Post on 24-Feb-2016
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The Oppositional Defiant ChildWhat underlies the behavior?
Douglas McCollum, Ph.D.Lori O’Dell McCollum, Ph.D.
Definition- DSM-IVA pattern of negativistic, hostile, and defiant behavior lasting at least 6 months, during which 4 or more of the following occur:1. Often loses temper2. Often argues with adults3. Often actively defies or refuses to comply with adults’ requests or rules.4. Often deliberately annoys people.5. Often blames others for his or her mistakes or misbehavior.6. Is often touchy or easily annoyed by others.7. Is often angry and resentful. 8. Is often spiteful or vindictive
Definition: DSM-IV• The disturbance in behavior causes clinically significant
impairment in social, academic, or occupational functioning.
• The behaviors do not occur exclusively during the course of a psychotic or Mood Disorder.
• Criteria are not met for Conduct Disorder, and, if the individual is age 18 years or older, criteria are not met for Antisocial Personality Disorder.
Other ODD Symptoms
• Poor problem solving skills• Need to control others• Low tolerance for frustration• Self-centered• Poor emotional control• Poor mental control (executive functioning)• Delayed moral development
Why is a clear diagnosis important?
• Diagnosis helps understand causality, and we can learn from research how to prevent the disorder.
• Helps to plan treatment options that have been proven effective.
• Helps predict how the child will act in the future because professionals have seen many other children with the same condition and we have research about course of the condition.
• Helps professionals communicate with each other because they all use the same criteria to diagnose the condition.
Syndrome vs. Disorder
• Syndrome means a collection of symptoms that don’t always follow the same trajectory.
• Disorder is more predictable and implies an underlying cause. It is also a separate category that doesn’t overlap with many other conditions.
• In the case of ODD it seems more like a syndrome than a disorder and this is important because we diagnose and treat syndromes differently than disorders.
ODD does not occur in a vacuum
Multi-factored Causes
• Learned behavior• Inherited traits • Co-existing disorders• Systemic Component– Culture– Parenting– Family Systems
Learned Modeling of Parent Anger
Nagging and Poor Parent Response
• Simpson Clip from DVD
Sibling Rivalry within Family Systems
Blended Family and Teen Disrespect
• www.youtube.com• Super Nanny Atkinson Family 3:55 to 6:30
Cultural Changes
• Self-esteem generation• Quick fixes and immediate gratification• Consumerism• Self-centered culture• Less connected to family and community• Fewer chores and responsibilities
Criteria are too subjective
• Different adults may have varying standards of what they consider defiant.
• Cultures define defiance differently.• “Normal” changes over time.– 1950’s defiance vs. today
Behaviors vary between settings.
• Home• School• Community
• Is the child ODD if he or she only acts out in one setting, or does that suggest that the problem is part of something else?
Behaviors vary between age groups.
• ODD behavior often peaks at certain ages.• Terrible Twos• The first adolescence (age 4)• The teen age years
Overlapping Conditions
• We believe that many children with ODD actually have underlying conditions that contribute to the ODD profile. Until those underlying conditions are diagnosed and treated, it is hard to reduce the ODD symptoms.
Subtypes of ODDOverlapping Conditions
• ADHD• Trauma• Attachment• Anxiety• Autism Spectrum/Sensory Disorder• Learning Disorder• Mood Disorders• Pre-delinquent• Health/Brain-based conditions
ADHD
• Inattention, impulsivity and hyperactivity• Inability to delay gratification• Poor executive functioning– Planning, maintaining attention, inhibiting
behavior, organizing skills.Triggers for ODD Behaviors:Listening demands, transitions, time demands, organizational demands, asking them to wait.
Trauma
• Abuse, witnessing domestic violence, war, violence in a neighborhood, death, illness, etc.
• PTSD: hypervigilance, memories/nightmares, avoidance of reminders
Triggers for ODD Behaviors:Startling them, anything that reminds them of the trauma, ongoing interactions with a perpetrator or traumatic situation.
Attachment Disorders
• Poor bonding at birth or poor attachment to caregivers leading to trust issues
• Behaviors include: – Stealing and lying– Poor cause and effect thinking – Consequences don’t work consistently– Lack of desire to please, – Operate in survival mode,
Attachment Disorders
• Behaviors include:– Poor communication skills– Inability to self-regulate – Limited sense of identity – Poor problem solving skillsTriggers for ODD Behavior:Demands for closeness, honesty, or trusting an adult. Situations that are out of their control.
Anxiety Disorders
• Social Anxiety, Separation Anxiety, OCD• Irritability• High arousal, panic• Demanding behavior• Involving parents in OCD ritualsTriggers for ODD Behaviors:Separation from caregivers, use of a babysitter, stopping them from doing a ritual, transitions, bad weather, bedtime, going to school, etc.
Separation Anxiety
• www.youtube.com• Super Nanny Atkinson Family 18:50 – 21:46
Autistic Spectrum Disorder
• Verbal Deficits• Stereotypical behaviors, Rituals• Social difficulties• Sensory issuesTriggers for ODD Behaviors:Sensory overload, transition points, verbal or social demands, interrupting their rituals
Learning Disorders
• Memory issues• Processing speed deficits• Specific academic deficits
Triggers for ODD Behaviors:Homework, memory demands, asking them to hurry, academic pressure, testing, comparisons to siblings or friends.
Mood Disorders
• Depression in kids looks like irritability and anger
• Bipolar Disorder• Situational depression• Sleep problemsTriggers for ODD Behaviors:Forcing withdrawn kids to interact, manic episodes, chronic conflict, lack of sleep, etc.
Pre-delinquent Children
• Conduct Disorders– Early onset vs. Adolescent onsetStealing, lying, lack of conscience, immediate gratificationTriggers for ODD BehaviorRules or structure, demanding compliance, an adult in a position of authority, etc.
Health/Brain-based Conditions• Sleep deprivation• Hunger and dietary• Hearing loss (frustration, poor comprehension)• Diabetes (high or low blood sugars)• Drug exposed prenatally (neurological abnormalities)• Lead exposure (leads to hyperactivity and learning
problems)Triggers for ODD Behaviors:Compliance demands during periods of pain, confusion or frustration.
Treatments
• Behavioral– Positive and negative interventions
• Counseling– Build emotional awareness and control– Build communication skills– Build problem solving skills– Build social skills– Build moral reasoning– Cognitive behavioral therapy
Treatments
• Parent Training– Setting rules– Type that works best: authoritative– Effective use of time out– Chores and responsibilities
• Family Systems– Is the child acting out for the family?– Marital or divorce issues, substance abuse, etc.
• Treatment for coexisting conditions– Medication, sensory treatments, school interventions
Authoritative Parenting
• Types: Authoritarian, Laissez Faire, AuthoritativeBEST: Authoritative ParentingPlace limits and have high expectationsListen to the childFair and consistent disciplineWarm and nurturing with calm demeanorEncourage children to discuss options and express their opinionsEncourage independence
The Compliant Child
• Respectful – Accepts authority• Responsible and independent• Able to attach and trust others• Pro-social skills• Appropriate communication skills• Identity development• Problem solving skills
The Compliant Child
Parent Readings
• Several books by John Rosemond• The Defiant Child by Russell Barkley• Transform your Child by James Lehman• Raising the Spirited Child by Mary Kurcinka• 1,2,3 Magic by Thomas Phelan• SOS - Help for Parents by Lynn Clark• Have a New Kid by Friday by Kevin Levine• www.supernanny.co.uk