Transcript Working with Oppositional and Defiant Children:

Working with
Oppositional
and Defiant
Children:
A School
Counselor’s
Guide to ODD
Kathryn Casey
The University of Arizona
A Case Example
Outline

What is ODD?
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Identifying ODD children
Examples of ODD behaviors vs. age appropriate
behaviors
Differential Diagnoses
Statistics
Prognosis
Correlates
Intervention Strategies
ASCA Standards
Ethical Considerations
Additional Information and Resources
Conclusion and Questions
What is ODD?
 Definition
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“A recurrent pattern of developmentally
inappropriate levels of negativistic, defiant,
disobedient, and hostile behavior toward
authority figures” (Hamilton & Armando, 2008)
Diagnostic Criteria
Argues with adults
Deliberately
annoys
others
Refuses to comply
Four or more symptoms
must be present for at
least 6 months
Spiteful and vindictive
Often angry and
resentful
Blames others
Easily annoyed or
frustrated
(American Psychiatric Association, 2000)
Diagnostic Criteria
 These
behaviors must cause
significant impairment in
social, academic, or
occupational functioning
 The behaviors are not due
to a psychotic or mood
disorder
 Criteria are not met for
Conduct Disorder or
Antisocial Personality
Disorder (18+ only)
(American Psychiatric Association, 2000)
At one time or another couldn’t
every child be considered
oppositional defiant?
ODD vs. Age Appropriate Behaviors
 Infancy
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More likely to have been fussy, colicky, or
difficult to soothe when compared to other
infants
(American Academy of Child & Adolescent Psychiatry, 2010)
ODD vs. Age Appropriate Behaviors
 Toddlers
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More extreme temper
tantrums surrounding
major power issues such
as toilet training, eating,
and sleeping
Much worse than what
one would expect in
the Terrible Twos
(American Academy of Child & Adolescent Psychiatry, 2010)
ODD vs. Age Appropriate Behaviors
 School
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
age
More likely to procrastinate,
dawdle, or claim they did not
hear the teacher
More likely to be set on
winning at all costs
 Even
willing to lose privileges
just to be “right”
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Power struggles center on
homework, cleaning up, and
bathing/grooming
Has little insight or ability to
admit their troubles, instead
they blame others
(American Academy of Child & Adolescent Psychiatry, 2010)
ODD vs. Age Appropriate Behavior
 Teenagers
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Power struggles center on
curfew, obscene language,
attending school, cleaning
up
May get into trouble with
the police
Question authority and
break rules
Different from Conduct
Disorder (CD)
(American Academy of Child & Adolescent Psychiatry, 2010)
ODD vs. Conduct Disorder
 Conduct
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disorder
More severe than ODD
 Physical
aggression toward
people or animals
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Examples: assault, bullying,
muggings, forced sexual activity
 Destruction
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of property
Examples : arson, vandalism
 Deceitfulness
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Examples: shoplifting, forgery
 Serious
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or theft
violation of rules
Examples: truancy, running away
from home
(American Psychiatric Association, 2000)
Differential Diagnoses
 Conduct
disorder
 ADHD
 Impaired
Language Comprehension
 Mental Retardation
 Mood disorders and psychotic disorders
 Normal individualization
School Counselors do not diagnose!
(Hamilton & Armando, 2008)
Statistics
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ODD is one of the most
diagnosed mental health
disorders in childhood (Hamilton &
Armando, 2008)
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2-16% of children meet criteria
for ODD (Turgay, 2009; Sprague &Thyer, 2003)
Tends to be diagnosed more
often in boys(Waschbusch & King, 2006)
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Girls often display aggression
more covertly (Hamilton & Armando, 2008)
Symptoms are often present
for 2-3 years before diagnosis
(Hamilton & Armando, 2008)
Statistics
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Co-occurring disorders are
common with ODD (Heflinger &
Humphreys, 2008)
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50% diagnosed with another
psychiatric disorder
ADHD and mood disorders
are most common
Children with dual diagnosis
of ADHD and ODD are
more likely to develop CD
and/or antisocial
personality disorder later in
life (Dickstein, 2010)
Prognosis
 Academic
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Homework completion,
classroom time
 Social
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Difficulties
Poor social skills (i.e. aggression)
 Career
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Difficulties
Following rules and authority
 Emotional
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Difficulties
Problems
More likely to develop
depression or bipolar disorder
 Higher
risk for suicidal ideation
and attempts
(Dickstein, 2010)
Correlates
 Dysfunctional
or maladaptive
family dynamics
(Cunningham, & Boyle 2002)
 Trauma,
abuse and/or
domestic violence
(Ford, Thomas, & Racusin, et al. 1999)
 Low
SES
(Boden, Fergusson, & Horwood, 2010)
 Lower
cognitive ability
(Boden, Fergusson, & Horwood, 2010)
 Association
groups
with deviant peer
(Boden, Fergusson, & Horwood, 2010)
Intervention Strategies
Parents and
Caregivers
Teachers
Interventions are
most effective
when
-Behavior
Plans
-Skills training
-Classroom
-Family
Parents,
Teachers,
management
Therapy
support work
-Resources
and
Counselors
-Referrals, CST
and Referrals
together!
School Counselor
-Boundaries
-Communication
-Effective
Discipline
-Social Modeling
-Effective
Discipline
-Establish
positive
relationship
-Establish clear
expectations
-Skills groups
-Individual counseling
-Establish positive relationship (Lanza, & Drabick 2011; Milne,
Edwards, & Murchie, 2001;
Sprague & Thyer 2003; Turgay,
2009 )
Applying the ASCA National Model
(American School Counselor Association, 2012)
Ethical Considerations
 School
Counselors do not diagnose
 Avoid over-identifying “problem” children
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Symptoms can be ambiguous
 Coordination
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Confidentiality
 Skills
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of care
Competency
Making appropriate referrals when needed
(Studer, 2005)
Case Study Follow Up
Additional Resources
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The Oppositional Defiant Disorder Resource Center
http://www.aacap.org/cs/ODD.ResourceCenter
The Total Transformation Program by James and Janet
Lehman http://www.thetotaltransformation.com/
Bright Hub Education: Strategies for Teaching Children
with ODD http://www.brighthubeducation.com/specialed-behavioral-disorders/26631-strategies-for-teachingchildren-with-oppositional-defiant-disorder/
The Defiant Child by Dr. Douglas A. Riley, Child and
Adolescent Psychologist
Oppositional Defiant Disorder and Conduct Disorder in
Children by Walter Matthys and John Lochman
Educating Oppositional and Defiant Children by Phillip
Hall and Nancy Hall
Solutions to Oppositional Defiant Disorder by Marilyn
Adams, LMFT
http://www.guidancefacilitators.com/odd2.html
References
American Academy of Child & Adolescent Psychiatry. (2010). Your ChildOppositional Defiant Disorder. Retrieved from
htt://www.aacap.org/cs/root/publications/store/your child oppositional
defiant disorder
American Psychiatric Association. (2000). Diagnostic and Statistical Manual of
Mental Disorders (4th ed., text rev.). Washington, DC: Author.
American School Counselor Association. (2012). ASCA National Model: A
Framework for School Counseling Programs, Third Edition. Alexandria,
VA: Author.
Boden, J., Fergusson, D., & Horwood, J. (2010). Risk Factors for Conduct Disorder
and Oppositional/Defiant Disorder: Evidence from a New Zealand Birth
Cohort. Journal of the American Academy of Child and Adolescent
Psychiatry, 49(11), 1125-1133.
Cunningham, C., & Boyle, M. (2002). Preschoolers at Risk for Attention-Deficit
Hyperactivity Disorder and Oppositional Defiant Disorder: Family,
Parenting, and Behavioral Correlates. Journal of Abnormal Child
Psychology, 30(6), 555-569.
Dickstein, D. (2010). Oppositional Defiant Disorder. Journal of the American
Academy of Child and Adolescent Psychiatry, 49(5), 435-436.
Ford, J., Thomas, J., Racusin, R., Daviss, W., Ellis, C., Rogers, K., Reiser, J., Schiffman,
J., Sengupta, A. (1999). Trauma Exposure Among Children With
Oppositional Defiant Disorder and Attention Deficit-Hyperactivity
Disorder. Journal of Consulting and Clinical Psychology, 67(5), 786-789.
References Continued
Hamilton, S., & Armando, J. (2008) Oppositional Defiant Disorder. American
Family Physician, 78(7), 861-866.
Heflinger, C., & Humphreys, K. (2008). Identification and Treatment of Children
with Oppositional Defiant Disorder: A Case Study of One State’s Public
Service System. Psychological Services, 5(2), 139-152.
Lanza, I., & Drabick, D. (2011). Family Routine Moderates the Relation Between
Child Impulsivity and Oppositional Defiant Disorder Symptoms. Journal
of Abnormal Child Psychology, 39, 83-94.
Markward, M., & Bride, B. (2001). Oppositional Defiant Disorder and the Need
for Family-Centered Practice in Schools. Children & Schools, 23(2), 73Milne, J., Edwards, J., & Murchie, J. (2001). Family Treatment of Oppositional
Defiant Disorder: Changing Views and Strength-Based Approaches.
The Family Journal: Counseling and Therapy for Couples and Families,
9(1), 17-28.
Sprague, A. & Thyer, B. (2003). Psychosocial Treatment of Oppositional Defiant
Disorder. Social Work in Mental Health, 1(1), 63-72.
Studer, J. (2005). The Professional School Counselor: An Advocate for Students.
Belmont, CA: Brooks/Cole.
Turgay, A. (2009). Psychopharacological Treatment of Oppositional Defiant Disorder.
CNS Drugs, 23(1), 1-17.
Waschbusch, D., & King, S. (2006). Should Sex-Specific Norms Be Used to Assess
Attention-Deficit/Hyperactivity Disorder or Oppositional Defiant
Disorder? Journal of Consulting and Clinical Psychology, 74(1), 179185.
Questions?