REVIEW ARTICLE Child Disobedience and Noncompliance: A Review

Child disobedience and noncompliance is a recurring problem frequently brought to the attention of pediatricians and others working with children and their parents. This article reviews empirical studies concerning childhood noncompliance. Definitions of noncompliance (also called disobedience) are presented, and observational studies that have measured noncompliance in the laboratory and at home are reviewed. Studies show considerable variability in the prevalence of noncompliance, but demonstrate that it is a frequent problem for parents. Longitudinal data from the Pittsburgh Youth Study are presented to more closely examine the onset and stability of noncompliance in childhood and adolescence. Evidence suggests that extreme childhood noncompliance is relatively stable over time, peaking slightly during early adolescence and decreasing during late adolescence. Studies indicate that for some children noncompliance predicts aggression and externalizing problems. Antecedents of noncompliance including parental discipline techniques and child characteristics are reviewed. Parent training programs designed to reduce noncompliance are described, and the effectiveness of such programs is examined. Pediatrics 2003;111:641–652; noncompliance, disobedience, parental discipline techniques, parental training programs, externalizing problems. ABBREVIATIONS. CBCL, Child Behavior Checklist; PYS, Pittsburgh Youth Study; OR, odds ratio; CI, confidence interval. Child disobedience and noncompliance is viewed by practitioners and researchers as a key element of child and adolescent problem behavior. Compliance training often is a key component of therapies for disruptive behavior disorders.1,2 Parents also tend to view persistent noncompliance of their child as especially troublesome. Child noncompliance is one of the most frequent reasons for the psychiatric referral of young children.3 Since the early 1970s, researchers have given childhood noncompliance a good deal of attention, focusing mainly on noncompliance in early to middle childhood.4,5 This article reviews empirical studies on noncompliance from childhood through adolescence with the goal of answering some of the key questions often raised by practioners. We begin by discussing what is meant by noncompliance and how it manifests itself differently in childhood and adolescence. We then review findings on the prevalence, onset, and stability of noncompliance in both clinic-referred and normal populations. We then ascertain whether noncompliance is associated with concurrent or future childhood problems. Next, factors that have been associated with increased or decreased noncompliance in childhood are reviewed. Finally, we describe and discuss the effectiveness of treatment programs that have been devised to reduce children’s noncompliance.