Transcript Disruptive Disorders Help! This child is making my life

Oppositional Defiant
Disorder
Creating an understanding for early
childhood teachers
Learner Objectives
Participants in this seminar will be able to:
• Identify symptoms and characteristics of
ODD
• Recognize the potential causes of ODD
• Describe risk and protective
factors for ODD.
Oppositional Defiant Disorder (ODD)
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DSM-IV-TR Definition
“A pattern of negativistic, hostile, disobedient and defiant
behaviors. Children display four or more of these
behaviors for more than 6 months
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Loses Temper Easily
Argues with Adults
Actively Defies Adults Requests or Rules
Deliberately Tries to Annoy Others
Blame others for their own misbehavior and mistakes
Seems touchy or is annoyed easily
Angry and resentful
Spiteful or Vindictive”
Oppositional Defiant Disorder
• Average age of onset is 6 years old, symptoms can be
seen in children as early as 3 years old3
• Symptoms usually manifests by 8 years old, with most
children diagnosed during preadolesence1
• Children with ODD have a significantly higher rate of
having more that one psychiatric disorder4
• Most children, 67%, will ultimately exit from the
diagnosis after a 3-year follow-up5
• Early onset of ODD is more likely to
persist and lead to subsequent
development of CD6
Conduct Disorder (CD)
DSM-IV-TR Definition1
“Repetitive and persistent pattern of behaviors in
which the basic rights of others or rules of
society are violated. Three or more of the
following behavior will have occurred within
the last 12 months.
• Aggression Toward People and Animals
• Destruction of Property
• Deceitfulness or Theft
• Serious Violation of the Rules”
Overlapping of disorders
It is rare for ODD/CD to occur outside the context
of other psychiatric disorders11
- Most common is ADHD
65% of children diagnosed with ADHD also had ODD
80% of children diagnosed with ODD also had ADHD
- Anxiety disorders
45% of children diagnosed with an anxiety disorder also had ODD
- Severe depression
70% of children diagnosed with severe depression also had ODD
- Bipolar
85% of children diagnosed with bipolar disorder also had ODD
- Language processing disorder (LPD)
55% of children diagnosed with LPD also have ODD
What causes
Disruptive Behavior Disorders?
• It is thought that children with severe behavior
disorders may be more influenced by neurological
and genetic factors12
• However mild to moderate DBDs are believed to
appear in children who have an accumulation of a
high number of risk factors and a low number of
protective factors in all contexts of their lives7
• This imbalance of risk to protective factors may
determines the presence and severity of
child’s DBD. 5 6 7
a
Risk Factors
A risk factor is
a characteristic within the
individual
or a circumstance of the
individual
that increases the probability of a
Disruptive Behavior Disorder.
Biological Risk Factors
• Difficult Temperament at birth – irritable, easily
frustrated, angry and hard to soothe13
• Aggression is highly influenced by genetic factors in boys
and girls.12
• In severe cases of ODD neurological factors may cause
the brain to function differently compared to how an
average child’s brain may function.12
• Children diagnosed with both ODD/CD and ADHD (ADHD
being highly genetic) are likely to have greater symptom
severity and increased risk of future disorders11
Individual Risk Factors
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Underdeveloped emotional regulation skills
Low tolerance of frustration
Little to no problem solving capabilities
Inability to adapt to new situations
Language development impairment11
Family Risk Factors
• Young age of the mother at birth of first
child
• Insecure Parental Attachment
• Coercive parent – child interactions
Parental behaviors include inconsistent/harsh discipline, poor
monitoring/ supervision, low levels of warmth/nurturance, high
numbers of negative verbalizations towards the child.
• Depressed or “distressed” mother
• High levels of substance abuse and
antisocial behaviors in parents7 14
Contextual Risk Factors
• Living in urban, low-socioeconomic
settings.
As the magnitude of poverty increases, so too does the severity
of aggression and conduct problems7
• Living in a disadvantaged neighborhood
Characterized by dilapidated housing, high crime rates, isolation,
lack of economic resources and unsafe conditions.15
• Witness of violence or being the
victim of violence or abuse7
• Stressful live events16
School Risk Factors
• Zero-tolerance discipline which is highly punitive
and erratic, escalating with little or no attention
to students’ good behaviors or efforts to
achieve10 17
• Negative interactions with adults, typical school
experience for these students is highly negative10
• Discipline including punishments that takes
students away from the academic environment17
• Deficits in social skills lead to rejection by
prosocial peers7
• Affiliation with “deviant” peers7 10
Protective Factors
Protective factors reduce the
likelihood of children
confronted with risk factors
to develop maladaptive
behaviors associated with
Disruptive Behavior
Disorders.
Resilience in Childhood
Resilience, a positive adjustment occurring in
children at-risk, seems to result from a
combination of internal and external
resources that function as protective factors.7
Child Protective Factors
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Easy Temperament
Good intellectual functioning
Self-confidence
Empathy
Talents3 7
Family Protective Factors
• Good supportive relationship with a
parent
• Close supervision by parents when not in
school
• Positive parent-child relationships:
warmth, structure, high expectations
• Connection to extended supportive
family networks 5 7 8
School Protective Factors
• Children with ODD/CD who had a positive
teacher-child relationship showed a
decrease in aggression.20
• Friendship with prosocial peers7
• Bonds to prosocial adults outside the
family7 17
• Attending effective school3
Interventions
Interventions will be more
successful if they not only reduce
the risk factors, but also promote
the protective factors observed in
resilient children.7
School-wide Interventions
• Create a positive school climate
• Define behavioral expectations
- Small set of general expectations and specific expectations for
different locations in the school
• Support positive behavior
- Monitor behavior especially during common problem times,
acknowledge and reward positive behavior, use reminders and
review of behavior expectations.
• Respond to problem behavior consistently
and effectively
- Use consistent procedures in responding to minor and
serious problem behaviors. Institute procedures for
problems solving meetings.
Classroom Interventions
• Establish and teach the classroom rules and
procedures
- Classroom rules and procedures need to be established and clearly stated,
explicitly taught, closely monitored and consistently followed.
• Manage common problem times: transition, seat
work, other unstructured times of the day
• Promote social and emotional functioning
• Use rewards effectively
• Use mild punishment effectively
• Manage angry/acting out behavior
Three-level: Triangle Approach
School-Based Interventions
Green-Zone
Positive behavior
support interventions
that are school-wide
will support all
children. This
foundational level is
sufficient for
promoting positive
behavior for
approximately 80%
of students
Red-Zone
Comprehensive and
individualized interventions that
focuses on 5% of children with
significant difficulties
Yellow-Zone
Early interventions for children at
risk, will affect 15% of children
Individual Interventions
• Consistently reinforce good behavior
• Use of proactive and instructive teaching
strategies to teach adaptive behaviors and
problem solve with the student
• Train student to self-monitor disruptive
behaviors
• Use positive reinforcement when
students reaches behavior goals.
IDEA Classification
Special Education Interventions
• If a student with ODD is labeled “emotionally
disturbed” they are included under and given all
protections under the Individuals with Disabilities
Education Act (IDEA)
• But, if a student with ODD is labeled “socially
maladjusted but not emotionally disturbed”,
they are denied any protection under
IDEA and special education services10
Piecing it all together:
What does all of this mean for a
teacher?
First Step:
Design a Multimodal Treatment
• One intervention is not going to change the
child’s behavior.
• You will need:
– Antecedent modifications
• Things you do before a behavior has a chance to show up
• You determine when those need to be employed by looking
at behavior patterns:
– Time of day
– Day of the week
– Contexts, settings, subjects being presented, certain peers being
around, certain adults being around etc.
Multimodal design continued
• You will need to teach replacement behaviors:
– This child has learned that certain behaviors have
a pay off
• The child will have to be taught ways to release anger
and frustration in socially appropriate ways.
• We cannot just tell them to “be good”, we have to
actually give them techniques that will help them do
something different.
Multimodal design continued
• You will need to make consequence
modifications:
– Everyone hates this one because it is “What will
you do different when the behavior occurs?”
• We don’t like to think about changing ourselves.
• How will we avoid paying off with attention or escape
from work consequences and yet still manage the
behavior?
• How do we refrain from going to brain stem?
How to CARE for behavior
• Control
– How can I make it appear the child has more control over
situations?
• Attention
– Does the child want the adult attention or peer attention?
• Revenge
– What social skills can we give the child to help them refrain
from reactive strategies?
• Escape
– Why does the child want to get out of work or get away from
a situation? (low self-esteem, inadequate skills, etc.)
Label appropriate behavior
Teach the “I” strategy for Independence
• Share the emotion (feeling)
• Explain the why (the cause)
• Make a request (the solution)
• I feel frustrated when I don’t know the answer
to a question. Please teach me a trick to make
it easy.
Cool down technique for YOU
• Children with ODD seem to be able to send us
from frontal cortex to brain stem in 20
seconds flat.
• This happens because we have been trained
to think, “I must react immediately to this
situation because that’s what we do.”
• The truth is…we don’t think best when we are
upset.
• Train yourself to do the following:
When you do deal with it….
• Handle all problems with compassion first.
– “Oh, man I can totally understand why you felt like
doing that.
– But the rules for that are x,y, and z at this school.
– So we’ll see you in detention on what day?
– After that, let’s get together and talk.
– Be sure to come see me the next day.”
Use a Point System
• How many of you collect frequent flyer miles
or reward points for hotels?
• It makes you want to engage in a particular
behavior.
Student-Teacher Rating Form
Date:
Student
Hour One
Hour Two
Hour Three
Hour Four
Hour Five
Hour Six
Respect
Self
Respect
Others
Respect
Property
Total
Points
3= Great Day- No or very few behavioral learning opportunities occurred
2= Pretty Good Day- few behavioral learning opportunities occurred
1= This day could have been better- more than a few behavioral learning opportunities occurred
Student Signature: _________________________________________________
Teacher Signature: _________________________________________________
Parents' Signature: _________________________________________________
For younger students use smiling faces:
Riffel, L.A. (2009)© - permission to copy
with no changes
Focus on the Four “P’s”
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Public Relations
Proficiency
Power
Philanthropy
Public Relations
• All children need to feel that they belong.
• Be their public relations person by letting their
appropriate behavior earn the class a reward.
Proficiency
• Many behavioral issues occur because the
student feels inadequate academically.
• Pre-teach part of the lesson in a study session,
an online learning lab, or resource room.
Power
• Give the child the power to control their
destiny by giving them independence.
• Using options, teaching them to think “How’s
this next decision going to affect me?”
Riffel, L.A. (2009)© - permission to copy with no changes
Philanthropy
• You will be surprised that these students are
generally great working with younger students
or students with disabilities.
– Their behavior is typically more appropriate with
younger and less able students.
Proactive not reactive
• Teach the child to have a plan to keep
themselves in frontal cortex:
– Teach them breathing techniques
– Give them an outlet for tensing muscles such as a
stress ball they keep in their pocket
– Teach them how to go to their “zen” place
Affirmative
• Teach the child to tell themselves positive
statements:
– I can handle this.
– I am better than this.
– This is not worth losing privileges over.
Move Away
• Teach the child to say something like:
– “Thanks for sharing your opinion and move away.”
• Teach the child to not make eye contact when
saying the above statement.
Parent Involvement
• Home-school collaboration has the
potential to significantly increase academic
success for students with ODD
• Teacher and parent use a “partnership
approach” to child’s success in school
• Send daily report card home
about the student’s behavior
• Encourage positive parental
reinforcement of specific
desired behaviors
What teachers should avoid
• Use of only reactive behavioral strategies
• Model antisocial behaviors by yelling or
insulting student, instead teachers should
model prosocial or problem solving
behaviors.
• Use of harsh punishment
• Only coercive interactions
with student
What teachers should do
• Understand that teaching children with ODD may
take a “superhuman tolerance for interpersonal
nastiness” 10
• Directly teach adaptive behavior strategies
• Model and teach prosocial skills, problem solving,
empathy and self-control
• Use individual interventions for
students with ODD
• Understand the teacher-student
conflict cycle and how to avoid it
The Conflict Cycle
Retrieved from:
http://cecp.air.org/interact/authoronline/april98/3.htm
Questions?
Glossary
• DSM IV - DSM-IV (Diagnostic and Statistical Manual of Mental
Disorders, Fourth Edition)
An official manual of mental health problems developed by the
American Psychiatric Association. Psychiatrists, psychologists, social
workers, and other health and mental health care providers use this
reference book to understand and diagnose mental health problems.
Insurance companies and health care providers also use the terms and
explanations in this book when discussing mental health problems.
(site is the
• Prosocial behavior -The term prosocial behavior describes acts that
demonstrate a sense of empathy, caring, and ethics, including sharing,
cooperating, helping others, generosity, praising, complying, telling
the truth, defending others, supporting others with warmth and
affection, nurturing and guiding.
• Antisocial behavior – The term anitsocial behavior describes behaviors
that are unacceptable in our society. Examples are acts of aggression
or malice, over-reactive displays of anger, inability to work or get
along with others, disrespectful towards others, and abusive towards
others.
References
1. AACAP Official Action, (2007). Practice parameters for the assessment and
treatment of children and adolescents with oppositional defiant disorder.
Journal of the American Academy of Child & Adolescent Psychiatry, 46(1),
126-141.
2. American Psychiatric Association. (2000). Diagnostic and statistical manual of
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References
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