Transcript ODD Oppositional Defiant Disorder

ODD
Oppositional Defiant Disorder
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ANGIE LABAY
July 31, 2010
Wiki Project
MICHIGAN STATE UNIVERSITY
Why ODD?
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The number of children with Special needs is on the rise.
Information is power! I have always wanted to be able to
understand this disorder. I want to help the children
afflicted with ODD and want to give my classmates the
information to help their peers. Teaching is our profession
and we need to power ourselves with knowledge to best
suite the needs of our students. We need to help the
students that nobody else is willing to help. I ask for all the
“bad” kids to be placed in my room every year. It is my job
to educate and make the kids a productive part of society.
This needs to stop!
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“When a child starts school, a pattern of passiveaggressive, oppositional behavior tends to provoke
teachers and other children as well. At school the
child is met wit anger, punitive reactions and
criticism. The child then argues back, blames others
and gets angry. By the time a youngster with ODD
reaches adolescence, she may have had years of
difficulty at school. Her behavior and attitude
regularly cause disruption in the classroom and
interfere with social and academic functioning.” (Pruitt)
Ask yourself these questions
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 Do you want to help all the children in your
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classroom?
Do you believe that all children are entitled to
education?
Do you believe children should be able to succeed
and be productive in society?
Do you believe that information is power?
If you answered yes to these questions then, continue
to empower yourself with the knowledge to help
children!
ODD Defined
 According to the Journal of
Emotional and Behavior
Disorders, “Individuals with
ODD display a recurrent
patterns of behavior that is
disobedient, negativistic,
defiant and hostile toward
authority figures that
impairs the individual’s
ability to function
personally, socially, or
academically over a period
of at least 6 months.”(Journal of
Emotional and behavior disorders – June 22, 06)
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 According to
www.conductdisorders.com,
“Oppositional Defiance Disorder
is a supposed and largely
disputed ‘mental illness’
characterized by an ongoing
pattern of disobedient, hostile
and defiant behavior toward
authority figures that goes
beyond the bounds of normal
childhood behavior. When a
child cannot seem to control his
anger or frustration, even or
what seems to be trivial or simple
to others, the child will often
react in violence or negative ways
to his own feelings.”(“Oppositional
Defiance Disorder”)
Who?
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1.More boys are diagnosed with ODD that girls,
especially before puberty. Kids begin to exhibit the
signs of ODD before the age of 8 and no later than
13-15. The professionals are cautious diagnosing
ODD before a child reaches school age, many kids
with ODD were fussy, argued and were likely to
throw temper tantrums as very young kids.(Evans Feb. 27, 2007)
2.ODD is characteristically seen in children below the age of 9 or
10 years. (Oppositional Defiant Disorder 1992)
3.After puberty the male: female ratio is about 1:1. (Tynan June 2004)
Statistics
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1.Estimated that 2%-16% or kids and teens have
ODD (www.jas.familyfun.go.com 2008)
2.According to the Journal of Abnormal Child Psychology,
“Diagnostic and Statistical Manual of Mental Disorders,
fourth edition (DSM-IV) DSM-IV gives the rate as
between 2-16% while the American Academy of Child and
Adolescent Psychiatry (AACAP) gives a figure of 5%-15%,
and a researcher at a children's hospital gives a rate of 610%.” (Tynan, June 2004)
Statistics
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“16%-22% of normal school –age children engage in
oppositional behavior. Thus, oppositional behavior
may be developmentally normal in early children.
It is when the oppositional behavior is significantly
greater than what would normally be expected in
other children of the same age that a diagnosis of
Oppositional Defiant Disorder is
appropriate.”(MedFriendly.com: Oppositional Defiant Disorder)
Symptoms of ODD
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Four of more of these symptoms need to have
occurred in the last 6 months
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Frequent Temper Tantrums
Argumentative with adults
Refusal to comply with adult rules or requests
Deliberate annoyance of other people
Blaming others form mistakes or misbehavior
Acting touchy or easily annoyed
Anger and resentment
Spiteful and vindictive behavior
Aggressiveness toward peers
Difficulty maintaining friendships
Academic Problems (Oppositional defiant disorder (ODD) Dec. 19, 2007)
Symptom Variables
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 According to the American Academy of Child &
Adolescent Psychiatry, “When a child is presenting
the symptoms of ODD it is extremely important to
look for other disorders; such as ADHD (attention
deficit hyperactive disorder), learning disabilities,
mood disorders (depression, bipolar disorder) and
anxiety disorders. It is hard to improve on ODD
symptoms without treating the coexisting disorder.
Some children with ODD may go on to develop
conduct disorder (CD). (AACAP 1999)
Symptoms
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According to the Journal of Abnormal
Child Psychology, “Symptoms of ODD
are common in young children, but
normally decline in prevalence with
age. They are considered pathologic
only when they are severe or when they
persist until ages when most other
children have outgrown them (i.e.,
middle to late childhood)”
(Loeber August 1993)
Causes of ODD
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 The child’s inherent temperament
 Family response to child’s style
 Genetic that when coupled with certain
environmental conditions – such as lack of
supervision, poor quality child care or family
instability – increases the risk of ODD
 A biochemical or neurological factor
 Child’s perception that he or she isn’t getting enough
of parent’s time and attention (Oppositional defiant disorder (ODD) Dec. 19,
2007)
Risk Factors
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Having a parent with a mood or substance abuse disorder
Being abused or neglected
Harsh or inconsistent discipline
Lack of Supervision
Poor relationship with one or both parents
Family instability such as occurs with divorce, multiple moves, or
changing schools or child care providers frequently
Parents with a history of ADHD, ODD or conduct problems
Financial problems in family
Exposure to violence
Substance abuse in the child or adolescent (Oppositional defiant disorder (ODD) Dec.
19, 2007)
Treatment
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According to WebMD, “Treatment is determined based
on risk factors, including the child’s age, the severity
of symptoms, and child’s ability to participate in and
tolerate specific therapies
Treatment usually consists of a combination of
psychotherapy and medication:
Psychotherapy: Is aimed at helping the child develop
more effective ways to manage and control anger.
Medication: The same medications that are used to
treat ADHD, depression or other mental illnesses.”
(Mental Health: Oppositional Defiant Disorder 2005-2007)
Treatment
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 Parent Training Programs
 Parents are taught negotiation skills, and positive reinforcement skills
 Individual Psychotherapy
 Allows the child to explore feelings and behaviors which may decrease defiant
behavior
 Family Therapy
 Family dynamics and strategies for handling difficulties are modified through
therapy
 Cognitive Behavioral Therapy
 This type of therapy helps kids control their aggression and modulate their social
behavior
 Social Skills Training
 Social skill training incorporates reinforcement strategies and rewards for an
appropriate behavior to help generalize appropriate behavior. Which means
applying one set of rules to many social situations. (Pruitt)
Treatment continued
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 Children with symptoms should see a doctor. The
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doctor will want to know the child’s behavior
history and possibly testing will be done.
Therapy (individual, group or family)
Anger management skills
Family is educated on how to support and help
child
Hospitalization – only if child is dangerous to
him/herself or others
Medication – sometimes (Nopoulos 2002)
Medication continued
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 Three basic principles when using psychiatric drugs in
children:
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Start Low
Go Slow
Monitor Carefully
 Types of medication:
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Atypical Antipsychotics – first used for schizophrenia
Risperidone (Risperidal) – Used for Tourettes, psychosis, aggression
and conduct disorders. Usually given twice daily.
Olanzapine (Zyprexa) – Used for mania in adults and given once
daily
Quetiapine (Seroquel) – No studies done on using for ODD, given
twice daily. (Chandler 2008 )
Medication Side Effects
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 Weight Gain
 Stiffness, restlessness and tremors
 Elevated Cholesterol and Triglycerides
 Diabetes
 Tardive Dyskinsea
 Sexual Side Effects
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Gynecomastia about 5% of boys and/or girls develop this
Menstruation in girls
Galactorrhea
 Neuroleptic malignant Syndrome
 Psychiatric Symptoms (Chandler 2008)
What can I do at Home?
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 Talk about new problems or ways to help
 Keeping daily schedule the same will help control
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behavior
Be consistent with rules and discipline
Set limits for him/her
Have a plan in place on what to do when child
misbehaves. Stay calm and follow through
Use time-out when child misbehaves. Separate child
from activity or group until child calms down
Praise and reward child (Nopoulos 2002)
The Context
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 One student at a local Area High School (he is a
Sophomore) – he is described in detail on the
following slide
 The staff it is affecting is:
5 teachers (Each subject teacher – a combined experience of 75+
years collectively)
 Special Education Director – 30 years experience
 Special Education Secretary – 20 years experience
 Principals (There is a Principal and Asst. Principal – combined
there is 35 years experience)
 Guardians
 Law Enforcement (the student is currently on juvenile probation)
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The Student
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 How do I as an educator teach a child who does not want to be
taught?
 The Scenario: (We will call him Devin)
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17 year old white male
Sophomore in High School
Failing every class
Mother died 6 years ago the day before Easter
Father signed off custody
Lives with Aunt and Uncle (The Aunt is his Mother’s sister)
Feels passed around and unwanted by everyone
No consequences for his action
Recently busted with marijuana, and for smoking cigarette’s on school property
Convict felon for selling his Ritalin while in Middle School
On Probation, very close to being placed in a juvenile detention home
Adopted at Birth
The Problem
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 Devin believes and trusts nobody. He has an I don’t care
attitude. He has an explosive temper, has ODD and
ADHD. He currently takes medication and visit a child
psychiatrist 4 times a year or as needed. Focusing on
school work is very hard, but the hardest part is he just
doesn’t care. He makes bad choices to see how mad he
has to make his Aunt and Uncle before they will kick him
out of the house. When he turns 18 he will be a junior in
High School and will no longer have a legal guardian. I
find this very disturbing. He says he is going to drop out
of high school when he turns 18 which will be in March.
The problem is getting him to focus and care about his
work, grades and future.
The Classroom
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 The classroom needs to be arranged to set the child
up for success
 Planning for the child and his/her environment
before meeting the child. (“Environmental
Engineering”)
 Avoid verbal directives because this usually results in
non-compliance and defiance from the children
 The intention of engineering the classroom is to
teach the child the skills to participate in a
relationship (Hall 2003)
The Action Plan
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 To improve Devin’s grades to passing
with a C.
 To improve Devin’s attitude, trust and
self worth through positive
reinforcement.
 To improve Devin’s explosive temper.
 To keep Devin in High School until
Graduation.
Action Plan step 1: How to improve Devin’s grades to
passing with a C or better.
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 Students with ODD like to create power struggles. State position
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clearly.
Choose battles wisely
Give 2 choices when a decision needs to be made. State the choices
briefly and clearly.
Establish classroom rules
Praise Devin positively
Academic work at the appropriate level
Teach Devin social skills (conflict resolution and anger management)
Provide consistency and structure
Allow Devin to re-do assignments
Structure activities so the student with ODD (Devin) is not always left
out or is the last one picked (Minnesota Association for Children’s Mental Health – MACMH)
Weekly progress meeting with Teacher, Aunt, Uncle and Devin
Action Plan Step 2: Improve attitude and self worth
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 Consistency of rules and consequences between
home and school
 Sit with Aunt, Uncle and Patrick to establish a rules
and consequence list. EX: An unfinished homework
assign results in a loss of a privilege
 Positive reinforcement at home and school. EX:
When assignment is turned in on time and done with
75% accuracy then an added privilege is granted.
 There is never too much positive reinforcement.
Praise all baby steps made. EX: If he arrives to
school or home in a good mood = reward
Action Plan Step 3: The Explosive Temper
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 Continue to see Psychiatrist
 Allow Devin a place at school and home to express his anger.
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A let it all out room. Some place where he will not disturb
other kids
Allow Devin to talk to school psychologist whenever necessary
an open door policy.
He needs to build a trusting relationship with someone with
whom he can share anything and everything that is bothering
him
Teach him different deep breathing techniques
Explain to him that it is OK to get angry and everyone does, it
is how we express our anger that is different. Reinforce in
him that anger is a normal emotion and what is OK and what
is not OK to do when he is angry
Action Plan Step 4:The Aunt and Uncle
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 They in themselves are a risk factor of ODD because they have
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inconsistent rules and consequences. Also, they are the third place
Devin has lived in 17 years.
Have the Aunt and Uncle go to therapy as singles and as group.
Make a poster of rules and consequences. EX of what not to do: Devin
just got busted with Marijuana and he still gets to go on an Oregon
snowboarding vacation during Spring Break. EX of what to do: Busted
with Marijuana = no spring break vacation
Both Aunt and Uncle need to be on same page. They need to unite.
Need to make Devin feel loved, nurtured, wanted and appreciated.
Need to watch tone of voice and words chosen when talking to Devin.
Positive reinforcement for every baby step made in the right direction
toward recovery.
Action Plan Step 5: Keeping Devin in High School
until Graduation
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 Make and stick to a plan (Devin, Aunt, Uncle and
school)
 Positive Reinforcement (a tremendous amount)
 Let Devin pick the reward if he follows through with
graduation plan
 Realize there will be bumps along the way, but get
right back on that plan.
Important Message about Children’s Mental
Health
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 Every child’s mental health is important.
 Many children have mental problems.
 These problems are real, painful and can be severe.
 Mental health problems can be recognized and
treated.
 Caring families and communities working together
can help. (Substance Abuse and Mental Health Service Administration – SAMHSA)
Something to think about
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According to EAP partners website written by Ablon and Greene, “Recent
research into the childhood diagnosis “Oppositional Defiant Disorder”
(ODD) found the presence of cognitive deficits amongst these children who
are behaviorally challenging. Such deficits were found most notably in
areas of executive functioning skills, emotion regulation skills, language
processing skills, and social information processing skills. For example,
approximately 55% of children with language processing difficulties also
the diagnostic criteria for ODD, suggesting that, if a child does not possess
the linguistic skills necessary to label and categorize emotions or
communicate needs to others, the stage may be set for concurrent
difficulties with frustration tolerance and problem solving. These cognitive
skill deficits suggest that it may be productive to understand
explosive/noncompliant behavior as the byproduct of a developmental
delay or learning disability. Unlike other well-recognized learning
disabilities that manifest themselves purely in the academic domain (i.e.,
dyslexia), the learning disability of a child diagnosed with ODD appears in
specific arenas in which frustration tolerant and flexibility are required.”
(Ablon 2008)
Conclusion
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According to EAP partners website written by Ablon
and Greene, “The analogy of ODD as a learning
disability points us in the right direction as it relates
to our understanding and treatment of children with
ODD. Sending a dyslexic child out of the class or
giving him/her a detention because he/she was not
reading? Unimaginable. Putting that same child in
time-out when he/she was not able to read a bedtime
story at home? Unfathomable. Hopefully the same
reactions will be applicable to ODD in the coming
years.” (Ablon 2008)
Conclusion Continued
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In the case of Devin a close monitoring will be
necessary along with many collaborative meetings
with family and school participants. Positive
reinforcement will be key to success along with
minimal extra stimulus. Baby steps to better grades
will be taken one assignment at a time. With careful
monitoring and strong support system, Devin can be
successful and overcome. The day he graduates I will
have the biggest smile on my face of anyone in
attendance.
Resources
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American Academy of Child & Adolescent Psychiatry(AACAP) Children with Oppositional Defiant Disorder
No. 72, (Dec. 1999) 1-800-333-7636 ext. 140 P.O. Box 96106, Washington, D.C. 20090. from
www.aacap.org/cs/roots/facts_for_families/children_with_oppositional_defiant_disorder.
Chandler, James M.D. FRCPC, Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD) in Children
and Adolescents: Diagnosis and Treatment. Retrieved April 3, 2009
http://jamesdauntchandler.tripod.com/ODD_CD/oddcdpamphlet.htm.
Children and Adolescents with Conduct Disorder, Substance Abuse and Mental Health Service
Administration (SAMHSA), 1-800-789-2647 Retrieved April 4, 2009
http://www.education.com/print/Ref_Children_Conduct/.
Ablon, Stuart J Ph.D. & Ross W. Greene, Department of Psychiatry, Massachusetts General Hospital,
Employee Assistance Program. The Learning disability of Oppositional Defiant Disorder. 1-866-724-4EAP
Retrieved April 4, 2009, from
www.eap.partners.org/WorkLife/Parenting/Special_Needs_Children/Oppositional_Defiant_Disorder .
Content Provided with Permission from Ross W. Green.
Evans, Garrett D Psy.D., Oppositional Defiant Disorder (ODD)(February 27, 2007). Retrieved April 3, 2009,
from http://edis.ifas.ufl.edu/FY002 . (University of Florida IFAS Extension)
Hall, Philip S. and Nancy D. Hall, Educating Oppositional and Defiant Children Association for Supervision
and Curriculum Development, (2003).
Loeber, Rolf. Evidence for developmentally based diagnoses of oppositional defiant disorder and conduct
disorder. Journal of Abnormal Child Psychology, (August 1993). Retrieved April 4, 2009,
http://findarticles.com/p/articles/mi_m0902/is_n4_v21/ai_13240555/print
Resources
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 Minnesota Association for Children’s Mental Health. 1-800-528-4511 (MN only) 165
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Western Avenue North, Suite 2, St. Paul, MN 55102 Retrieved July 14,
2008www.macmh.org.
MedFriendly: Oppositional Defiant Disorder Retrieved June 4, 2008
http://www.medfriendly.com/oppositionaldefiantdisorder.html.
Mental Health: Oppositional Defiant Disorder, (2005-2007) Retrieved June 3,
2008 www.webmd.com/mental-health/oppositional-defiantdisorder?page=3&print=true.
Napoulos, Peggy M.D., Donna D’Alessandro M.D. and Lindsay Huth, B.A.,
Oppositional Defiant disorder. (April 2002). Retrieved June 3, 2008
http://www.virtualpediatrichospital.org/patients/cqqa/odd.shtml
Oppositional Defiance Disorder, Wikipedia Contributors. Retrieved June 3, 2008
http://www.conductdisorders.com/ourarticles/oppositional_defiance.shtml
Oppositional defiant disorder (ODD) (Dec., 19, 2007) Retrieved June 3, 2008
www.mayoclinic.com/print/oppositional-defiantdisorder/DS00630/METHOD=print.
Oppositional Defiant Disorder, (1995). Retrieved June 4, 2008
http://jas.familyfun.go.com/sendpage?page=sendpage&dest=print.
Resources
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Oppositional Defiant Disorder, (1992).Retrieved April 3, 2009
http://www.mental-health-matters.com/disorders/print.php?disID=67.
Oppositional defiant disorder rating scale: preliminary evidence of reliability and
validity.(psychological research)(includes statistical tables) (22-Jun-06). Journal
of Emotional and Behavioral Disorder. Retrieved April 4, 2008,
http://www.accessmylibrary.com/comsite5/bin/aml_landing_tt.pl?purchasetype=I
TM&ite.
Pruitt, David M.D. and AACAP, Your Child: Emotional, Behavioral & Cognitive
Development from through Preadolescence. Retrieved April 14, 2009
http://www.aacap.org/cs/root/publication_store/your_child_oppositional_defia
nt_disorder.
Pruitt, David M.D. and AACAP Your Child: Emotional, Behavioral & Cognitive
Development from Early Adolescence through the teen years. Retrieved April 14,
2009
http://www.aacap.org/cs/root/publication_store/your_adolescent_oppositional
_defiant_disorder.
Tynan, W. Douglas, PhD Journal of Abnormal Child Psychology 32 (June 2004):
263-271."Oppositional Defiant Disorder." eMedicine November 2, 2003. ...
Retrieved April 15, 2009
www.healthatoz.com/healthatoz/Atoz/common/standard...
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