al (2003) and Phillips and Lochman (2003) continuous monitoring and regulation of pessimist emotions through self-assessment or relaxation aid greatly in reduction of reactive aggressiveness in aggressive children, therefore becoming difficult for an aggressed child to develop ODD.
Concurrently, a common finding in general population studies is that the parents of children with ODD and other disruptive behavior problems report higher levels of parenting stress and display parenting styles marked by harsh, coercive, and inconsistent discipline (Bayer, Hiscock, Ukoumunne, Price, & Wake, 2008; Sanders, Markie-Dadds, Rinaldis, Firman, & Baig, 2007). The impact of negative parenting on children’s behavior is reinforced by studies of children who meet clinical criteria for disruptive behavior disorders (Fossum, Morch, Handegard, & Drugli, 2007; Fossum, Morch, Handegard, Drugli, & Larsson, 2009; Kolko, Dorn, Bukstein, & Burke, 2008) or are identified by teachers as displaying disruptive behaviors in school (Mihalas, Morse, Allsopp, & McHatton, 2008). Perhaps the most compelling evidence of the link between parenting styles and problematic behavior comes from longitudinal research implicating abusive and coercive parenting practices as major risk factors for adult criminal behavior (Leschied, Chiodo, Nowicki, & Rodger, 2008).
Leschied et al. (2008) drew studies from the international literature and found that, within the U.S., researchers have discerned that ethnic differences exist not only in parenting styles but also in effects of parenting practices on children’s externalizing and internalizing behaviors (Hill, Bush, & Roosa, 2003; Supplee et al., 2009). Most of the research involved Caucasian and African American children, however. Latinos represent the fastest growing ethnic minority in the U.S. and there is evidence that children of Latin heritage, including Mexican Americans (who comprise the largest segment of the Latino population in the U.S.), are at increased risk for psychosocial problems (Garza, Kinsworthy, & Watts, 2009; Manongdo & Ramirez Garcia, 2007). Numerous researchers call for more extensive study of the relationship between parenting practices and children’s social development among Mexican American and other Latino families (Domenech Rodriguez, Donovick, & Crowley, 2009; Dumka, Gonzales, Wheeler, & Milsap, 2010; Gamble & Modry-Mandell, 2008; Garza et al., 2007; Hill et al., 2003; Manongdo & Ramirez Garcia, 2007; Livas-Dlott et al., 2010; Parke et al., 2004; Valiente, Lemery-Chalfant, & Swanson, 2009).
The compelling body of evidence linking harmful parenting practices with childhood behavior problems and negative adolescent and adult outcomes implies an urgent need for primary prevention and intervention focused on changing parents’ and children’s behavior (Bayer et al., 2008; Leschied et al., 2008; Sanders et al., 2007). Arguably the most popular and research-supported program for at-risk children with serious behavior problems is Webster-Stratton’s Incredible Years training program for parents and teachers, including the Dina Dinosaur School curriculum for children. This program began with studies exploring the efficacy of child, parent, and teacher training among Head Start families (Webster-Stratton, Reid, & Hammond, 2004). Individually and in conjunction, parent, child, and teacher training programs have produced positive results in family, educational, and clinical settings with a wide range of populations within the U.S. (Beauchaine, Webster-Stratton, & Reid, 2005; Brotman et al., 2005; Bywater et al., 2009; Fossum et al., 2009; Hautmann et al., 2009; McMahon & Kotler, 2008; Reid, Webster-Stratton, & Hammond, 2007; Webster-Stratton & Hammond, 1997; Webster-Stratton & Reid, 2003; Webster-Stratton, Reid, & Hammond, 2001; Webster-Stratton, Reid, & Stoolmiller, 2008). A recent innovation in the program includes a technology-driven version of the Incredible Years curricula that combines computer- and web-based program delivery with coaching via phone calls, electronic messaging, and home visits (Taylor et al., 2008).
Another evidence-based intervention program for children with behavior problems is Eyberg’s (2005) parent-child interaction therapy (PCIT). Eyberg strongly endorses research into tailoring PCIT to fit the needs and preferences of culturally and linguistically diverse families. Culturally tailored PCIT has been successfully used with Puerto Rican families on the island (Matos, Torres, Santiago, Jurado, & Rodriguez, 2006; Matos, Bauermeister, & Bernal, 2009) and Mexican American families in California (McCabe & Yeh, 2009). Mexican American parents particularly have expressed satisfaction with child-parent relationship training (CPRT), which is highly congruent with the Latin cultural values of familismo (strong family bonds that emphasize the good of the family) and personalismo (warm interpersonal relationships; Garza et al., 2009).
There is, therefore, according to this brief overview of the literature, a specific need to review the links between ODD and parenting styles and levels of gratification, specifically as they apply within Mexican American family culture. Similarly, there are a number of proven and promising treatment options for Mexican American families with children having ODD and other behavior disorders. Because symptoms of ODD, CD, and attention deficit hyperactivity disorder (ADHD) often occur in conjunction and have their etiology in negative parenting practices (Bayer et al., 2008; Gordon, 2010; Kolko et al., 2008), a more in-depth analysis of the literature is required to see the levels of support in the literature for the proposed associations relevant to this research. Further, the methodological framework of considering the links between ODD, parenting styles and levels of gratification needs to be explicated. The conceptual framework for this study is drawn from Houck and LeCuyer’s work on maternal limit setting, delay of gratification, and the development of self-regulations strategies (LeCuyer & Houck, 2006) and problem behaviors (Houck & LeCuyer-Maus, 2004) in young children. The following sections address these topics in depth.
Parenting Practices and Delay of Gratification
According to Houck and LeCuyer-Maus (2004), young children’s development of self-regulatory skills has gained attention since the 1980s in view of awareness that the capacity to comply with the wishes of caregivers, self-monitor behavior, and delay immediate gratification are critical milestones in human development. Moreover, Baumrind (1967), asserts that along with a sense of autonomy, these competencies are key contributors to self-regulation, defined as “the ability to achieve one’s goals without violating the integrity of the goals of others”. Further more, Mauro and Harris (2000), states that autonomy is linked with self-regulation because it implies the ability to make decisions and carry out actions. Self-regulation involves the capacity to comply with a request, initiate and halt activities in accordance with social demands, manage or adapt one’s behavior in social and educational contexts, delay gratification or action, and independently adopt socially appropriate behavior in the absence of external monitoring or control. Self-regulation can be regarded as “a balance between compliance and assertion” (Houck & LeCuyer-Maus, 2004, p. 30).
Self-regulation is contingent on recognition of socially appropriate behavior, which arises from early socialization experiences. Leschied et al. (2008) and Houck and LeCuyer-Maus (2004) both invoke Kopp’s developmental model of socialization toward self-regulation, which postulates that by the preschool years, children’s optimal level of maturity is marked by compliance, delay of gratification, and self-monitoring without the presence of adults. Kopp labeled the third stage of development (12-18+ months) control. In this stage, children have an emerging awareness of the different demands of specific social situations and the ability to initiate, sustain, and cease their actions. At the same time, the toddler’s immature stage of development limits the scope of autonomous control. Social cues from the parent are needed to elicit the appropriate behavioral response. Self-control is the next stage in the model, beginning in the second half of the child’s second year and covering roughly the span from 24-42 months (Benson & Haith, 2009). As the child becomes familiar with the behavioral standards, rules, and goals conveyed by parents and other caregivers, emotions such as pride, guilt, and shame, emanating from self-conscious judgments, begin to emerge. The development of memory recall and representational thinking further advances the child’s capacity for delaying gratification or ceasing behaviors either independently or in compliance with others’ requests (Baumrind, 1967). In short, the child internalizes external cues and is capable of reflecting upon and appraising elements of his or her behavior. The challenge that remains for the child at this stage is, literally, resisting temptation: the toddler still has a very limited repertoire of strategies for delaying gratification and behavior, particularly in the face of pleasurable stimuli. Self-regulation is the final stage in the young child’s development, emerging from roughly 36 to 60 months (Houck & LeCuyer-Maus, 2004). At this stage, children are capable of going beyond desires for social approval to make their own personal judgments. Mastery of delay strategies and covert speech enables the young child to engage in self-monitoring and self-regulatory behavior in the absence of adult supervision. Therefore, observation of a child’s ability to delay gratification serves as an indicator of the development of self-regulation skills. The vast majority of children exhibit some degree of externalizing behaviors, especially between the ages of 2 and 5 years (Maccoby, 1992). As their capacity for self-regulation increases, the problem behaviors decline, replaced by actions reflecting social competence. However, children with poorly developed self-regulatory capabilities may continue to display problem behaviors, which interfere in their relationships with parents, peers, and teachers thus further undermining the development of prosocial skills.
Baumrind (1967) label maternal limit setting as a critical factor in providing children with a sufficiently safe environment for exploring the larger world, thereby developing independence, autonomy, and self-assertion. Limit setting also provides a basic context for transmitting standards, rules, objectives, and other socially relevant demands. The techniques that mothers use in limit setting situations influence their children’s development of self-regulatory strategies. In prior research, it has been found that mothers who used a teaching-base approach had children who displayed significantly higher self-regulatory capabilities. Teaching-based strategies are characterized by clarity, explanations, responsiveness, and distractions and seem to present toddlers with excellent opportunities for testing, comprehending, and internalizing the desired social behaviors as well as facilitating the development of the child’s self-awareness and self-control. In contrast to teaching-based strategies, some mothers use power-based strategies marked by commands, restrictions, force, and punishment. In their earlier research, Mauro and Harris (2000) did not find the use of power-based strategies as harmful to the developing child as they had expected. Nevertheless, mothers who used power-based strategies essentially relied on the use of directives without explaining things to the child or trying to distract the child into engaging in alternative activities. Additionally, they were insensitive to the child’s goals and emotional reactions, and used few reasoning strategies. A third pattern of interaction was indirect limit setting in which the mothers were highly responsive and relied heavily on distractions but used few commands or reasoning strategies in engaging the child. Evidence is inconsistent on the effects of indirect limit setting, with one study by the authors reporting that children whose mothers rely on indirect strategies lag in the development of self-regulation and self-concepts at age 3 and another study suggesting that the mothers’ high levels of sensitivity and responsiveness fosters the development and internalization of self-regulation.
Houck and LeCuyer-Maus (2004) and Mauro and Harris (2000), explored the relationship between maternal limiting setting and toddlers’ development of self-concepts and social competence at 3 years with observations conducted when the children were 12, 24, and 36 months old. The longitudinal study was designed to assess the relationship between parent-child interactions and later delay of gratification. The researchers noted that most studies focused on concurrent maternal socialization practices and children’s behaviors, invoking the work of Jacobsen (1998).
Building on an earlier study identifying prospective factors in children’s ability to delay gratification, Jacobsen (1998) focused on the influence of maternal expressed emotion, defined as “an attitude of criticism or of overinvolvement with the child” (p. 118). The participants were 30 mothers and their 6-year old children (15 girls and 15 boys) randomly drawn from day care centers in Berlin. At the time of the study, the children had been in first grade for two months. Jacobsen used Mischel’s protocol, first asking the children to choose between two types of candies and then between a larger or smaller quantity. The experimenter told the children that if they wanted the larger amount they would have to wait until she returned (15 minutes later) but if they chose to ring the bell sooner (which they were free to do at any time) they could have only the smaller amount. The mothers’ expressed emotion was assessed by coding a 5-minute sample of the mother’s description of her child’s attributes and her relationship with the child (Cherry, 2011). Criticism consisted of comments showing resentment of the child’s qualities or behavior and over involvement was based on comments denoting excessive praise or over-protectiveness. Both types of comments were rated as high expressed emotion. The analysis revealed that the children whose mothers displayed high expressed emotion had significantly shorter delay times than their peers whose mothers were low in expressed emotion. Although the boys had significantly shorter delay times than the girls, in the final analysis, maternal express emotion overrode the effect for gender, which lost significance. According to Jacobsen (1998), being subjected to high levels of criticism or over involvement by parents is a stressful experience for children and is associated with behavior problems. Her findings show that the impact of expressed emotion on the ability to delay gratification is one mechanism by which such stress interferes with children’s development of self-regulation.
Mauro and Harris (2000) used an adaption of the Block Child Reading Practices Report (CRPR) to examine the mothers’ childrearing attitudes in a study of 30 mothers and their preschool children. The children were provided with crayons and coloring books and the mothers were instructed to teach the child ways to keep the child from touching a vividly wrapped present. The mothers were told they were free to use any strategy they chose as long as the child remained in the chair. Most of the mothers employed what Houck and LeCuyer-Maus (2004) label a teaching-based approach. That is, they elaborated the delay activity to the child, emphasizing the importance of the child’s waiting or refraining from touching or opening the present (Kolko et al., 2008). Distraction was a common strategy. Another strategy was focusing the child’s attention on the present, employed by 17 of the mothers. With young children, the focusing technique has the counterproductive effect of piquing their interest in the present and mothers who used that technique had a difficult time keeping their child from touching the present. Ironically, focusing was used most often with the younger children in the group for whom that strategy is least developmentally appropriate. The findings showed that the children whose mothers concentrated on the demands of the waiting task were significantly less successful in delaying gratification (Mauro & Harris, 2000). Based on their self-assessments, these mothers tended to favor a permissive parenting style. The mothers who preferred an authoritative parenting style had children who were most capable of delaying gratification. Authoritative parenting is marked by a balance between nurturing and restrictive behavior (Baumrind, 1991). Mauro and Harris proposed that authoritative mothers might be more adept at setting limits, having their children listen to them, and helping them understand the task. In the sample of relatively well-educated, middle class mothers, there was minimal evidence of restrictive parenting and all the mothers were highly nurturing. Thus the distinguishing factor in the child’s capacity to delay gratification was authoritative versus permissive parenting.
Houck and LeCuyer-Maus (2004) presented a follow-up study of their longitudinal research project. The original study included 126 mothers and their children who completed all the observational and self-report assessments over 36 months. The follow-up study included 78 pairs of mothers and children. The researchers used the Self-Imposed Delay Waiting Paradigm created by Mischel and colleagues, involving larger and smaller portions of candy or snacks. The children were asked their preferred food item and size and told they could have the preferred item if they waited until the experimenter returned or the non-preferred item if the child chose not to wait. The child’s delay score was based on the number of seconds lapsed from the onset of the task to the time he or she rang the bell or the session ended. The Child Behavior Checklist (CBCL) was used to evaluate the child’s behavior and the mother’s limit setting behavior derived from observations was coded according to teaching-based, power-based, indirect, and inconsistent approaches. The combined data from the larger longitudinal and follow-up study revealed different effects for the four limit setting approaches. While the children of mothers with a teaching-based style had significantly higher self-concepts and social competence at 3 years, the children whose mothers used an indirect style or even an inconsistent approach could delay gratification for a longer duration at age 5. Interestingly, the children of indirect mothers could delay gratification much longer than the other children but had poor self-concepts and social competence at age 3 whereas the children of teaching-based mothers tended to have the most favorable overall personal and social development. The children of power-based mothers were only slightly less competent than the children of teaching-based mothers but their self-concepts were compromised. In fact, the most striking finding according to Houck and LeCuyer-Maus was the very limited ability to delay gratification of the children of power-based mothers (an average of 3 minutes at 5 versus 6.5-7 minutes for a “normal” child of that age). To the researchers, this finding clearly highlighted the negative impact of power-based parenting on children’s development of self-regulation. In short, these children did not internalize the control their mothers attempted to impose externally through verbal commands or physical restraint rarely accompanied by distractions, explanations, or sensitive feedback.
Children of mothers who had inconsistent parenting styles approached the social competence of those with teaching-based mothers but had slightly lower self-concepts and delay times (Cherry, 2011) and (Maccoby, 1992). There also emerged a group of mothers whose parenting practices fit no set pattern and whose children had outcomes similar to those with indirect mothers. The findings suggested that indirect and teaching-based strategies each might be more effective in different points of the young child’s development. The overarching finding was that directive parenting without empathy, explanations, reasoning, social feedback, or appropriate distractions is detrimental to the child’s social and self-development. Conversely, the use of reasoning, explanations, sensitive feedback, and appropriate distractions rather than parenting style per se facilitate positive social and self-development including the capacity to delay gratification. This echoes the finding in both directions of the studies by Jacobsen (1998) and Mauro and Harris (2000). Disconnected and highly expressive or controlling parenting if found generally to lead to less internalized delayed gratification, while patient and directional parenting leads to higher levels of delay gratification.
In a subsequent study, LeCuyer and Houck (2006) focused on the specific maternal behaviors that underpin children’s development of self-concept, social competence, and delay of gratification. Actively engaging the child in distractions emerged as the overriding factor in the child’s delay of gratification at all ages. The mothers who engaged in this type of behavior frequently played games with their children, sang songs together, or even ran around the room with the child thus substituting another pleasurable activity for touching the tempting object. Those mothers who were sensitive to the child’s interests and activities, particularly during the early stages of toddlerhood, were most effective in fostering the child’s social competence and self-concept. While this type of maternal sensitivity was not directly related to delay of gratification, it promoted the development of successful self-regulation. Among indirect mothers, limited use of reason in interacting with the child seemed to be the key factor in the children’s lower self-concepts and social competence. The use of physical and verbal commands or directives seemed to have a positive role only as a foundation for teaching-based mothers’ use of less directive techniques. According to Maccoby (1992), the mothers who relied on power-based strategies seemed to be unaware of alternative, less directive ways of encouraging the child toward their goals. The inconsistent mothers also relied heavily on directives and made limited use of active distractions. Although they also used reasoning with their young toddlers, they did not clearly communicate what they meant, which would have enhanced the child’s development of self-regulation. As in the follow-up study described by Houck and LeCuyer-Maus (2004), the most definitive finding was the negative impact of power-based strategies due to the absence of maternal behaviors that facilitate the child’s health social and self-development.
Drawing from Bandura’s (1977) social learning theory, Reitman and Gross (1997) view parental modeling as a powerful mechanism for helping young children learn to delay gratification. To examine the relationship between mothers’ parenting practices and children’s delay of gratification, Reitman and Gross recruited 64 mothers and their young boys from a public elementary school. The largest group of boys was in first grade, with roughly equal numbers of boys in kindergarten and second grade. The sample included 46 Caucasian, 15 African American, 1 Hispanic, and 2 East Indian families. In the delay task, the child first played a board game and was then asked to choose between a larger or smaller bowl of marshmallows or M&Ms. The children who selected the smaller bowl were dismissed and those who chose the larger bowl were told they could have the large bowl if they waited until the experimenter returned but if they rang the bell first they could only have the small bowl. The experimenter returned after 25 minutes or when the child rang the bell. A modified version of the CRPR was used to classify the mothers’ parenting style as authoritarian, authoritative, neglectful, or permissive (Reitman & Gross, 1997). Due to the finding that 12 of the 18 parents classified as authoritarian were African American, Reitman and Gross restricted the analysis only to the Caucasian and African American parents for comparison purposes. The sociodemographic profiles of the participants showed that the African American mothers were more likely to be single and have lower incomes. They suggested that a more restrictive and less nurturing parenting style might reflect work pressures that interfere with the time to devote to monitoring their children and modeling and reinforcing behaviors associated with delayed gratification. The children who were better able to delay gratification tended to have mothers who were very nurturing and restrictive and more predisposed to monitor their children and reward appropriate delay behavior.
While the review of the literature did not, therefore, provide significant evidence of a causal link between delayed gratification and ODD, it did show a knock-on effect of delayed gratification and parenting styles for behavioral problems that are associated with ODD. The current study – in positing a proposed separate and, more importantly, combined effect with parenting styles – seems supported by the research literature.
Oppositional Defiant Disorder and Parenting Styles
An estimated 2% to 16% of children and youth have ODD (APA, 2000). DSM-IV-TR defines ODD as marked by a pattern of negative, hostile, defiant behavior that can include willful defiance or refusal to comply with adults’ rules or requests, angry outbursts, angry and resentful behavior, spitefulness or vindictiveness, blaming others for one’s mistakes or misbehavior, hypersensitivity, deliberate attempts to annoy people, and frequent arguments with adults. By definition, these behaviors manifest to a degree that they interfere with the child’s ability to function in personal, social, and educational contexts. Children diagnosed with ODD generally show signs before age 8 and, without intervention, such behaviors are largely stable from early childhood through elementary and middle school age (Hommersen, Murray, Ohan, & Johnston, 2006). In young children, ODD behaviors are associated with internalizing as well as externalizing behaviors and may be forerunners of more enduring problems such as ADHD, CD, and depression. According to Hommersen et al., who developed a rating scale specifically designed for assessing DSM-IV-TR symptoms of ODD, the link between ODD and other psychological problems, and in particular the risk for CD, underscores the importance of evaluating ODD behaviors in early childhood.
Kolko et al. (2008) undertook a comparison study involving 6-11 year old clinically referred children diagnosed with ODD, either with or without CD, and a matched sample of healthy boys and girls. The study was designed to illuminate the various factors related to the children’s psychosocial functioning. The sample consisted of 136 children with ODD alone, 40 children with ODD and CD, and a control group of 69 children. The children were predominately male (81%) averaging 9 years of age and were either Caucasian (53%) or African American or biracial (47%). Also included in the study were adult informants, primarily biological mothers (86.1%), with small numbers of fathers (9%), and other relatives including adoptive parents (4.9%). Slightly more than half the children (51.8%) lived in households with a single adult. The CBCL was used in conjunction with other assessments including the DSM-IV diagnostic interview, the Parental Self-Efficacy Scale (PSES), the Parent Perception Inventory (PPI) to examine parenting practices, and measures to assess family functioning, children’s peer interactions and school functioning, and neighborhood quality. The analysis disclosed several distinctions between the two groups of children with ODD and the control group children (Sadock & Sadock, 2009). In terms of parenting practices, the parents of children with ODD displayed more hostility and engaged in fewer positive parenting behaviors than the parents of the healthy children although there were no differences in negative parenting practices. The parents of children with ODD also had lower self-efficacy and were more apt to display psychological aggression. In addition, the children with ODD experienced more family stresses, had more behavior problems in school, and were more likely to associate with delinquent peers. Areas in which the children with ODD and their families and the control group were comparable included parents’ depression, family support and adaptability, support from teachers and peers, reliance on negative parenting practices, neighborhood conditions. Certain parent characteristics distinguished the children with ODD only from those with ODD and CD. Specifically, parental hostility was associated with comorbid ODD and CD while parents’ use of psychological aggression was linked with ODD only (Kolko et al., 2008). Kolko et al. pointed out that the behaviors of parents and children with behavior disorders tend to influence one another reciprocally. Perhaps not surprisingly, the children with comorbid ODD and CD were also more likely to associate with delinquent peers. The overall pattern highlighted poor parenting practices, parents’ lack of confidence in managing their children’s behavior, exposure to antisocial peers, and behavior problems in school as the key factors distinguishing children with ODD from their non-behavior disordered peers. Gender differences were minimal in the study although the girls with ODD reported more negative parenting practices and there was greater divergence between the academic performance and school behavior problems of the girls with ODD compared to their healthy peers (Valiente et al., 2009). While stating that girls and boys could benefit equally from multifaceted interventions, Kolko et al. suggested that greater emphasis on parenting practices and peer interventions for peers might be warranted.
The concern of gender differences in studies of ODD and its relationship to parenting styles has shown mixed results. Norwegian researchers reported few gender differences among 4-8 year old children with ODD or comorbid ODD and CD (Fossum et al., 2007). However, the way that others in their environment viewed the members of both sexes differed according to gender. Specifically, parents rated girls and boys as both being extremely aggressive and defiant, while the teachers stated that boys displayed significantly more behavior problems in school and were less socially competent than girls. In addition, the families of girls with behavior disorders reported more family stress and the mothers of girls were more vulnerable to depression.
In their study of children with behavior disorders participating in the Incredible Years program with their families at two outpatient clinics, Patterson, DeBaryshe, and Ramsey (1990) found that boys tended to have greater reductions of problem behaviors at home than girls. Significantly the gender of the dominant parent was found to have a significant impact on effects and treatment regarding behavior problems. Specifically, reductions in mothers’ harsh and inconsistent discipline practices significantly reduced the children’s conduct problems. This was similar to results reported for the Incredible Years program in the U.S. (Beauchaine et al., 2005). Webster-Stratton et al. (2001) reported that among 4-8-year old children with conduct problems who participated in the Incredible Years Dinosaur Social Skills and Problem Solving Curriculum, the only factor precluding significant reductions in conduct problems was the mothers’ continued reliance on critical statements and physical force. This finding suggested that the role of parenting style, particularly as it is driven by parental stress and approach, is a key factor in the development of social problems leading to ODD.
Parenting, Stress, and Behavior Problems
In general, the international literature shows similar patterns related to the etiology, trajectories, and contextual influences of behavior disorders (Bayer et al., 2008; Leschied et al., 2008; Sanders et al., 2007). The lack of differences in family stress and parental depression between children with ODD and the health control group reported by Kolko et al. (2008) is actually unusual. Families of children with behavior problems usually have higher levels of stress and depression. One explanation for the lack of discernable differences may be the matching of the two groups on sociodemographic and neighborhood characteristics. Economic stresses are linked with parental depression, marital problems, and hostile parenting, which in turn influence the development of Caucasian and Mexican American children although not in identical fashion (Parke et al., 2004). Parke et al. (2004), for example, utilized a family stress model to investigate the impact of economic hardship on 167 Mexican American families and 111 Caucasian families and their 5th grade children. The study was part of the Riverside Economic Stress Project, and examined the variables of economic hardship, economic pressure, marital problems, hostile parenting, children’s adjustment problems, and acculturation. On the whole, the model illustrates comparable pathways for both ethnic groups but with certain notable differences. Economic hardship for mothers and fathers in both groups was linked with economic pressure. However, the association between the two economic measures was stronger for the Caucasian families, partially due to the higher absolute income level of the Caucasian families. Parke et al. proposed that the Mexican American families might be more apt to share resources thus mitigating some of the impact of economic disadvantage. Both mothers and fathers in low-income families were more susceptible to depression. For the Mexican American families, as their level of acculturation increased so did their family income. In both ethnic groups, mothers and fathers with depression were more likely to experience marital problems, which influenced the children’s adjustment. In fact, both Fossum et al. (2009) and Parke et al. (2004) noted that there were direct links between marital problems and child outcomes and fathers’ hostile parenting and child outcomes, which was more pronounced in the Mexican American families. Parke et al. surmised that the stronger impact of marital problems on the Mexican American children reflects the cultural emphasis on familism, implying that family conflicts are more disruptive in families that give precedence to family cohesion and interdependence.
Using observational and self-report data on family conflict, family dynamics, and children’s adjustment, National Alliance on Mental Issues according to Sommer (2011), found more evidence of similarity than difference between Caucasian and Latino families. The main focus of the study was the impact of parents’ marital problems and behavior problems in boys and the findings confirmed that for both ethnic groups, higher levels of marital conflict were associated with boys’ externalizing behaviors. In families with a hierarchical parenting structure, fathers reported numerous conflicts over childrearing practices. Parents in families marked by marital conflicts were more likely to display lax and inconsistent parenting and these families had more dysfunctional patterns of interaction. These findings were common to both ethnic groups. One significant distinction was that in Anglo and bicultural families, a hierarchical parenting style was linked with boys’ clinical levels of disruptive behaviors but for the Mexican American families, clinically disordered behavior was linked with lax and inconsistent parenting. Lindahl and Malik (1999) related the ethnic differences in the effects of parenting styles on the boys’ behavior to the cultural environment in which parenting takes place. In a study that Lindahl (1998), investigated the relationship of family dynamics and boys’ behavior problems in a sample consisting of four groups of 11-year old boys: boys with ODD, boys with ADHD, boys with ADHD and ODD, and a control group of boys with no behavior problems. The results showed that a discriminant analysis including marital and family factors alone could effectively classify families into one of the four behavioral groups with accuracy of almost 90%. Compared to the control group and the boys with only ADHD, the families of boys with ODD, with and without ADHD, were marked by exceedingly high levels of marital and family conflict, marital dissatisfaction, and marital hostility. Dysfunctional marital and family dynamics rather than parenting practices per se were the critical factor in the children’s behavior problems.
In the Riverside Economic Stress Project, Parke et al. (2004) had found lower incidence of hostile parenting by mothers and father in Mexican American families where the mothers were more acculturated. The researchers suggest that this reflects the mothers’ knowledge of viable alternatives to harsh and punitive discipline such as reasoning and loss of privileges as well as awareness of the negative attitudes toward harsh disciplinary practices in American culture. Mexican American mothers who attended child-parent relationship training eagerly embraced the new parenting techniques they learned and firmly rejected the punitive disciplinary strategies used by their own parents (Garza et al., 2009).
Hill et al. (2003) confirmed the benefits of positive parenting on children’s externalizing and internalizing behaviors in a study of 344 economically disadvantaged Mexican American and Anglo parents. In both ethnic groups, the children of parents who displayed low levels of conflict and hostile control and who employed consistent parenting and showed acceptance toward their children were less vulnerable to developing conduct problems and depression. Certain intriguing patterns emerged based on acculturation. In Spanish-speaking families, the combination of hostile control and acceptance was not unusual, leading Hill et al. to theorize that acceptance in families with low levels of acculturation is related to familism and that high levels of warmth and acceptance in these families protect children against the potentially adverse impact of hostile control. Hill et al. point out that research with Anglo families reveals that in the presence of high levels of warmth and emotional support, even spanking has no detrimental effect.
Manongdo and Ramirez Garcia (2007) found that in Mexican American families with adolescent children between the ages of 13 and 17, supportive parenting by mothers was associated with lower incidence of externalizing behaviors among girls but not boys, whereas mothers’ hostile control parenting was associated with depression among boys. The researchers attribute the gender differences to the traditional cultural gender roles described by machismo and marianismo whereby boys are expected to be dominant and independent whereas girls are socialized to be docile and self-sacrificing and assume more family responsibilities. By comparison, Norwegian parents’ equivalent descriptions of their sons and daughters’ defiant and aggressive behaviors (Fossum et al., 2007) reflect the egalitarian roles in Scandinavian countries.
Valiente et al. (2009) used a stress and coping model to investigate children’s responses to everyday social stressors and their relationship to effortful control, psychosocial adjustment, and parenting practices. The sample consisted of 240 children between the ages of 7 and 12, with Mexican American children comprising the largest group (55%). Effortful control is a measure of self-regulatory capacity and an aspect of temperament. Effortful control works to regulate reactivity and plays a role in activating and suppressing cognitive and behavioral responses. The parents’ behaviors were captured by the Coping with Children’s Negative Emotions Scale and the children’s reactions were assessed through the Responses to Stress Questionnaire (RSQ). The CBCL and the Youth Self-Report were used to assess the children’s behaviors. Significant associations emerged between the parents’ emotional responses and their children’s coping and involuntary reactions. Cherry (2011) noted that children’s expression of negative emotions is a source of stress for parents; therefore the parents are modeling ways of dealing with stress by their reactions. When parents react negatively, the children learn maladaptive coping strategies and such observational learning interferes with their ability to learning appropriate emotional and behavioral responses to stress. Consistent with the conception of effortful control as a self-regulatory mechanism, effortful control was positively linked with engagement coping and inversely linked with involuntary stress responses. As Valiente et al. expected, engagement coping was related to children’s adjustment and moderated the relationship between parents’ emotional responses and their children’s adjustment. Specifically, the children’s use of engagement coping and involuntary stress responses mediated the relationships between parenting or effortful control and children’s problem behaviors and success in the academic setting. The overall implication is that interventions designed to promote responsive parenting and children’s effortful control has the potential to decrease children’s problem behaviors and enhance academic performance.
The research into the etiology of children’s emotional and behavioral problems has identified a number of risk factors that heighten vulnerability to psychosocial problems. Recognition that there is no single factor leading to negative outcomes has led to a sizable body of literature on cumulative risk (Trentacosta et al., 2008). The theoretical and empirical premise of a cumulative risk model is that, as the number of risk factors accrues there is a consequent increase in children’s internalizing and externalizing behaviors. From the perspective of cumulative risk, Trentacosta et al. focused on nurturant and involved parenting as a mediator of the relationships between contextual risk and internalizing and externalizing problems in young children in high-risk environments. The sample consisted of economically disadvantaged families attending a family centered program designed to prevent conduct problems in toddlers. The families were recruited from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) from metropolitan and rural areas of Pennsylvania, Oregon, and Virginia. The ethnic composition of the participants differed across the three locations. Path analysis confirmed the theory of National Alliance on Mental Issues (2011) that cumulative risk indirectly affected the development of externalizing and internalizing behavior problems, mediated by nurturing and involved parenting. Many of the families were subjected to numerous stressors, which can strain the resources of caregivers and impede their capacity for nurturing and involved parenting. While acknowledging that some families have inner resources that enable them to transcend environmental stressors and provide their young children with sufficient or optimal care, Trentacosta et al. (2008) reported that such resilience was not usual in the WIC families. The powerful impact of cumulative risk on the parenting practices of the participants led the researchers to propose the use of a cumulative risk index to guide the development of primary prevention for behavior problems in young children.
The effects of parenting stress on the development of social and behavioral problems seems clear from the literature review. While such a link has not been shown explicitly to cause ODD, a variety of factors that are involved in parenting styles – namely, the levels of and type parenting involvement that results from parenting stresses such as divorce or poverty – have been linked in the literature to increased behavioral problems among children of both Mexican American and Caucasian descent. The link between parenting style and ODD, therefore, seems well-supported in theory, particularly when combined with the effects of delayed gratification. The researcher, therefore, next turned to a review of the literature as regards methodologies for evaluating child behavior problems.
Evaluating Children’s Behavior Problems
Kerr, Lunkenheimer, and Olson (2007) critically analyze the overreliance on mothers’ behavioral reports for assessing children’s behavior, arguing that obtaining information from multiple sources is more effective for gaining understanding of children’s problem behaviors for early and appropriate intervention. The researchers note that problems manifesting in various settings are typically more serious and recalcitrant. At the same time, they acknowledge that gaining information from different sources is a complex enterprise, especially given the modest degree of association between reports by observers in different settings. A particular point of concern is the uncertainty of how the observations of different informants are related to children’s problems in other contexts or risk for subsequent problems. To address this issue, Kerr et al. investigated whether the ratings of examiners would produce internally consistent indices of children’s internalizing and externalizing behaviors at the ages of 3 and 5 years. In addition, the study explored the congruity of the ratings of mothers, fathers, teachers, and examiners, and the degree that these rating predicted problem behaviors at age 5.
The participants consisted of 240 children, their parents or caregivers, and their teachers, who were part of a larger longitudinal study. Children with medium to high scores on externalizing behavior on the CBCL were deliberately over-represented in the predominately Caucasian sample. In addition to the CBCL, completed by the parents, the teachers and laboratory examiners completed the Caregiver/Teacher Report Form, Ages 2-5 (CTRF/2-5). The analysis revealed a substantial degree of variance in the assessments of the various observer groups. The fathers’ assessments of the children’s externalizing behavior problems were more closely aligned with the multi-informant problem factors than the assessments of the teachers and examiners, leading Kerr et al. to state that researchers should include fathers in studies of development and psychological problems. The correlations between the mothers’ and fathers’ appraisals of the children’s internalizing behaviors were moderately strong but other correlations between informant groups were typically small to negligible at age 3 and small two years later at 5 (Kerr et al., 2007). The mothers, fathers, teachers, and examiners of the 3-year olds observed externalizing problems and each accounted for 9% to 33% of the variance in the children’s latent problem behaviors. Although the predictive value was small in some cases, Kerr et al. state that the mothers’, fathers, and teachers’ assessments all contributed to predicting the children’s problem behaviors. The researchers described the examiners’ contributions as “valuable but redundant” (p. 973). The most intriguing finding was that only the fathers’ appraisals of internalizing behaviors at age 3 predicted the manifestation of internalizing problems at age 5, adding further support to the argument for including fathers in research. Overall, the findings support the use of multiple informants in assessing young children’s behavior problems, and in particular, including the input of fathers.
According to Burns et al. (2000), a major weakness of the assessment tools used to measure the symptoms of disruptive behavior disorders is the use of vague or subjective rating criteria (such as never, occasionally, often, and very often). The development of the SNAP rating scale in 1992 marked the beginning of the utilization of rating scales designed specifically to assess the DSM symptoms of ODD, ADHD, and CD. The scale was based on a 4-point system for rating the frequency that the child displays the behavioral symptoms, a protocol that was continued with subsequent scales. One of the problems with such measures is that different observers may attach different meanings to the descriptors. Burns et al. use ODD as an example; while one parent may construe very often to mean several times per day, the other parent may view very often to mean a few times per week. Hommersen et al. (2006) supported this finding, highlighting the discrepancies that occur in mothers’ and fathers’ appraisals of children’s problem behaviors.
Kerr et al. (2007) consider frequency counts for a designated time interval a more effective strategy for measuring behavioral symptoms. Using this protocol, the rater reports the manifestation of symptoms according to a frequency of occurrence scale (never, once, twice, once per month, once per week, once per day, and many times per day). While acknowledging that a frequency count is a still as subjective appraisal, they regard as less subjective and ambiguous than the rating systems that are commonly used. According to Burns et al., the specific nature of the frequency count has several conceptual advantages for assessing the symptoms of disruptive behavior disorders. First, the frequency count can potentially be more effective for distinguishing the perception of symptom occurrence from the perception of the impairment resulting from the symptoms due to the defined symptom frequencies. Second, the frequency count system also provides more meaningful information on each specific symptom displayed by the individual child. Third, the frequency count has the capacity to measure the manifestation of clinically significant symptoms at a low, medium, or high frequency of occurrence on the same rating scale. For example, the same scale can be used to measure displays of problem behaviors that are infrequent but severe (such as setting fires) or frequent but much less severe (fidgeting or squirming).
To test the frequency count procedure, Burns et al. (2000) recruited a large, diverse, non-clinical sample of children and adolescents (aged 2-19 years) from a variety of locations and community settings. The Child and Adolescent Disruptive Behavior Inventory: Parent Rating Scale (CADBI-PRS) was completed by the parents of 1,496 children and youths from Washington State and Montana. The CADBI-PRS captured 34 disruptive behavior symptoms: 14ADHD symptoms, 9 ODD symptoms, and 13 CD symptoms measured by a 7-point frequency scale covering the last 6 months. The final section of the instrument asked the rater’s relationship to the child, child and family socio-demographic information, and whether the child was currently under treatment for a learning disability or behavioral problem, and if so, to specify the specific disability or problem. The analysis demonstrated that the frequency count protocol produced clinically meaningful information at the level of the symptom and the disorder (Burns et al., 2000). In the nonclinical sample, CD symptoms, particularly the more serious manifestations, occurred infrequently, while symptoms of ODD, ADHD-I, and ADHD-H/I were significantly more frequently but only a small proportion of children exhibited symptoms at an extremely high frequency. The levels at which the disorders occurred were consistent with the expected occurrence in a normative sample. In addition, the frequency with which the symptoms of specific disorders were reported was consistent with the treatment information included in the questionnaire. Burns et al. also noted that the frequency count also seemed to minimize the relationships of factors such as gender, ethnicity, SES, and the rater’s relationship to the child to the symptoms of ADHD-I, ADHD-H/I, ODD, and CD, suggesting greater objectivity.
Burns et al. (2000) acknowledged that their study did not compare the results produced by the CADBI-PRS to the ratings assessments typically used. Nonetheless, the researchers find the specificity of the frequency count for useful for determining the severity of a child’s behavioral symptoms and evaluating the effectiveness of an intervention with greater precision. Moreover, it was believed that, when coupled with the finding by Kerr et al. (2007) that multiple sources provide a more accurate portrayal of behavioral problems, the specificity of the frequency counting instrument provided a more useful tool for both comparative and individual assessment of variables.
The Oppositional Defiant Disorder Rating Scale. Hommersen et al. (2006) point out that the most popular and well-validated ratings instruments for children’s problem behaviors tend to be cumbersome and expensive. Additionally, although they are designed to cover a broad array of behaviors, they rarely have subscales targeting DSM-IV-TR criteria for ODD. There are a few brief rating scales directly aligned with DSM-IV-TR criteria for externalizing behavior disorders but none had included ODD symptoms, analyzed the psychometric properties of the ODD items independent from other items, been utilized with parents, subjected to peer review, or were suitable for use with elementary school children. To address this gap, Hommersen et al. devised the Oppositional Defiant Disorder Rating Scale (ODDRS), which uses a 4-point scale that directly taps into the 8 ODD symptoms outlined in DSM-IV-TR. The reliability and validity study of the ODDRS included data from six separate data sets drawn from the Parenting Laboratory of the Psychology Department of the University of British Columbia. Based on prior research on ODD documenting a link between harsh or overreactive parenting and children’s ODD symptoms, Hommersen et al. (2006) anticipated findings significant associations between ODD behaviors and parenting of that type. The studies drawn from the data sets included family social and parenting information as well as behavioral assessments from questionnaire and observational data. The parents completed the ODDRS as part of the assessment procedure, and the data analysis also included families with at least one child who had ADHD or at least one child who did not have ADHD. Additional instruments for the study included the CBCL and the Overreactivity subscale of the Parenting Scale, which evaluates discipline “mistakes” that are either theoretically or empirically associated with children’s externalizing behavior problems such as ODD (Arnold, O’Leary, Wolff, & Acker, 1993).
Arnold et al. (1993) and Hommersen et al. (2006) deem it especially important to have an accurate tool for identifying ODD, given its prevalence in the general population and prospective relationship to more serious aggressive and antisocial behaviors. The analysis revealed that the ODDRS had high internal consistency for parents of children with ADHD and parents of children without behavior disorders. The ODDRS also showed high interrater reliability between fathers and mothers. Because Arnold , O’Leary, Wolff, & Acker (1993) argue that measurement of parenting effectiveness varies across different levels of involvement, the fact that both father and mother responses proved reliable indicated that the tool was applicable in a wide variety of situational studies. In addition, the stability of ODD symptoms shown by the ODDRS over a one-year period was consistent with the stability reported by prior research on ODD and with a more lengthy assessment instrument. Additional analyses showed strong support for the single factor model of ODD delineated in DSM-IV-TR, as well as a high correlation with the Aggressive Behavior subscale of the CBCL and a relationship to the Internalizing Attention Problems and Delinquent Behavior CBCL subscales. Therefore the instrument seemed to pick up both discrete and combined effects of explanatory variables on ODD.
Comparisons with results on children with ADHD demonstrated that the ODDRS sufficiently captured the focus on oppositionality distinct to DSM-IV-TR criteria for ODD (Hommersen et al., 2006). The analysis also confirmed the connection between the mothers’ reports of over reactive parenting and the manifestation of behavior problems by the children. Another expected association was that children with ADHD scored significantly higher on the ODDRS than children without ADHD, consistent with evidence that ODD behaviors are more common in children with ADHD. There was no difference in the degree of ODD behaviors reported by parents of children with ADHD although the parents of boys without ADHD assessed them as having significantly more ODD symptoms compared to the parents of girls without ADHD. Another finding consistent with the existing research was that age was not a significant factor in the manifestation of ODD behaviors. Overall, the analysis supported the strong psychometric properties of the ODDRS. Hommersen et al. (2006) view the ODDRS as a highly promising assessment tool that is directly linked with DSM criteria, simple to use and interpret, cost-efficient, and suitable for children across the full age range in which ODD typically manifests. The researchers consider the ODDRS a useful screening instrument applicable to educational, clinical, and research contexts.
Having defined possible tools for use in measuring behavioral problems, the researcher turned to a consideration of two final factors that are closely linked to the study’s aims – a consideration of Mexican American family cultural factors that are relevant to the design of the study, and a consideration of intervention strategies that have been developed to deal with problems associated with ODD, delayed gratification, and parenting styles. It was believed that both of these factors were critical for review, as the culturally-sensitive nature of the study and any related findings or responses that may arise from it are bound by socialization considerations in the Mexican American community, and the effective worth of the findings will revolve, ultimately, around an ability to find intervention programs that can be used to address parenting styles and gratification levels with training should they be found to be causally linked to ODD. The information gleaned from the review of the literature regarding both of these issues therefore follows in the sections below.
Parenting and Socialization Practices in Latino Families
Gamble and Modry-Mandell (2008) explored the role of family cultural values in family relations and children’s adjustment in 55 Mexican American families of children attending Head Start programs in Arizona. The key cultural values were familismo and simpatia. Sympatia encourages the avoidance of interpersonal conflict, stressing positive behaviors in agreeable situations and de-emphasizing negative behaviors in conflict situations. Although there are numerous references to familism in the literature, the researchers note that simpatia has received minimal attention. However, the existing studies suggest that values and attitudes reflecting simpatia are integrated into the socialization of Mexican heritage children. For example, Mexican American children tend to favor cooperation over competition in games while Anglo children tend to show the reverse preference.
The data presented by Gamble and Modry-Mandell (2008) were part of a large, longitudinal study exploring the socialization of emotion regulation in families of preschool children. Replicating earlier research with older children, the findings showed that close relationships between mothers and children produced fewer internalizing problems among the children. In addition, warm sibling relationships were negatively related to behavior problems and positively linked with children’s emotional and peer adjustment. Values reflecting familism, namely close family bonds, warmth, and interdependence, had a mediating effect on children’s adjustment but were not related to children’s behavior or academic performance at school. However, the children of mothers who endorsed the value of familism seemed to thrive in a classroom environment marked by warmth and closeness. Simpatia did not emerge as a factor in children’s adjustment at home or in the family, leading the researchers to surmise that simpatia might be more relevant to the behavior of older children. The researchers concluded that the value of family’s can promote young children’s healthy adjustment in social settings beyond the family, a belief shared by therapists who work with young Mexican American children and their families (Garza et al., 2009; McCabe & Yeh, 2009).
While the research provided Gamble and Modry-Mandell (2008) seemed to suggest a clear picture of the values that play a critical role in Mexican American family socialization, other research was not so clear. Domenech Rodriguez et al. (2009) argue that inconsistent findings for research on parenting in Latino families may reflect a mismatch between Latino cultural values and the four parenting styles outlined by Baumrind’s model. The researchers explored this issue in a study of Spanish-speaking families in which at least one parent was a first generation immigrant. The sample of 49 families (49 mothers and 46 fathers) was limited to parents of children aged 4-9 years. For a comprehensive portrait of the participants’ parenting styles, Domenech Rodriguez et al. developed the Parenting Style Observation Rating Scale (P-SOS), a synthesis of published self-report scales augmented by additional items. The analysis confirmed that the four traditional parenting styles delineated by Baumrind did not completely capture the parenting practices of the first generation Latino parents. Most of the parents (61%) were labeled protective parents. In addition, while the mothers and fathers had similar parenting styles, they showed different behavioral expectations for male and female children, consistent Manongdo and Ramirez Garcia’s (2007) findings for parents of adolescents. Domenech Rodriguez et al. (2009) included warmth, autonomy granting, and demanding, and their analysis produced eight potential parenting styles for Latino parents.
Like Domenech Rodriguez et al. (2009) and Gamble and Modry-Mandell (2008), Livas-Dlott et al. (2010) argue that understanding of cultural values is essential for an accurate portrayal of parenting in Latino families. In addition to familismo, Livas-Dlott et al. invoked respeto, respect for adults, and bien educado, learning proper deportment. Domenech Rodriguez et al. (2009) observed relatively few instances of autonomy granting, which Livas-Dlott et al. (2010) consider consistent with Latin cultural values. Their study included 24 families of Mexican descent, either first generation of second generation, who had a 4-year old child. The analysis of compliance strategies in mother and child interactions disclosed a complex array of high and low-power assertion strategies. There were few instances where the mothers used reasoning or discussion. In 40% of the compliance attempts, the mothers relied upon direct verbal commands without explanation. However, there was minimal evidence of harsh or punitive behavior and the commands were delivered within the context of a supportive atmosphere and displays of emotional warmth. Overall, the intricate patterns of mother and child interactions supported the assertion of Domenech Rodriguez et al. (2009) that Baumrind’s parenting styles do not fully illuminate the socialization practices of Latina mothers.
Children’s social competence. Using data from the Early Childhood Longitudinal Study (ECLS-K), Galindo and Fuller (2010) found that socioeconomic status (SES) and national heritage were significant factors in the social competence of Latino children compared to their white peers as perceived by teachers. For middle-class children there were no significant differences in social development based on ethnicity. However, Latino children from poor families were rated significantly lower on social competence than their white peers. The discrepancies between white and Latino children were most apparent in children of Puerto Rican heritage, while children of Mexican American heritage were closer to white children on self-control, interpersonal skills, and approaches to learning, and there were no differences between white and Mexican American children in the display of externalizing and internalizing behaviors. For children of Cuban and South American descent, whose parents tend to have higher educational attainment, there were minimal differences in social competence compared to white children. Latino children with higher social competence enjoyed greater growth in mathematical development and understanding, which was the main focus of Galindo and Fuller (2010). The disparity in social competence between white and Latino children was primarily limited to children in the two lowest income classes. This finding underscores the importance of promoting young children’s social development. An important issue brought out by the study is the need to consider cultural factors, including acculturation, social class, and the diversity of families of Latin heritage, in understanding young children’s social competence and school performance.
Interventions for Children and Parents
Although children make significant gains through the classroom curriculum, the synthesis of child and parent training is the most effective mode for negative parenting as well as children’s externalizing behaviors and promoting children’s development of emotion regulation (Reid et al., 2007). The Incredible Years has been found to be on effective program for decreasing behavior problems in children with conduct problems such as ADHD as well as children with conduct problems without ADHD (Hautmann et al., 2009; McMahon, & Kotler, 2008). In this section a number of other intervention and concepts options will be reviewed
Parenting self-efficacy. Using Bandura’s (1997) social cognitive theory as a framework, Dumka et al. (2010) examined parenting self-efficacy and parenting practices in a longitudinal analysis involving 189 Mexican American adolescents and their mothers (or maternal caregivers). At the onset of the study, the students were in 7th grade and ranged in age from 11 to 14 years. Recruited from middle schools serving predominately Mexican American populations, the students comprised the non-intervention control group of a study evaluating an intervention designed to support the psychosocial health and school engagement of students making the transition to middle school. The second assessment took place after 6 months during the second semester of 7th grade, the third assessment six months later during the second semester of 8th grade, and the final assessment took place one year later in the second 9th grade semester. The students, their mothers, and teachers participated in the study.
In analyzing the reciprocal relationships between parenting self-efficacy and positive control, Dumka et al. (2010) found that parenting self-efficacy preceded positive control. Parenting self-efficacy was linked with lower incidence of conduct problems, leading Dumka et al. to propose that interventions designed to boost parenting self-efficacy could be effective for decreasing behavior problems in adolescents. Parents who participate in the Incredible Years parent training program report increased confidence in parenting (Hautmann et al., 2009; McMahon, & Kotler, 2008).
Parent-child interaction therapy. Parent-child interaction therapy (PCIT) is a manualized treatment for young children with externalizing behavior problems that has accrued a firm evidence base (Eyberg, 2005). The current direction for proponents of PCIT is adapting and expanding upon the core therapy for new populations including culturally and linguistically diverse families, families with special needs children, families with histories of child abuse, and foster families. Regardless of the population or setting, however, PCIT is built on several key principles. As the name of the treatment implies, the therapeutic sessions are designed to actively engage the parent in child in learning new and better ways of interacting with one another. At the onset of therapy, the therapist observes and codes the joint interactions (“tallies the relevant behaviors”) as a starting point for evaluating progress and determining which behaviors of the parent and child should have the most immediate focus (p. 198).
In teaching the parent positive parenting skills, the therapist coaches the parent via verbal cues and reinforcement, leading the parent toward closer and closer enactments of the target behaviors derived from the initial coding (Eyberg, 2005). This exercise is accomplished through the use of two distinctive patterns or templates for interactions between the parent and child: following the child’s lead (child-directed interaction) and leading the child (parent-directed interaction). According to Eyberg, “These two interactions represent the two aspects of Baumrind’s authoritative parenting, nurturance, and firm limits, required for optimal psychological development of the child” (p. 198). Eyberg (2005) conceptualizes positive parenting techniques as principles that can be applied and adapted to different situations. Parents are not provided with any specific statements to use to elicit the desired behaviors but rather, “parents learn broad classes of behavioral antecedent and response behavior” through the mechanism of “the intensive operant conditioning that occurs during coaching” (p. 198). The child learns and masters the new behaviors (social interaction skills and cooperation) through a parallel process. Eyberg describes the parent-child coaching sessions as a “moment-by-moment functional analysis” geared toward molding the behaviors of both participants toward positive interpersonal interactions that are essential to healthy parent and child attachments and collaborative social competencies (p. 199). The inherent flexibility of PCIT makes it an excellent program for adapting to the unique characteristics of different families.
Eyberg (2005) noted that the original empirical evidence base for PCIT came from work with Caucasian preschool children and parents. She envisioned future research examining the efficacy of PCIT with culturally diverse families. In particular, Eyberg cited the innovative work of McCabe and her colleagues who adapted PCIT for Mexican American families. Known as Guiando a Ninos Activos (GANA) for Guiding Active Children, the culturally tailored intervention grew out of extensive quantitative and qualitative analysis in which the researchers explored the preferences of Mexican American families for therapy for their young children, which were incorporated into a culturally modified version of PCIT (McCabe & Yeh, 2009).
Part of the inspiration for GANA came from the work of Matos et al. (2006, 2009) who adapted PCIT for Puerto Rican families. According to Matos et al. (2006), Puerto Rican mothers tend to emphasize respect, loyalty, and obedience, reflecting the cultural values of respeto and familismo. In contrast, Anglo mothers espouse a more individualistic philosophy that fosters a sense of independence and autonomy. Other values embraced by Latino families include personalismo, which stresses warm interpersonal relationships with family and friends, and a time orientation that gives precedence to the present as opposed to planning for the future. Matos et al. also suggest that culturally sensitive parent training for Latino families consider the roles of extended family members in the child’s socialization. The project undertaken by Matos et al. (2006, 2009) involves Puerto Rican children between the ages of 4 and 6 with ADHD and significant behavior problems. The core PCIT principles were adapted on the basis of eight culturally sensitive program features: language (assuring that the language used is appropriate to the target culture), person (attention to socio-cultural influences on the relationship between the client and the therapist), metaphors (culturally shared symbols and concepts), content (cultural knowledge of the target group), concepts (culturally relevant treatment concepts), goals (supporting positive and adaptive cultural values), methods (culturally adapting the basic treatment), and context (contemplation of changing contexts).
Transforming the PCIT intervention to be culturally sensitive to Puerto Rican family was accomplished through a four-step process (Matos et al., 2006). The first step entailed the translation and preliminary adoptions of the PCIT manual by a predominately Puerto Rican research team (and one Columbian) who had extensive clinical experience working with Latino children and families. The researchers translated the PCIT manual and parent handouts into Spanish, revising the manual to be relevant to the socio-cultural context of families living in Puerto Rico but with equivalent content to the original English version. The subsequent steps were outlined in the report presented by Matos et al. (2006). Step 2 consisted of an exploratory study with 9 families of children who met the inclusion criteria for hyperactivity and disruptive behaviors. Step 3 involved the revision and refinement of the culturally tailored treatment and Step 4 consisted of in-depth interviews with 15 Puerto Rican parents who completed PCIT and 5 Puerto Rican clinical psychologists who analyzed the treatment manual. The nine families included two single mothers and their children and seven families in which both parents (including one stepfather) and their children participated (Wolff, & Acker,1993). Most of the children were boys, and the group had a mean age of 4 years 9 months and normal IQs. Seven of the children met diagnostic criteria for ADHD (combined or predominately hyperactive type) and all but one met diagnostic criteria for ODD. The parents were well-educated, with educational credentials ranging from associate degrees through postgraduate degrees. All the fathers and seven mothers were employed full-time; of the two remaining mothers, one worked part-time and one was a college student (Arnold et al., 1993). A battery of tests were used for assessment purposes including the Disruptive Behavior Scale for Children (DBRS), the hyperactivity and aggression subscales of the Behavioral Assessment System for Children-Parent Rating Scales (BASC-PRS), the Peabody Picture Vocabulary Test Hispanic American Adaptation (PPVT-HAA), the NIMH Diagnostic Interview Schedule for Children IV-Parent Version, the Children’s Global Assessment Scale-Spanish, the Eyberg Child Behavior Inventory (ECBI), the CBCL, the Family Experiences Inventory (FEI), and the PPI. The researchers also included the Treatment and Evaluation Survey (SES), developed by Matos for work with Puerto Rican clients, and Eyberg’s Therapy Attitudes Survey (TES), both designed to assess the clients’ satisfaction with therapy as well as its effectiveness in achieving the desired goals. The cultural adaptation of the PCIT is similarly proposed by Francisco Villaruel (2009) who argues that the interventionists should be the ones to change their behavior when facing patients. In this light, Villaruel pointed out that professionals in the field should be more sensitized to the issues faced by Latinos within treatment (Villaruel, 2009).
In Matos et al.’s model of the PCIT, the families participated in one weekly 1.5 hour session for an average of 16 weeks (Matos et al., 2006). There was no arbitrary treatment duration and the families attended sessions until they had satisfactorily mastered the interaction techniques, the children’s behavior problems diminished, and the clients felt ready to conclude the therapy. Matos et al. noted that they placed significant emphasis on the person dimension; reflecting the concept of personalismo, the families favored a warm interpersonal relationship with their respective therapists. The mothers reported feeling comfortable, understood, confident, and supported by their therapists. Additional time was added to the therapy sessions as needed to discuss issues that were important to the clients such as sibling care giving and work or financial issues. One issue that repeatedly arose was the integration of extended family members into the treatment process, and the therapists took time to advise the parents on how to explain the treatment to other care giving relatives to facilitate their support and prevent them from undermining the treatment with well-intentioned but misguided actions that would result in inconsistent discipline (Eyberg, 2005; McCabe & Yeh, 2009). In particular, the therapists offered guidance in helping the grandparents understand the basic treatment strategies. The concepts and goals of the therapists and the families were well aligned, with emphasis on concepts such as family relationships, attachment, and discipline, goals targeted toward creating warmer relationships between the parents and child and improving the parents’ ability to manage the child’s behavior (Matos et al., 2005; Domenech Rodriguez et al.,2009). The more culturally sensitive PCIT procedure was also posited by Hood & Eyberg (2003) who based their intervention from the model created by Matos. Hood & Eyberg designed a PCIT wherein all the professionals and paraprofessionals involved are familiar with the cultural sentiments of Mexican Americans or any other cultural minority being treated (Hood & Eyberg, 2003). PCIT has also been shown effective in cases of treating young children with ADHD as well as for children who experienced abuse in the past (McCabe & Yeh, 2009; ). However, two elements of PCIT aroused some objection from some of the parents. Some parents construed child-directed play as a loss of control and some disapproved of the use of time-outs. Based on the parent’s input and the initial experiences, certain revisions were made to the treatment protocol. The new criteria established a maximum of eight sessions of child-directed interactions and nine sessions of parent-directed interactions and loss of privileges was proposed as an alternative to time-outs for parents whose children actively resisted going to the time out room or chair (Fossum et al., 2009). Strategies for including extended family members into child care at home and dealing with related challenges became an integral part of the therapy protocol. An additional improvement was to make the treatment more user-friendly by giving out handouts at the beginning of each stage (rather than the beginning of each session) so the parents had opportunities to study them before each discussion.
Both the parents and the clinical psychologists had highly favorable opinions of the therapy (Matos et al., 2006). The parents reported marked reductions in their children’s problem behaviors and satisfaction with the treatment was high. Matos et al. noted that the children’s behavioral progress was sustained at the 3-month follow-up. However, despite the overall positive findings, the researchers acknowledged that there were some problem areas. The biggest challenge for the parents occurred during child-directed interactions when the parents are expected to ignore their children’s disruptive behaviors and avoid questioning or commanding them. Many parents interpreted this as “doing nothing” (p. 218). According to Matos et al., Puerto Rican mothers are inclined to direct their children’s behavior to a greater degree than Anglo mothers, which may make the problem behavior especially difficult to ignore. At the same time, they concede that ignoring the child’s bad behavior during therapy seems to be a ubiquitous problem for parents in the U.S. mainland as well thus it may not be culture specific.
According to Parke et al., (2004), a major concern in working with Latino families is creating a warm, friendly, welcoming atmosphere. Rather than focusing on protocols, they recommend that therapists engage the clients in conversation about the family and their views on their problems and how they deal with them. With encouraging results from their exploratory study of PCIT with Puerto Rican families, Matos et al. (2009) undertook an efficacy study involving 32 families with 4-6 year old children with ADHD and behavior problems assigned to either PCIT or a 3.5 month waiting list condition. The PCIT group consisted of 20 families. Participants for the study were recruited through media campaigns in addition to families who were referred from clinics and preschool centers (Matos et al., 2009). Families that met the inclusion criteria were randomized to one of the two conditions. Consistent with the very low dropout rate in the exploratory study, only one family dropped out of PCIT (at the onset) and 9 fathers attended the therapy sessions. The researchers utilized the same assessments as in the earlier study with the addition of the Spanish version of the Beck Depression Inventory (BDI).
The overall aim of child-directed interaction is to create or enhance a positive, mutually rewarding relationship between the parent and child (Matos et al., 2009). At the first session, the therapist coached the parent in child-directed interaction skills through instruction, modeling, and role play exercises. During child-directed interaction, the parents model praise and prosocial behavior but are taught to ignore negative behavior, the most challenging aspect for many parents (Matos et al., 2006). The participants are expected to practice the child-directed interaction skilled learning during the session for 5-minute sessions each day (Matos et al., 2009). During parent-directed interaction sessions, the overarching goal is increasing prosocial behaviors and decreasing problem behaviors. Clarity and consistency are the central facets of parent-directed interaction skills. The parents are coached in strategies for creating and enforcing “house rules” for the child’s behavior at home and in public settings. During each session, the parents took turns practicing the techniques with the child in the playroom with the spouse and the therapists observing through a one-way mirror.
As part of the cultural adaption, Matos et al. (2009) established specific mastery and treatment criteria that enabled them to alter the original time-unlimited PCIT format. The child-directed interaction stage generally concluded when the parents reached the goal of displaying 7-10 behavioral descriptions, reflections, and clear praises, and 3 or less criticisms, commands, and questions during a 5-minute coding period. The parent-directed interaction stage concluded when at least three-quarters of the parents’ commands were direct and followed-through correctly during a 5-minute coding period at the onset of each therapy session. The format of eight child-directed interaction sessions and nine parent-directed interaction sessions determined from the initial study was generally followed although two families required an addition session of child-directed interaction and one family needed an extra parent-directed interaction session in order to progress satisfactorily.
Although Matos et al., (2009) considered relying entirely on the mothers’ reports for the outcomes assessment a limitation and recommended including fathers who might have a different perspective, the efficacy study was also limited to only the mothers’ assessments. As in the exploratory study, the mothers were highly satisfied with PCIT and reported that their children showed significant decreases in hyperactivity, impulsivity, attention problems, ODD, and aggressive behaviors, which translated into lower levels of stress in parent-child interactions. The mothers also felt much more confidence in their parenting skills and ability to manage the child’s behavior and said that their parenting practices had improved substantially. McCabe & Yeh, 2009; Matos et al., (2009) noted that the treatment gains were clinically significant and were sustained at the 3.5 month follow-up. Given the documented association between ADHD and conduct problems in early childhood and negative school, adolescent, and adult outcomes, Matos et al. envision PCIT as part of an early childhood prevention program for antisocial behavior, stating that such a program has good potential and warrants further research.
Matos et al., 2009 ; McCabe & Yeh, (2009) point out that the treatment effect sizes were large (1.37-2.04), demonstrating powerful and significant positive changes in the target behaviors. PCIT is recognized as an evidence-base treatment, and Matos et al. note that other studies of PCIT have found similarly impressive results. In fact, they state that the treatment effects they observed are equal or superior to the effect sizes reported for medication for ADHD. Webster-Stratton & Hammond, 1997; Webster-Stratton & Stoolmiller, 2008; McCabe & Yeh, (2009) suggest that PCIT could be considered as an alternative to stimulant medication for preschool children, or where medication is needed, PCIT might be useful for lowering the required dosage. Matos et al. (2009) included the BDI on the basis of research showing that mothers of children with ADHD are vulnerable to depression. However, none of the mothers approached clinical depression. Adherence and satisfaction were high. According to Matos et al, the advantages of PCIT include the fact that the treatment involves parents and children together as opposed to parent training alone and the sessions are highly individualized and easily adapted to any challenges that arise. A particularly positive feature is that the parents are active partners in the therapy and encouraged to devise their own solutions to the child’s behavior problems as the treatment goes on. To Eyberg, 2005; Cherry (2011), this flexibility facilitates the application of the parenting skills learned during the therapy sessions to the real world environment.
McCabe and Yeh (2009) compared the effectiveness of GANA, the cultural adaptation of PCIT for Mexican American families, with the standard PCIT in a randomized clinical trial involving 58 Mexican American families with children diagnosed with serious behavior disorders. Ranging in age from 3 to 7 years, the children and their families were randomly assigned to standard PCIT, GANA, or a treatment as usual (TAU) condition. The adult participants were all female primary caregivers, primarily mothers (92%), but also including grandmothers, aunts, or other caregivers. In 40% of the families, the male primary caregiver participated in at least one therapy session. Boys represented the majority of the children, and Spanish was the preferred language of most participants. On average, the mother’s educational level and the family income was low.
Consistent with Eyberg’s (2005) conception of culturally tailored PCIT, GANA includes the core principles of PCIT but the presentation is modified on the basis of a cultural assessment of the family. Cultural concepts were infused throughout the program, reflecting the family’s values, with additional modifications including: (a) framing the program as an educational and skill building intervention, (b) expanding the clients’ orientation to therapy, (c) expanding the session time to allow for rapport building, (d) translating, simplifying, and adding images of Mexican American families in the handouts, and (e) implementing an engagement protocol derived from earlier research (McCabe & Yeh, 2009). The assessment instruments used included the CBCL, the Early Childhood Inventory, the Parenting Practices Scale, and the Parenting Stress Index. Edberg’s Dyadic Parent Child Coding System (DPICS) was used to assess the social interactions displayed during child-directed interaction, parent-directed interaction, and clean-up activities. For the TAU condition, the families worked with therapists at the clinic who had various therapeutic orientations but no training in PCIT. There were no limits on the number of sessions for families in any of the three conditions.
GANA was significantly superior to TAU in decreasing the children’s behavior problems on all the self-reported assessments and standard PCIT produced superior results to TAU on the CBCL Externalizing Problems and the Parenting Stress Index Total Stress (McCabe & Yeh, 2009; Manongdo & Ramirez, 2007; Lindahl & Malik, 1999; Supplee et al., 2009). Based on the written assessments, there were no significant differences between GANA and standard PCIT. Neither were there significant differences between GANA and standard PCIT on the observational measures, in which both forms of PCIT proved significantly more effective than TAU in enhancing the elements of labeled praise, reflection of child speech, and description of child behaviors and reducing questioning, criticism, and commands. In a study conducted by Rachael Murrihy (2010), results show that GANA exhibits higher efficacious rates as compared to TAU and PCIT in the case of treatments for Mexican American youths. On the other hand, Murrihy nonetheless recognizes that even though GANA exhibited the most efficient results, PCIT is still an effective treatment since its gap from the score garnered from TAU assessment is still significantly higher (Murrihy, 2010).
The fathers were significantly more inclined to participate in GANA than TAU, with standard PCIT occupying an intermediate position that was not significantly different from either GANA or TAU (McCabe & Yeh, 2009). Both GANA and standard PCIT elicited significantly higher satisfaction than TAU. Overall, all three of the interventions resulted in significant reductions in the children’s problem behaviors. Most of the difference between TAU and the two forms of PCIT came from the observational assessment, which is aligned with the parent behaviors that are the focus of PCIT. Noting the seeming incongruence between the parents’ self-reported improvements of their children’s behavior and the seeming lack of change in the parents’ behavior, McCabe and Yeh (2009) speculated that the other forms of therapy (person-centered CBT, trauma focused CBT, and family systems) might operate through other dynamics that were not captured by the observations.
For all three conditions, the therapists were bilingual and either bicultural or very knowledgeable of Mexican American culture. Satisfaction was high for all three conditions but described by McCabe and Yeh (2009) as “quite near the ceiling” for GANA and PCIT (p. 758). McCabe & Yeh, 2009; Manongdo & Ramirez Garcia, 2007; Lindahl & Malik, 1999; Supplee et al., (2009) suggest that the lack of significant differences in satisfaction and parent and child outcomes for GANA and PCIT may reflect the techniques for engaging families that are integral to the principles of PCIT and the fact that both forms of PCIT were conducted by culturally sensitive therapists. In effect, the cultural sensitivity of the therapists more than the cultural adaption of PCIT might have been the pivotal factor in engaging the families and producing the positive results. McCabe and Yeh noted that the adherence to treatment was comparable with other trials of PCIT involving Anglo families. The researchers concluded that PCIT is a highly effective treatment for Mexican American children with serious behavior problems. In the hands of a culturally sensitive therapist, the original PCIT formal appears to be equally effective to the culturally tailored version National Alliance on Mental Issues. (2011).
Child-parent relationship training. Based on the premise that a secure attachment bond between parent and child is critical for children’s healthy development child-parent relationship training (CPRT) is designed to help parents respond to their children emotionally (Garza et al., 2009). The parents learn child-centered play therapy principles and techniques which they utilize to interact with their children in structured weekly play therapy sessions using specially selected toys. CPRT synthesizes elements of didactic instruction and group dynamics. The didactic elements emphasize basic relationship-building skills, consistent phrasing in talking with children, catchy “rules of thumb,” interesting stories and metaphors, success oriented homework, and play-lab assignments. Augmenting this instruction, the group facilitators provide the parents with feedback on their videotaped play sessions. Throughout the process, the focus is on building the parents’ skills rather than changing the child’s behavior. The group format allows the parents to share and discuss their parenting experiences with one another while the facilitator relates the dialogue to the relevant CPRT material, normalizes the parents’ concerns, and highlights commonalities in the parenting issues discussed (Domenech et al., 2009; Dumka et al., 2010). According to a case study by Terrence Patterson, a 4-year old boy diagnosed with oppositional and aggressive behaviors such as ODD and ADHD, the parent handled supervising the boy by catching his attention in negative ways such as punishment which will not solve the case. PCIT was introduced to the boy and to the parent as a method of catching the child’s attention through positive ways without worsening his condition (Patterson, 2002).
According to McCabe & Yeh, 2009; Garza et al., (2009), the principles of CPRT are highly congruent with the Latin cultural values of personalismo and familismo, which should make it ideally suited for working with Latino families. The researchers point out that culturally sensitive treatment promotes higher treatment adherence, a premise that also underlies culturally tailored PCIT (Matos et al., 2006, 2009; McCabe & Yeh, 2009). To illuminate the perspectives of Latino CPRT clients, Garza et al. (2009) conducted a phenomenological group study with three participants of a larger CPRT group comprised of first generation Mexican Americans. All the participants were Spanish speakers who had been in the U.S. more than nine years and were married with young children. Although several participants had more than one child, CPRT is based upon interactions with one child-of-focus (COF) during the 10 training sessions. For the group interview participants, the COF was a 3- or 4-year old child enrolled in the Head Start center where the CPRT and the interviews took place. The CPRT training program consisted of 10 weekly 2-hour group sessions at the school combined with weekly 30-minute play sessions at home that were either videotaped by the families or supervised in person by trainer for those who did not have access to video camera equipment (Garza et al., 2009). Two counselors with specialized training and supervision in play therapy conducted the training and research project, led by Garza, a professor and registered play therapist fluent in Spanish. For the group interview, the researchers derived eight questions from prior qualitative studies of CPRT, covering three broad areas: the structure and content of the sessions, the overall helpfulness and applicability of the program, and the relationship of the CPR training model to their personal beliefs about parenting.
An interesting finding was that the three parents admitted that they were originally skeptical of the program after being disappointed with other parenting classes they attended (Garza et al., 2009; Matos et al., 2006, 2009; McCabe & Yeh, 2009). However, once they became familiar with CPRT, they enjoyed the group interactions with other parents and the play time at home with their children. In fact, a common theme was that the participants wanted the group to be larger and thought their friends and neighbors would benefit from being part of the group. One parent summarized the group’s feeling by commenting, “I learned things I never would have tried on my own; it improved by parenting. It is more useful than using punishment and rewards; we learned that in another parenting class” (p. 221). The group members thought such programs should be more accessible to Hispanic parents and proposed that teachers and church leaders could play an important role in encouraging parents to participate. Of all the points discussed, the overriding theme centered on the positive changes the parents saw in the child (Garza et al., 2009). The parents described marked decreases in problem behaviors and increases in pro-social behavior. Oppositional behavior was greatly reduced, accompanied by reductions in the parents’ experiences of stress and frustration as well as reliance on yelling or threats: both counterproductive techniques. The parents described the child as calmer, having a better attitude, and more cooperative in school. One parent commented that she and her son “understand each other more” and another reported that her child’s teacher noticed the positive changes in behavior. The changes in the child and the parent mirrored each other, resulting in greater confidence for the parents and a happier, closer, and warmer relationship with the child. These themes overlapped with the final issue, the relationship of CPRT to the parents’ personal values and beliefs. There was unanimous agreement that the parent-child relationship that grew out of CPRT was consistent with their ideals of parenting. Furthermore, the participants viewed CPRT as service needed by the Hispanic community.
An advantage of the culturally homogenous group is that it enabled the participants to reflect upon and discuss their own family upbringings and contrast their parents’ and grandparents’ behaviors with the skills they learned from CPRT (Garza et al., 2009). As a group, the participants felt that traditional Hispanic parenting practices were harsh, outmoded, and detrimental and wanted to warn other Hispanic parents against perpetuating parenting practices that were potentially damaging to the parent-child relationship. Garza et al. noted the “intensity and passion” the parents displayed in endorsing CPRT, as well as their excitement in expressing their desire for other parents to share their experiences (p. 226). They also pointed out that the participants’ suggestion that teachers and church leaders encourage parents to attend the CPRT program is consistent with respeto, which is also reflected in the confidence they gained as the children became more respectful and less disobedient. Noting that Mexican Americans typically underutilize community services, they suggest building on parents’ perspectives and recommendations to expand involvement in CPRT. In addition to respected authority figures, the parents’ enthusiasm suggests that satisfied parents may be the best sources for recruiting their friends and neighbors into CPRT.
Supportive-Expressive Therapy—Parent Child. Supportive Expressive Therapy—Parent Child (SET-PC) is an innovative brief psychodynamic therapy for young children with disruptive behavior problems (Cummings & Wittenberg, 2008). Similar to CPRT, SET-PC includes videotaped play sessions between the parent and child combined with discussions between the parent and the therapist. However, SET-PC utilizes an individual rather than a group discussion format and has its roots in the psychodynamic concept of the transference. In its original version SET is used for adults and has documented effectiveness in treating depression. The theoretical basis for SET is that “distorted mental representations of the self and of significant others learned early in life endure and influence current interpersonal relationships” (p. 149). The client’s most persistent transference pattern forms the Core Conflictual Relationship Theme (CCRT) that encompasses all facets of relationships with others, including desires, goals, expected and perceived responses of others, and one’s own repeated responses. The parent’s CCRT is the focus of SET-PC, which directly addresses the parent’s goals for the parent-child relationship and the parent’s distorted representations of and counterproductive responses to the child. SET-PC is structured and manualized into a brief intervention including a formal assessment, a socialization interview, and 16 therapy sessions (Cummings & Wittenberg, 2008). During the assessment when the therapist formulates the parent’s CCRT the parent attends the sessions alone (2-3 sessions), the CCRT is discussed during the socialization interview to gain agreement between the parent and therapist that the CCRT appropriately explains the child’s behavior problem(s) and the therapy process is described and the dates planned for the 16 parent- child sessions. The videotaped play sessions are similar to those of other therapeutic modalities in that the videotapes provide the parent with opportunities for observational learning and reflection while the therapist offers appropriate interventions for enhancing the parent-child interactions.
Noting that there are no empirically based psychodynamic therapies for children with behavior disorders, Cummings and Wittenberg (2008) compared the efficacy SET-PC with the Webster-Stratton’s Incredible Years in a randomized controlled study completed by 37 parents with a child referred for externalizing behavior problems to an urban outpatient psychiatry clinic in Ontario. The Incredible Years was chosen for comparison because it was the intervention typically used at the clinic and the researchers felt it was unethical to randomize parents seeking help for their children to a no-treatment condition. The mean age of the children was 4 years and 2 months, and boys accounted for 61% of the children. The finds showed that SET-PC produced positive results that were equivalent to the Incredible Years on the three outcome criteria: the child’s externalizing behaviors, the relationship between the parent and child, and the parent’s psychological functioning. The positive benefits were sustained at the 1-year follow-up.
The effect size observed for SET-PC regarding reduction of the child’s problem behaviors compared favorably with the results reported by Beauchaine et al. (2005) for the Incredible Years, and the remission rate of 64% for the participants who adhered to SET-PC was comparable to the 66% remission rate reported for the Incredible Years (Cummings & Wittenberg, 2008). Among the families that began the study but did not fully complete the sessions, the remission rate was 41% for SET-PC and 56% for the Incredible Years. Cummings and Wittenberg acknowledged that despite the positive results, a substantial number of children remained in the clinical range, highlighting the importance of ongoing intervention for recalcitrant problem behaviors.
Both interventions resulted in substantial increases in positive parenting behaviors although neither one seemed to decrease negative parenting. According to Cummings and Wittenberg (2008), the effectiveness of both interventions appeared to center on the marked improvements in parent-child interactions that were apparent for families in both groups. The parents rated their children as significant more cooperative, enthusiastic, and happier after the intervention. The children’s positive mood and behaviors maintained over one year, accompanied by significant declines in problem behaviors. The positive emotions of the parents and children at the follow-up reflected the higher quality of their interactions. SET-PC and the Incredible Years work through entirely different mechanisms but are both effective. The favorable outcomes demonstrated by SET-PC suggest that the treatment offers a viable alternative to parents who prefer a more reflective, emotion oriented psychodynamic approach.
Conclusion
The ability to delay gratification was found to be a pivotal factor in the development of self-regulation, which in turn, is central to the development of social competence. In young children, power-based parenting inhibits the capacity to delay gratification (Houck & LeCuyer-Maus, 2004; LeCuyer & Houck, 2006). Harsh, critical, and punitive parenting practices are related to conduct problems in children and adolescents, which are recalcitrant in the absence of changes in parenting (Beauchaine et al., 2005; Fossum et al., 2009; Webster-Stratton et al., 2001). Conversely, positive changes in parenting result in significant decreases in children’s behavior problems that are sustained over time. While this review does not link ODD and delayed gratification causally, the over whelming research implication is that gratification issues are linked to the kinds of behavioral problems that are found in ODD generally, especially when that consideration if combined with research concerning parenting styles.
There is general agreement in the literature that an authoritative parenting style is the most effective for promoting children’s social and self-development. While the findings regarding parenting style do not conclusively link it to ODD, the research regarding both parenting styles and parenting stressors offer abundant theoretical support for the present study regarding a link between the two concepts. There does remain a question of whether the four parenting styles outlined by Baumrind can completely illuminate the parenting practices of Latino parents (Domenech Rodriguez et al., 2009; Gamble & Modry-Mandell, 2008; Livas-Dlott et al., 2010), but research into the influences of cultural values such as familism and personalismo on parents’ socialization practices and children’s behavior is a very recent endeavor and there are few studies in this line of research. There is, however, evidence that cultural awareness is essential to understanding the relationship between parenting practices and the social competence of Latino children, c supposition that lies at the heart of this study.
Intervention studies show that Mexican American and Puerto Rican parents favor therapeutic approaches that are aligned with cultural values that emphasize warm interpersonal relationships (Garza et al., 2009; McCabe & Yeh, 2009; Matos et al., 2006, 2009). For a more conventional therapeutic approach, the Incredible Years has a strong evidence based with diverse families (Reid et al., 2007). Families with children with ODD and other behavior problems have a number of highly supportive therapeutic options. What is needed, therefore, is a greater understanding of the effects of parenting practices in Latino families that shows the most effective way to facilitate the development of self-regulation for the purpose of primary prevention of childhood behavior problems. To that end, the research turns to a consideration of methodology in Chapter 3.
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