View metadata, citation and similar papers at core.ac.
uk brought to you by CORE
provided by Jefferson Digital Commons
Jefferson Journal of Psychiatry
Volume 14 | Issue 1 Article 8
January 1998
Defiant Children: A Clinician's Manual for
Assessment and Parent Training by Russell A.
Barkley, M.D.
Stephen Zerby M.D.
Follow this and additional works at: https://jdc.jefferson.edu/jeffjpsychiatry
Part of the Psychiatry Commons
Let us know how access to this document benefits you
Recommended Citation
Zerby, Stephen M.D. (1998) "Defiant Children: A Clinician's Manual for Assessment and Parent Training by Russell A. Barkley, M.D.,"
Jefferson Journal of Psychiatry: Vol. 14 : Iss. 1 , Article 8.
DOI: https://doi.org/10.29046/JJP.014.1.007
Available at: https://jdc.jefferson.edu/jeffjpsychiatry/vol14/iss1/8
This Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of Thomas
Jefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarly
publications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers and
interested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship. This article has been accepted for inclusion in
Jefferson Journal of Psychiatry by an authorized administrator of the Jefferson Digital Commons. For more information, please contact:
[email protected].
Book Review
Defiant Children
Defiant C hildre n:
A Clinician 's Manual for Assessment a nd Pa rent Training
by Russell A. Barkl ey, M.D .
Seco nd Edition
New York : The Guilford Pr ess, 1997
Stephen Zerby, M.D.
Defiant Children, by Russell A. Barkley, is th e culm ination of 20 years of clinica l
expe rie nce and is a n effort to form aliz e a se ries of procedu res for t rai ni ng pa rent s in
child management skills. Dr. Barkl ey has co nside ra ble ex pe rie nce in teachi ng m ent al
health profes sionals and was e nco u raged by th ese expe rie nces to d evelop a manual of
his techniques. This is th e second ed ition of his manual wit h improvem ents in
addi tiona l referen ces, assess me n t tools, a nd training se ssions. Th e program devel-
oped ou t of a n olde r " two-stage" mod el whi ch focused first on tcaching parents to
a tte nd positively to th eir ch ild re n a nd ignore in app ropriat e behavior and sec ond ly,
th e imm edi at e use of tim e ou t. Th ese principl es form t he core of Ba rkl cy's progr am
a nd he has both expa nd ed on th e use of th ese pr oced ures and add ed additiona l
principl es a nd exe rcises . The progr am cons ists of a n eva lua tion period and a training
pe riod. Th e training pe riod cons ists of ten seq ue nt ia l steps which include bot h
in-session training of parents as well as handout s on th e use of t hc met hod s a t home
with hom ework assi gnm ents give n for th e parents to co m ple te. Th e target popula tion
for th e program is " de fia n t or beh avior probl em childre n" up to th e age of 12 yea rs.
Barkley provid es a wealth of d et ail ed forms whi ch includ e st r uct u red inte rviews,
beh avior rating scal es, qu estionnaires, and self-r eport forms, a ll of whi ch are to be
used during t he evaluation stage. Ext ensive in structi on s a rc includ ed for a ll form s,
incl ud ing a set of informat ion shee ts for parental ed uca tion a bout th e child's
evalua tion. Thes e are intended to be free ly photocopi ed a nd di sp en sed. T he seco nd
se t of handouts is for use in conj unc tion with th e training manual an d on e ha ndou t is
provided for each of th e tcn ste ps. At eac h st ep th e cor res po nd ing ha ndout is to be
di stribut ed a nd di scu ssed in det ail with th e parent s. Th e ha nd outs th ems elves are
very com ple te a nd oftc n givc useful and clevcr advi ce. For exa m ple, suggestions givc n
for giving positive feedback and a pproval to th e child incl ud e ac tions such as giving a
wink a nd com men ts like " I a m very proud of you wh en you .. . ." T hes e exa m ples are
ve ry clear, concise, a nd ca n be ve ry helpful to paren ts to hel p gct th em sta rte d in
43
J EFFERSO l'\ J O UR 'A I. OF PSYCHI AT RY
practi cin g a new, more positive approach to d ealing with th ei r child. H oweve r, th e
handouts do t end to be rath er lon g and wordy and m ay prove intimida ting to a parent
with limit ed tim e or cog nit ive fun cti oning. Mor e st rea m line d handouts wit h major
points or suggestions highlighted and in more of an outlin e form with more concret e
suggestions for parents would be an improvem ent. Of course it is up to th e th e rapi st 's
dis cr etion to us e th e handouts as a n a ll-incl us ive g uide line wh ich ca n be ed it ed to
what he or she beli eves is most pertin ent a nd useful for th e family. Th e tex t would be
diffi cult to impl em ent as a st ep-by-st ep m anual a nd di gesti on , re processing, and
reformulation by th e th erapist into hi s or her own person al ized t reatm ent , a lbe it
ba sed firml y in Barkl ey's, would be th e ideal use of his m anual.
O verall , th e manual is fill ed wit h ve ry useful in formation. Wit hin th e text ca n be
found back ground mat erial rega rding th e prope r eva lua t ion of child re n, whi ch
pati ents and whi ch co ndit io ns a re best suit ed to this program , th eo ry of whi ch
strat egies work and wh y th ey do, a nd very co nc re te plan s a nd suggest ions for
treatm ent repl et e with exe rc ise s a nd hom ework assig nme n ts as well as th e rationa le
behind th em. Th ere is a g re a t deal of information in th e manu al but this a lso leads to
som e difficulti es with it s use as a t eaching tool. Som e parag ra ph s are too lo ng a nd
densel y writt en to th e point that th e read er ca n lose t rack of th e main poin t of th e
paragraph , whi ch may necessitat e reread ing of sec t ions. Eve n wh e n at first glance th e
pa ges see m ou tl ine d a nd a ppa re n t ly easy to o rga n ize a nd com pa rtm enta lize th e
inform ation it see ms sur prising ly easy to ge t lost wh ile reading. Pe r ha ps more
highlight ed points, subhead ings , a nd clinical pearls mi gh t help to break th e mat eri al
up into mor e di gestibl e portions a nd m aximize th e efficiency of lea rn ing. Th e
handout s a re in th e rear of th e book whi ch ca n mak e for a mild inconv e nie nce wh en
referred to in th e t ext. Another conce rn is th e sugges t ion th at each of th e te n s teps
outlin ed in th e manu al ca n be acc o m plishe d in on e sess ion each . If a ste p is not
maste red , it is to be re pe a te d, but no clear gu ide lines to le ng t h of session or th e
number of repeat ed sessions a llowed before th e fa m ily fa ils th e rap y is allud ed to .
Perhaps th ere is room for th e th e rapi st to use his or her di scretion a nd cr eativity to
crea te hi s or her own pr ogram.
All- in- all , Barkl ey's Defiant Children is a n impressive wor k t ha t refl ects years of
cl inica l expe rie nce a nd pr ovid es a grea t d eal of useful information. It ca n be used to
guide th e th erapist in d eveloping a n effec tive program in behavioral techniqu es to be
used by parents to deal with d efi ant child re n. It s ba ckground inform ation and
d escription of th e rational e for th e program is exhaus t ive. The ste ps involved in t he
training program are clearly out lin ed with gen erous suppor t provid ed by det ail ed
handouts . If carefully studied and implem ented, Barkley's pr ogram a ppears to have
th e pot ential to be put into cle ar, useful clinical practi ce a nd ca n serve as th e basis for
approaching a clinic popul ation . Th erefore it is highl y recomm end ed for th erapi sts
interest ed in learning more about behavioral treatm ent of child re n a nd plan ni ng to
put this knowl ed ge into practi ce.
