Transcript The Oppositional Defiant Child

The Oppositional Defiant Child
What underlies the behavior?
Douglas McCollum, Ph.D.
Lori O’Dell McCollum, Ph.D.
Definition- DSM-IV
A pattern of negativistic, hostile, and defiant behavior lasting at
least 6 months, during which 4 or more of the following occur:
1. Often loses temper
2. Often argues with adults
3. 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
Super Nanny
• www.youtube.com super nanny minyon
family
• 16:42 to 19:45
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 ODD
Overlapping 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 skills
Triggers 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 rituals
Triggers 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 issues
Triggers 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 problems
Triggers 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 onset
Stealing, lying, lack of conscience, immediate
gratification
Triggers for ODD Behavior
Rules 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
Super Nanny
• www.youtube.com
• Super Nanny Minyon family 14:55-16:42
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, Authoritative
BEST: Authoritative Parenting
Place limits and have high expectations
Listen to the child
Fair and consistent discipline
Warm and nurturing with calm demeanor
Encourage children to discuss options and express
their opinions
Encourage 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