29

CHAPTER II

LITERATURE REVIEW

This chapter contains review and interpretation of the empirical research on ODD,

its possible causes and treatments, parenting styles and behaviors, and the impact of

parenting styles on adolescents’ psychological and behavioral manifestations.

Oppositional Defiant Disorder

Oppositional Defiant Disorder (ODD) is a recurring pattern of defiant,

disobedient, negativistic, and hostile behavior toward authority figures that is clearly

more frequent, intense, and persistent across the child’s or adolescent’s development than

is typically observed in individuals of similar age and developmental level (APA, 2006;

Connor, 2002). DSM-IV-TR defines ODD as, “a pattern of negativistic, disobedient and

hostile behaviors towards authority figures that persists at least six months and is

characterized by frequent occurrence of at least four of the following behaviors: arguing

with adults, actively defying or refusing to comply with requests or rules of adults,

deliberately doing things that will annoy other people, blaming others for his or her own

mistakes or misbehavior, being touchy or easily annoyed by others, being angry or

resentful, or being spiteful and vindictive.”

WHO, (1992) defines ODD as a pattern of persistently negativistic, hostile,

defiant, provocative, and disruptive behavior, which is clearly outside the normal range

of behavior of a child of the same age in the same socio-cultural context, and which does

not include the more serious violations of the rights of others. Because the symptoms of

30

ODD are normal in children, the diagnosis is only given when symptoms are more

intense, more frequent, and cause more impairment than in children and adolescents of

comparable age. The onset of a clinically recognizable disorder is usually evident by 8

years of age (Connor, 2002).

Connor (2002) writes about ODD, “Associate features include low self-esteem,

mood lability, low frustration tolerance, swearing, and the possibility of early-onset

alcohol and substance experimentation and misuse.” Connor, (2002) also adds

“Adolescents’ ODD symptoms have been shown to be a distinct antecedent of adult

antisocial outcome.” These results likewise suggest that although ODD is not strongly

and directly related to aggressive behavior in youth, it may have important developmental

implications for the possibility of later aggressive outcomes for some, but not all,

children with ODD.

According to the American Psychiatric Association (APA, 1999), the prevalence

of ODD is 5-16 percent. It is more common in boys than girls in younger children but by

the time they reach adolescence, the rate is the same in boys and girls (APA, 1999).

According to Barkley et al., (2001), children with Attention Deficit Hyperactivity

Disorder (ADHD) are more difficult to differentiate from ODD than Conduct Disorder

(CD) especially since the majority of children with ODD have ADHD as a coexisting

condition. Due to commonality in behavioral symptomatology, it is important to know

that subjects are often included under a number of diagnoses other than ODD for research

purposes. Other terms used for ODD include Disruptive Behavior Disorder (DBD)

31

(APA, 2000), which includes ADHD, ODD, and CD; ADHD, with aggressive ODD

(Connor, 2000); and behaviorally disturbed.

Etiology of ODD

To explore appropriate treatment for any diagnosis, finding the risk factors could

provide insight into its treatment. These risk factors can be biological, individual, and

psychosocial. The following will present empirical research and theoretical frame works

on risk factors for ODD.

Biological Factors

1. Genetics

The evidence for genetic influence on Disruptive Behavior Disorder (DBD)

illustrates methodological issues that must be addressed through additional research

before conclusions may be drawn. Eaves et al. (2000), using clinical interview data from

a study of twins, with maternal, paternal, and child reports, found a high genetic

correlation, across gender, in liability for ODD and CD, which suggested a common

underlying condition. Pike et al. (1996) examined composites of parents’ and children’s

reports and observer ratings in a sample of same-sex sibling pairs in late childhood and

adolescence. They found evidence that genetic factors primarily explained the

association between familial negativity and adolescent antisocial behavior, although a

modest effect for siblings who did not share the same environment was also found. In a

study of preschool-age twins, Deater-Deckard (2000) considered data sources separately.

When observer ratings were used, no evidence of genetic effects were found, however the

32

effects of a shared environment mediated the correlations between parental and child

behaviors. Using parental ratings, however, revealed a significant genetic mediation

between parental and child behaviors. Finally, evidence suggests differential associations

between genetic factors and aggression versus environmental factors and nonaggressive

delinquency (Edelbrock et al., 1995), and between early criminal behaviors (primarily

environmental) versus adult criminal behavior (primarily genetic) (Lyons et al., 1995).

Future behavioral genetic research must more fully ascertain the influence of

different informants, developmental stages, and types of measurement in evaluating

genetic, compared with shared and non-shared environmental contributions to DBD and

its subtypes, and the distinction between aggressive and nonaggressive symptoms.

2. Neuroanatomy

The application of relatively new techniques to examine brain functioning has

clarified associations between certain neuroanatomical regions and elements of DBD, but

research in this area is still evolving. Frontal lobe functioning, including decreased

glucose metabolism, has been repeatedly associated with violence (Pliszka, 1999; Raine

et al., 1998; Volkow et al., 1995). Frontal lobe damage has also been associated with

aggression, especially orbitofrontal damage with impulsive aggression (Brower and

Price, 2001; Giancola, 1995). Furthermore, Golden and colleagues (1996) contrasted

frontal lobe and temporal lobe aggression in humans. The former is characterized by

clearer provocations to aggression and patterned aggressive responses, and the latter is

characterized as responding to minimal provocation and without premeditation (Golden

et al., 1996). Davidson et al., (2000) considered evidence indicating that impairments in

33

the function of the amygdala are associated with deficits in the interpretation of social

cues, such as facial expression, and that a connection between the amygdala and

prefrontal cortical regions serves to aid in the suppression of negative emotion. Baving et

al. (2000) hypothesized that atypical EEG-measured frontal lobe activation patterns in

children with ODD were a biological substrate of a negative affective style.

3. Neurotransmitters

During the past decade, increasing attention has been given to the study of

neurochemistry associated with DBD. In large part, the focus has been on the

relationship between aggression and different measures of the neurotransmitter serotonin.

Low levels of a serotonin metabolite (5-hydroxyindoleacetic acid) in cerebrospinal fluid

have been linked to concurrent and future aggression in children (Kruesi et al., 1990).

Blood serotonin is higher in boys with childhood- versus adolescent-onset CD and is

positively associated with violence in adolescence (Unis et al., 1997). In men, but not

women, blood serotonin in a general population sample of 21-year-olds was related to

past-year self-reported and lifetime court-recorded violence (Moffitt et al., 1998).

Prolactin levels, which index synaptic serotonin levels, are increased with the

administration of fenfluramine and appear to show developmental variation between

aggressive and nonaggressive children. Aggression (and maladaptive parent–child

interactions) among a sample of boys, at age 8 and again at 10, was positively correlated

with prolactin response to a fenfluramine challenge (Pine et al., 1997b). Other studies

support an age-related change in prolactin response and aggression (Halperin et al., 1997;

Pliszka, 1999) and find an inverse correlation between aggression and prolactin response

in adults (Coccaro et al., 1997).

34

The findings suggest that a reduction in the turnover of central serotonin is

associated with aggression and other aspects of DBD in children. However, serotonin

function is also linked to the regulation of mood and impulsive behavior (Davidson et al.,

2000), as well as to particular brain regions and other neurotransmitters (Pliszka, 1999).

Thus the link between serotonin and aggression likely reflects a more complex

relationship between neuroanatomical and neurochemical interconnectivity, executive

brain function, and behavioral deregulation. At present, no evidence is available to

suggest that the same relationship exists for nonaggressive DBD symptoms as exists

between aggression and serotonin. Pliszka (1999) called for research that combines

methods from several fields, measures serotonin and dopamine through multiple

indicators, and includes a sample large enough to address the effects of variables such as

gender, age, race, family environment, family history, and psychosocial stressors.

4. Other Neurochemicals

Research has also focused on the hormone cortisol and its relationship to

disruptive behaviors. Low salivary cortisol level is associated with ODD (van Goozen et

al., 1998) and both the early onset and persistence of aggression in a clinic sample of

boys (McBurnett et al., 2000). Vanyukov and colleagues (1993) reported that salivary

cortisol level was negatively associated with child CD. Furthermore, cortisol level was

lower among sons of fathers with a childhood history of CD than those without such a

history (Vanyukov et al., 1993). Testosterone has also been associated with aggression,

including the early onset of aggression (Pliszka, 1999). Relatively few studies of

neurochemistry have specifically examined diagnostic features of DBD. Studies of

35

aggression are a first step, but research using diagnostic categories will help to identify

their strengths and limitations.

5. Under arousal of the Autonomic Nervous System

Research continues to suggest that those with DBD experience general

physiological under arousal, including lowered heart rate (Pliszka, 1999). Lower heart

rate is associated with adolescent antisocial behavior (Mezzacappa et al., 1997) and is

predictive of later criminality (Raine et al., 1990) and desistance from violence (Raine et

al., 1995). Lower levels of baseline heart rate are found in boys with ODD versus

controls, while experimentally induced frustration is associated with higher heart rate

levels among boys with ODD versus controls (van Goozen et al., 1998). There is

evidence that an association between low heart rate and CD, and between higher heart

rate and anxiety, also applies for girls (Rogeness et al., 1990). Lower skin conductance

has been associated with disruptive boys (Harden et al., 1995), whereas higher skin

conductance is found among those who desist from violence (Raine et al., 1995) or avoid

criminality despite a history of paternal criminality (Brennan et al., 1997). These

measures may be markers of anxiety, which is hypothesized to inhibit children from

engaging in disruptive or criminal behavior.

6. Prenatal and Perinatal Problems

Maternal smoking during pregnancy has been found to predict CD in boys

(Wakschlag et al., 1997), including an onset before puberty (Weissman et al., 1999).

Parent substance abuse has been linked to DBD in offspring (Frick et al., 1992; Stanger et

al., 1999). Pregnancy and birth complications have also been shown to be associated

36

with the development of behavior problems in offspring (Hack et al., 1992; Raine et al.,

1997). However, low birth weight may be linked to ADHD rather than ODD (Breslau et

al., 1996), an association that may be mediated by intellectual and neuromotor delays

associated with prematurity (Nadeau et al., 2001).

7. Neurotoxins

Environmental toxins, such as lead, are among the most preventable DBD risk

factors. High levels of lead in bones of children at age 11 are associated with greater

parent and teacher ratings of aggressiveness, higher delinquency scores, and greater

somatic complaints (Needleman et al., 1996). Bone lead levels measured at ages 6 to 8

predict cognitive performance, inattention, and restlessness at ages 12 and 13 (Fergusson

et al., 1993). Furthermore, Lanphear et al. (1996) concluded that racial differences in the

blood lead levels of urban children are due to differences in housing conditions and

environmental exposure. There is a present need to investigate which other neurotoxins

are likely to affect DBD.

The literature on child biological risk factors for DBD has been largely focused

on aggression and violence. Evidence exists of the contributions of genetic factors to

DBD, as well as the contributions of prenatal or early developmental exposure to toxins,

other prenatal problems, and physical damage to brain structures. Alterations in

functioning evidenced by atypical glucose metabolism, EEG measures, levels of

neurochemicals, and underarousal are also linked to DBD features. However, no

empirical evidence incorporating these varied biological factors is known; thus,

etiological explanation based on these factors remains hypothetical.

37

Individual Factors

1. Temperament and Personality as Potential Factors in the Development of

ODD

The development of disruptive behavior in children and adolescents is examined

from the perspective of Hans Eysenck’s biosocial theory of personality (Kemp & Center,

2003). The findings of this theory have been supported by many large-scale studies

across cultures worldwide. The theory views personality as a product of the interaction

of temperament, which is a biologically based trait, and socialization experiences. The

theory is sometimes called the three-factor model in which the three factors are

extroversion, neuroticism and psychoticism. The extroversion is hypothesized to be

dependent upon the baseline arousal level in an individual’s neocortex and mediated

through the ascending reticular activating system (Kemp & Center, 2003). Eysenck

found that the neuroticism is dependent upon the individual’s emotional arousability due

to differences in ease of visceral brain activation, which is mediated by the hypothalamus

and limbic system (Kemp & Center, 2003). The third factor, the psychoticism, is said to

be a polygenic trait in that it is determined by a large number of genes each of whose

individual effect is small. Eysenck found that the influence of these ‘small effect’ genes

is additive, so that the total number inherited determines the degree of the psychoticism

trait in the personality (Kemp & Center, 2003). Lykken cited in Kemp & Center (2003)

discussed three different temperament genotypes and their relationship to socialization.

The first genotype is rare. Children with this genotype often achieve good socialization

even with socially inadequate parents. The second genotype is the average genotype.

Children with this genotype require parents of at least average competence for good

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socialization. The third genotype is the hard-to-socialize genotype. Children with this

genotype are more prone to develop antisocial and aggressive behavior than other

children. Such children need highly competent parents to attain adequate socialization

and even with such parents, factors such as poor neighborhood conditions and peer

influences may play important roles in the development of antisocial behavior (Kemp &

Center, 2003).

2. Intelligence and Academic Performance

Low intelligence is often considered a precursor to DBD, yet a review by Hogan

(1999) suggested that this conclusion might be premature. Of 27 studies that reported a

positive association between CD and IQ, 80% of them failed to control for ADHD.

When ADHD was controlled, the CD–IQ relationship was often reduced to non-

significance (Hogan, 1999). Further confounding the issue, IQ appears to be related to

low achievement and school failure, which are related to later antisocial behavior

(Farrington, 1995; Frick et al., 1991).

Psychosocial Factors

1. Parenting

Numerous studies show that poor parenting is related to disruptive behavior (e.g.,

Frick et al., 1992; Haapasalo and Tremblay, 1994), while favorable parenting behaviors

may be protective (McCord, 1991). Several aspects of childrearing practices, such as

degree of involvement, parent–child conflict management, monitoring, and harsh and

inconsistent discipline, have been correlated with children’s disruptive or delinquent

39

behavior (Frick, 1994). Stormshak and colleagues (2000) found that positive and

negative parenting behaviors were relatively independent of one another and that punitive

discipline by parents was a common risk factor among children with oppositional,

aggressive, hyperactive, and internalizing behaviors. Specificity between parenting and

child behaviors was found in links between physically aggressive punishment and child

aggression, and low parental warmth/involvement and oppositional child behavior

(Stormshak et al., 2000). It is clear that the relationship between parenting behavior and

child conduct problems is a dynamic and reciprocal one. Patterson and colleagues’

(Snyder and Patterson, 1995; Stoolmiller et al., 1997) model of coercion between child

and parent illustrates how child behavior might modify parenting behaviors in

maladaptive ways (Deater-Deckard, 2000). Wootton and colleagues (1997) found that

the effect of ineffective parenting on child behavior held only for children with high

levels of callous and unemotional traits.

Much of the research has been done on boys, however. Parents interact

differently with boys and girls, especially with regard to the development of conduct

problems (Keenan and Shaw, 1995). Differential treatment between siblings by parents,

particularly regarding parental negativity, influences disruptive behavior (Pike et al.,

1996). The assessment of conflict in the context of the dynamic structure of the family

(e.g., mother–daughter dyads, intersibling differences in parental behavior) may be

particularly important for girls at risk for externalizing disorders (Deater-Deckard and

Dodge, 1997; Webster-Stratton, 1996). Coercive parenting behaviors appear to lead to

aggressive behaviors in younger girls as well as boys (Eddy et al., 2001).

40

The past 10 years have seen an increase in the complexity of models of child–

parent interactions and recognition of the importance of considering the full configuration

of parenting behaviors and contextual and genetic factors together in any effort to

describe the relationships among parenting and child behaviors. Frick’s review (1994)

highlighted the need for comprehensive models that include both risk and protective

factors to explain the relationship between parenting and child conduct problems.

2. Peer Effects

Several aspects of peer relationships work to influence the development and

maintenance of CD symptoms. One potential process is that peers both reject an

individual demonstrating CD (Coie and Miller-Johnson, 2001) and reinforce pushy and

demanding behaviors through acquiescence. In addition, affiliation with like peers

further fixes the behavior and social role of the child with CD (Coie and Miller-Johnson,

2001). Peer influence likely differs at different developmental stages as well.

Adolescents spend one third of their time talking with peers (compared with 8% of their

time talking with adults), experience an increase in conflicts with parents, and

demonstrate greater conformity with peers engaging in antisocial behaviors (Spear,

2000).

3. Peer Rejection

The stability of peer rejection in children identified as having conduct problems is

significant (Coie and Dodge, 1998; Coie and Lenox, 1994) and related to aggressive

responding (Dodge et al., 1990), whereas peer rejection within a nonreferred community

sample showed little consistency and little relation to aggression (Dumas et al., 1996).

41

Furthermore, chronically maltreated children are more likely to be aggressive and to be

rejected by peers (Bolger and Patterson, 2001). However, the combination of peer

rejection and aggression was found to predict serious delinquency in boys, while only

aggression predicted serious delinquency in girls (Miller-Johnson et al., 1999).

4. Association with deviant peers.

Association with deviant peers appears to lead to the initiation of delinquent

behavior in boys (Keenan et al., 1995; Simons et al., 1996). Exposure to delinquent peers

may enhance preexisting delinquency (Coie and Miller-Johnson, 2001), but early-starting

compared with late-starting delinquents may be less influenced by deviant peer affiliation

(Simons et al., 1996). Finally, interactions with CD peers in treatment groups with boys

and girls have been shown to potentially result in iatrogenic effects for youths with CD

(Dishion et al., 1999).

5. Life stressors and coping skills

Exposure to daily stressors may add to the risk for DBD in children and can be

exacerbated by life circumstances caused by their own DBD. Stressful life events were

the strongest proximal influence on child behavior problems in a study of 9- to 16-year-

olds (Mathijssen et al., 1999). In late adolescence, youths with CD, compared with

youths who do not have CD, reported experiencing greater stress and engaging in more

maladaptive coping strategies (Hastings et al., 1996). Girls with CD, compared with

boys with CD, reported more daily stress, higher levels of emotion-focused coping, fewer

active coping strategies, and a higher frequency of self-harm (Hastings et al., 1996). One

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stressor in particular, family disruption, was a risk factor for externalizing problems in

girls but not boys (Lee et al., 1994).

Treatments for ODD

There are many different types of interventions that have been used in treating

children and adolescents with ODD. A few current treatment interventions that have been

empirically evaluated in treating ODD are presented below. Treatments include

medication management, individual therapy, group therapy, and parent/family therapy or

training.

1. Medications

Pharmacotherapeutic interventions for ODD are not well studied, but several

agents have received support in open-label and double-blind placebo- controlled studies

of disruptive behavior (CD or ODD) in the context of other principal diagnoses (Connor,

2002; Pappadopulos et al., 2006; Schur et al., 2003; Steiner , 2004). Medications, such as

stimulants and atomoxetine, used to treat ODD in the context of other principal diagnoses

such as ADHD, may result in improvement of the oppositional behavior as well (Connor

et al., 2008). According to Steiner (2004), at this point, medications for youth with ODD

are mostly considered to be adjunctive, palliative, and noncurative and that medication

should not be the sole intervention in ODD.

An international consensus statement on ADHD and disruptive behavior disorders

(comprising ODD, conduct disorder, and disruptive behavior not otherwise specified)

says that psychopharmacologic treatment would not be appropriate for cases of ODD in

43

the absence of psychiatric comorbidity, unless severe aggression or destructive behavior

persisted despite attempts at psychosocial interventions of established efficacy (Kutcher

S. et al., 2004).

2. Individual Psychotherapy/Counseling

By and large, isolated individual treatment of DBD has not been proven to be a

superior form of treatment. Brestan and Eyberg’s (1998) review found only modest

support for individual treatment compared with more effective parent-training programs,

but characterized interventions in anger control/stress inoculation, assertiveness training,

and rational-emotive therapy as "probably efficacious." Other studies have found child

focused problem-solving skills training programs (Kazdin, 1996; Webster-Stratton and

Hammond, 1997). Individual interventions may be most effective as a component of a

broader treatment program addressing a variety of risk domains.

3. Group Counseling

There is evidence that some forms of group treatment can have significant

negative effects on outcomes, especially among deviant youth (Dishion et al., 1999).

Including normal peers in community- based groups treating delinquent boys can

shape some prosocial peers to become more antisocial. Punitive treatments like ‘ boot

camps’ and ‘behavioral modification schools’ which restrict contact with parents, and

place the child amongst other disturbed children can do more harm than good

(National Institute of Health, 2006).

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4. Parent and Family Treatment

There is evidence from randomized trials that suggests that parent management

training (PMT) strategies are "well-established," and among the most effective in the

treatment of DBD (Brestan and Eyberg, 1998). In a randomized, controlled study of

young children with DBD, Webster-Stratton and Hammond (1997) found the

combination of parent and child training to be superior to either component alone and to a

control condition. The effects were maintained at 1-year follow-up and were associated

with component-specific changes in parent behaviors and child behaviors.

Parent child interaction training (PCIT) has been demonstrated to result in

clinically significant improvement in children with ODD in controlled studies with

randomized assignment (Schuhmann et al., 1998). PCIT uses two phases of training:

child-directed interaction, in which parents are trained in nondirective play skills to alter

the quality of parent–child interactions, and parent-directed interaction, which focuses on

improving parenting skills by teaching parents to give clear instructions, praise for

compliance, and time-out for noncompliance. Training includes the coaching of parents

in the use of appropriate parenting behavior from an observation room, via a "bug-in-the-

ear" receiver. Because of its use of naturalistic play settings, PCIT is most beneficial for

younger children. In a study of PMT versus family-oriented problem-solving

communication training, Barkley and colleagues (2001) found that while both

interventions were associated with significant overall improvement, problem-solving

communication training, when provided by itself, was associated with a significantly

higher dropout rate than treatment that involved PMT. Finally, parent psychopathology,

expectations regarding treatment and family stressors are predictive of retention in and

45

success of treatment (Borduin, 1999; Chamberlain and Moore, 1998; Kazdin, 1995).

Corresponding improvement in parent and family functioning has been found with child

improvement after PMT and problem-solving treatment in children with DBD (Kazdin

and Wassell, 2000).

Of all the treatment for maladaptive behavior, Parents’ behavior Management

training (PMT) has been the most researched (Connor, 2002) and has the most empirical

support for its effectiveness (Kazdin, 1997). In PMT parents are trained to interact

differently with their children to promote pro-social rather than coercive behavior within

a family and they are trained to alter their child’s behavior at home. Kazdin (1997, p.

1349) states the procedures “are based on social learning principles that are used to

develop positive, prosocial behaviors and to decrease deviant behaviors.” Treatment is

conducted with the parent or parents, who immediately implement the new procedures in

the home. Parents are helped to refocus their attention from maladaptive behavior to a

pro-social goal. This process had been found to soften rigid patterns and pave the way

for more productive problem solving skills to practice and to refine the use of the

procedures through extensive role-playing. Friedberg and McClure (2002) warned that

attention must not only be paid to what parents say during sessions but to how they say it.

The non-verbal communication, such as body posture and facial expressions, should be

watched as "disingenuous commands sabotage PMT effectiveness" (Friedberg &

McClure, 2002, p. 272). The use of positive reinforcement and punishment to extinguish

deviant behavior are also practiced. Friedberg & McClure reported that equipping

parents with such skills has many advantages. It helps to decrease the parents' all-or-

none thinking. This is so because as parents try to catch the child when he/ she is on his/

46

her better behavior, parents are shifting their attention set. Such skills help to shape the

behavior of a conduct-disordered child. They also replace ineffective methods being

used within the family such as the overuse of punishment techniques, coercion and

calling of insulting names, to which the child is unlikely to listen. The therapist may use

video-based lecture demonstrations and manuals. Usually only one parent is directly

involved in PMT programs. The duration of treatment varies according to the severity of

the child dysfunction. Kazdin (2000) states the treatment for adolescents’ ranges from 10

to 25 weeks, one hour per week depending on the severity of the problem.

The effects of PMT have led to the marked improvement of children's deviant

behavior on a wide range. Positive reports on the behavior of children have been

received from parents, teachers and institutions such as prisons. Through PMT conduct

problem behaviors have been changed to be within non-clinical levels of functioning at

home and at school and treatment gains have been maintained to one to three years. Long

et al. cited in Kazdin (1995) reported treatment gains that lasted for 10 to 14 years later.

Kazdin further found that the impact of PMT is relatively broad. It led to the

improvement in the behavior of the siblings of children referred for treatment. In

addition, maternal psychopathology, particularly depression, has been observed to

decrease systematically following PMT (Kazdin, 1995). The PMT effectiveness depends

on the various family, child, therapist and treatment characteristics (Kazdin, 2000).

Socio-economic disadvantage, marital discord, parent psychopathology and poor social

support tend to be associated with fewer gains in treatment and poorer maintain of gains.

Among the child characteristics, more severe and chronic antisocial behavior as well as

comorbidity predict reduced response to treatment (Hubble et al., 1999). Kazdin (2000)

47

found that there is some evidence that therapist's training skills are associated with the

magnitude and durability of therapeutic changes.

There is a magnitude of study supporting PMT and also various parenting styles

have been identified as contributors to adolescent problem behaviors. Such studies have

been contributing factors in choosing this research to examine the relationship between

parenting styles in India and adolescent’s ODD and to explore the impact of parent

emotional intelligence training on ODD behavior. It is only appropriate to extend

literature review on parenting styles and their contributing factors on adolescents’

psychological and behavioral outcomes. In addition, the significance of the perception of

parental behavior is discussed.

Parenting Styles

Parental behavior that contribute to parenting style is a complex activity that

includes many specific behaviors that work individually and together to influence a

child’s outcomes. Evidence has found that practicing one parenting style over another

can influence a child’s personality, and also physical and psychological development

(Forhand, R., & Nousiainen, S. 1993).

Development of Dimensions of parenting styles

One of the first attempts in creating parenting styles was Schafer’s (1959) factor

analytic study of maternal behavior. His maternal behavior model presented two

behavior factors, love vs. hostility (parental support and autonomy vs. parental control).

His model helped to summarize nearly two decades of research on parenting styles.

48

Following Schafer’s model, Becker (1964) generated a three dimensional model

that subdivided Schafer’s autonomy vs. control dimensions into restrictiveness vs.

permissiveness and anxious-emotional involvement vs. calm-detachment. Becker

explicitly identified the relationship between parenting style and the behavior of children.

For example he found that behavioral inhibition in children correlated with parents’

restrictiveness while aggressiveness in children correlated with the parents’

permissiveness.

In 1967, Diane Baumrind developed one of the best known theories of parenting

style. Baumrind identified three major styles of parenting: Authoritative, Authoritarian,

and Permissive. Later McCoy and Martin (1983) came up with a fourth one called

Uninvolved or Neglectful parenting style. This style also includes rejecting-neglecting.

Baumrind (1967) stresses that authoritative parents are demanding and responding as

well as in control, flexible, warm and moderately strict. These parents allow their

children to express themselves, they are ready to hear their children while they offer them

guidance and directions. Studies done by Baumrind (1971, 1991) suggest that children of

authoritative parents are rated by objective measures to have lower internal distress, are

more competent and less deviant than children from parents who practice other parenting

styles.

According to Baumrind (1971, 1991), authoritarian parents expect their children

to obey them. They have strict rules and punishment and lack flexibility. These parents

do not allow their children to express their own opinions and they are so demanding that

they are unresponsive when children refuse to obey them. The children from

authoritarian parents tend to be unhappy, anxious and withdrawn. Study shows that

49

demandingness appears to be less critical for girls than boys’ well being (Weiss &

Schwartz, 1996).

Permissive parents allow excessive freedom; they do not set boundaries and

control (Buri, 1991). Baumrind (1971, 1991) found that the children of Permissive

parents are less involved in school learning, are more disobedient, have behavioral

problems and are rebellious. Parents implementing uninvolved/neglectful parenting

which also include rejecting-neglecting are not responsive or demanding. They do not

care what their children are doing or where they are. These parents are lacking parental

warmth, empathy, and support (McCoy & Martin, 1983).

Frequently, parental rejection has been observed to have a strong association with

the development of problem behaviors in adolescence. Rohner (1986) argued that while

some rejecting parents are merely indifferent to their children, others adopt a harsh and

aggressive parenting style, which is thought to contribute to adolescents' psychological

problems in general and to aggressive behaviors in particular. Consistent with this

contention, many researchers report that parental hostility is significantly related to the

occurrence of internalizing problems in adolescence such as low self-esteem, withdrawal,

and depression. For example, in a study of adolescent depression, Robertson and Simons

(1989) found that parental rejection directly affected adolescent depression. Simons et al.

(1989) also found that adolescents with rejecting parents, compared to those with warm

and accepting parents, are more likely to suffer from low self-esteem and other

psychological problems. Similar to the findings of these researchers, Maccoby and

Martin (1983) noted that parental rejection is related to withdrawal and a passive coping

style in adolescence.

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In addition to being related to internalizing problems, parental rejection has also

been found to be significantly linked to externalizing problem behaviors in adolescents

such as aggression, substance abuse, and juvenile delinquency. For example, in a study

comparing substance abusers and nonusers, Campo and Rohner (1991) found that the

perception of parental rejection was significantly higher among substance abusers.

Rohner, R.P. & Khalegue, A (2002) stress that over 2000 research results in different

parts of the world have indicated that no matter where the children come form or what

ethnic backgrounds they have, they all need to feel loved, accepted, appreciated, valued,

and wanted by their parents or their caregivers. When those children are rejected or when

those needs are not met, children worldwide, regardless of their culture, age, or gender

tend to report themselves to be depressed, hostile, defiant, aggressive, having low self-

esteem, being emotionally unresponsive and unstable and having a negative world view

and experiencing delinquency (Al- Falaij, 1991) from Bahrain; (Chen, Rubin, & Lee,

1997) from China; (Saxena, 1992) from India; (Salama, 1990) from Egypt.

The research on parenting styles mostly has viewed parental control as a single

dimension that ranges from excessive control to insufficient control, but research that

began in the late 1980s has focused on distinguishing among different forms of parental

control. The primarily distinctions are between psychological control and behavioral

control. Psychological control was differentiated from behavioral control in 1965 by

Schaefer. However the construct was not studied regularly until Parental Psychological

control was distinguished from parental behavioral control (Steinberg, Elmen, &mounts,

1989). Parental psychological control refers to parental behavior that includes use of

power and pressure, guilt or shame induction, and love withdrawal (Schafer, 1965,

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Barber, 1996), or creating an environment in which love and positive regards is

contingent on child’s behavior (Silk, et al, 2003). Many researchers view parental

autonomy support the opposite end of the same continuum, as if the low level of

autonomy support automatically involve high level of psychological control and vice-

versa (Schafer, 1965; Steinberg, 1990, 2001).

According to Barber (1996), psychological control has been consistently

associated with depression, low self-esteem, guilt, aggression, and social withdrawal in

children. Silk et al, (2003) stress that psychological control interferes with children’s

psychological and emotional development. Psychological control involves attempts to

impede child's psychological and emotional development (e.g., cognitive processes,

emotions, and attachments), which threatens the emergence of psychological autonomy

and independence (Barber, 1996; Pettit et al., 2001; Steinberg, 1990). High levels of

psychological control are associated with a negative parent-child relationship (Barber &

Harmon, 2002). The parent-child interaction consists of manipulation of their

relationship through love-withdrawal and guilt induction, intrusiveness, negative

expressions, criticisms, and excessive protectiveness (Barber, 1996; Barber & Harmon,

2002). This construct definition corresponds with what is known in the anxiety literature,

which suggests that anxious households have more intrusive and restrictive parents

(Hudson & Rapee, 2001; Krohne & Hock, 2000; Last & Strauss, 1990; Parker, 1993).

More research has demonstrated that internalizing problems are a result of psychological

control (Barber et al., 1994; Barber & Shagle, 1992; Fauber, Forehand, Thomas, &

Wierson, 1990; Stone, Buehler, & Barber, 2002, Olsen et al. 2002)). There are similar,

but less consistent, findings on the role of psychological control on externalizing

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problems, which may suggest that this relationship is more contingent on other aspects of

the environment (Barber & Harmon, 2002; Olsen et al., 2002). Psychological control has

also been correlated with passive, inhibited, and over controlled characteristics (Beavers,

1982), social withdrawal (Baumrind & Black, 1967), depressed affect (Barber, 1996;

Barber & Olsen, 1997), and low self-esteem (maternal but not paternal control; Litovsky

& Dusek, 1985). In regards to child gender, Barber, Bean, and Erickson (2002) noted in

their review that out of fifteen studies, eight found higher levels for boys, two studies

found higher levels reported for girls, and five found no significant child gender

differences.

An abundance of support exists in the literature for the notion that problem

behaviors should correspond with adolescent’s report of parental behavior because the

adolescents’ perception of their parents’ behavior is what will guide their behavior not

the actual behavior. Schafer (1965) asserts that a child’s perception of his parent’s

behavior may be more related to his adjustment than is the actual behavior of his parents.

Review of literature by Gecas & Seff (1990) found that the development of self and

identity in adolescents was related to parental behavior but this correlation was stronger

when it was based on the adolescents’ perception of parental behavior.

US National Institute of Health (2006), states that appropriate behavior should be

modeled by parents in the household. The statement is an influencing factor in choosing

this study of training parents on Emotional Intelligence skills, which promotes pro-social

behavior, in order for adolescents to learn pro-social behavior from their parents.

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Emotional Intelligence (El) Theory and Practice

Seymour Epstein (1998) stresses that individuals have two minds: The rational

mind and the experiential mind. Each mind has its own form of intelligence. The

rational mind could be measured through IQ tests. The experiential mind of constructive

thinking provided the key to an understanding of emotional intelligence. Emotionally

intelligent individuals possess skills that allow them to adjust to their surroundings and

adapt to new situations (Sterberg, 1995). Emotional intelligence is knowing what one’s

feelings are and using that knowledge to make good decisions. It is also the ability to

maintain hope and an optimistic outlook in the face of disappointments and difficulties

(Goleman, 1995).

Emotional intelligence became popularized in 1995 by Daniel Goleman through

his bestselling book, (Emotional Intelligence: Why it can matter more than IQ). However

emotional intelligence characteristics and traits have been noted and discussed as early as

2000 years ago when Pluto wrote, “all learning has an emotional base.” Thorndike

(1920) defined social intelligence as “the ability to understand and manage men and

women, boys and girls… to act wisely in human relations.”

Many theories have been developed since the popularization of EI by Goleman

but the four that have been more popular in terms of research and application are the

theories of Mayor and Salovey (1997), Goleman (1998:200) and Bar-On (1997) and six

seconds (1997).

Emerling, Goleman (2003) state, “ while each theory represents a unique set of

constructs that represent the theoretical orientation and constructs in which each of these

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authors have decided to frame their theory, all share a common desire to understand and

measure the abilities and traits related to recognizing and regulating emotions in

ourselves and others.”

A review of the literature suggested that EI and related, non-traditional measures

of intelligence and performance were better indicators of success than were traditional IQ

test and other standardized measures of academic ability and achievement (Astin &

Astin, 1993; Bar-On, 2000; Bar-On & Parker, 2000; Bergin & Garfield, 1994; Bernet,

1996; Betts & Kercher, 1999; Boyatzis, Goleman, & Rhee, 2000; Buzan, 1995; Callicott,

1998; Campbell, 1997; Cooper & Saway, 1997; Dryden & Voss, 1994; Epstein, 1979,

1998, 2001; Gardner, 1983, 1993, 1997; Gardner, Mayer, & Sternberg, 1997; Goleman,

1995, 1998; Goldstein, 1968; Lazarus, 1970; Lazarus, Averill, & Opton, 1970; Nelson &

Low, 1979-2003; Perkins, 1995; Robbins & Camburn, 1999; Sternberg, 1985, 1995;

Stottlemyer, 2003; Townsend & Gephardt, 1997; Walker, 1982; & Weisenger, 1985,

1998). Research suggested that both the cognitive and emotional domains of students'

academic growth should be equally important goals in educating at-risk students (Coil,

1994 & 1999; Costa & McCrae, 1992; Damasio, 1994; Deatley, 1986; Ferrett, 1994;

Gerler, Kinney, & Anderson, 1985; McKay & Fanning, 1991; & Pope, 1981). EI has

been shown to be a key factor in successfully reaching at-risk students (Nelson & Low,

2003a).

Can EI be developed?

New findings in the field of affective neuroscience have begun to demonstrate

that the brain circuitry of emotion exhibits a fair degree of plasticity, even in adulthood

55

(Davidson, Jackson, & Kalin, 2000). Research on animals, for long, has established that

the prefrontal cortex, amygdale, and hippocampus are all located where plasticity is

known to occur; however it has only recently been demonstrated that such plastic

changes can occur in the adult human hippocampus as well (Erikson et a., 1998 as cited

in Davidson, Jackson & Klin, 2000). According to LeDoux (1996), although there are

stable individual differences in activation patterns in the central circuitry of emotion,

there is also pronounced plasticity. All the above findings suggest that EI could be

developed considering the plasticity of the emotional region of the brain but there are

those who are skeptical about whether or not EI could be developed. McCrae (2000)

states, “We know a great deal about the origins of personality traits. Traits are influenced

by genes (Reimann, Anglithner, & Stelau, 1997) and are extraordinarily persistent in

adulthood (Costa &McCrae, 1997). Many researchers believe that social and emotional

experiences of individuals can influence genetics (Meaney, 2001). Bar-On (2001) has

found older executives score higher on his scale of EI, postulating that EI may be learned

through life experiences. Many findings in the field of psychotherapy (Hubble et al…,

1999), cognitive behavior therapy (Barlow, 1985), and training programs (Marrow,

Jarret, Rupinski, 1997) have shown improvement in people’s behavior, self image,

relationships, and emotional competencies with motivation, commitment and a

systematic program. A longitudinal study at Weatherhead School of Management of

Case Western Reserve University has shown that people can change on EI competencies

(Boyatziz, Cowan, & Kolb, 1995). The students in this study participated in a required

course on competence building while being MBA students. The results of the study has

shown that emotional intelligence competencies can be significantly improved and that

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the improvements are long lasting (Boyatzis, 2000). EI could be developed and the

development of social and emotional competencies takes commitment and sustained

effort over time (Cherniss & Adler, 2000; Cherniss & Goleman, et al., 1998; Goleman,

Boyatzis & Mckee, 2002).