Office Management of the Oppositional Child

Abstract

Few things are more exasperating to the primary health care provider than the child who refuses to do anything and everything that he is told. Technically, to be diagnosed as oppositional, a child must be over three and under 18 with a least a 6-month history of disobedience, negativism, and provacative opposition to authority figures. The truly oppositional child has no trouble meeting and exceeding these criteria. While some parents will try very hard to convince themselves that “It’s a stage he’s going through,” few adults really believe that. An oppositional 3-year-old child may still have a number of behaviors that some adults will describe as “cute,” but, the word cute simply does not fit the older oppositional child. In practice, the parents’ reluctance to admit that their child is oppositional may prevent early diagnosis and delay treatment recommendations. For this reason, many primary providers have begun to ask parents to complete parent rating scales or inventories on their children. Two such inventories are the Conners’ Parent Symptom Questionnaire (Goyette et al, 1978) and the Eyberg Child Behavior Inventory (Robinson et al, 1980). Both are only one page in length and can be completed by the parent in a matter of minutes. Rather than compulsively score the answers and compare them to standardized names, most providers just scan the answers, mentally comparing them to the hundreds of completed forms that they have previously viewed.