Canadian and Finnish prevalence estimates suggest that about 9 or 10% of children meet diagnostic criteria for Oppositional Defiant Disorder (ODD). The disorder begins early and is characterized by a pattern of hostile, irritable, uncooperative behaviour, inability to follow rules, and a pattern of conflict with parents and authority figures. It is among the most common, persistent, and costly early childhood psychiatric disorders. Moreover, many children with ODD symptoms never receive proper diagnosis and treatment. Both children diagnosed with ODD and those with the hallmark behaviours are unlikely to receive treatment that will prevent the escalation of problematic interactions that leads to a spectrum of negative outcomes for the child, the family, and society. When ODD emerges in the preschool years, the persistence of the problem and the costs at all levels are amplified. Left untreated, early onset ODD often leads to Conduct Disorder. The societal savings have been estimated to be approximately $1.5 million for each case of Conduct Disorder that is prevented.
Parents of children with ODD have a punitive and negative parenting style, more stress, less confidence in their parenting skills, more family conflict, and more symptoms of depression. An intervention designed to reduce oppositional problems by improving parenting skills is the focus of this project. Parent training has been shown effective in ODD but most trials are of short duration or not replicated. Few trials have been performed in a European society or in Canada. No intervention has been a population sample and the long term effects of treatment are not well understood. Importantly, no intervention has used the power of interactive web technology to provide personalized intervention that could be cost beneficial and sustainable in a public health system.
Although the burden associated with ODD is significant and ODD can be treated, Finnish and Canadian health utilization studies indicate that, as in other countries, about 80% do not receive specialist care. Logistical barriers prevent many, often those at greatest risk, e.g. isolated and poor families, from using services.
In summary, ODD is common, the impact is large, there are treatments that work. However there is no system of care to insure that every child at high risk of or with ODD gets the best evidence-based, family-oriented intervention. Team Finland-Canada has the experience and expertise to develop, implement and evaluate such a system.