Transcript Adolescent Brain Presentation

Oppositional Defiance
Disorder
What is it and how do we survive it in the classroom?
What is it?
Definition:
Diagnostic and Statistical Manual of Mental Disorders (DSM)
as an ongoing pattern of disobedient, hostile and defiant
behaviour toward authority figures which goes beyond the
bounds of normal childhood behaviour.
Behaviours associated with ODD
 out of seat often
 disruptive noises
 does not listen
 rummages shelves/cupboard
 hits, kicks, shoves
 giggles in silly way
 cries over small matters
 argues in angry way
 destroys property
 forces someone to do
something they don't want to
do
 takes something from another
child
 defies teacher
 throws an object at someone
 refuses to share
 curses
 speaks out of turn
 Interrupts
 repeatedly asks same
question
 makes fun of another
 forces someone to do
something they don't want to
do
How do we know if it is not just
typical adolescent behaviour?
Typical Adolescent
Adolescent with ODD
 Normal to moderate
oppositional behaviour
 EXTREME oppositional
behaviour
What is the cause of ODD?
Biological:
1.) Possibly defects in or injuries to certain areas of the brain
2.) Abnormal amounts of special chemicals in the brain called
neurotransmitters.
3.) Also have other mental illnesses, such as ADHD, learning
disorders, depression, or an anxiety disorder.
Genetics:
Frequently family members with mental illnesses, including
mood disorders.
Environmental:
Dysfunctional family life
How common is this?
 Disruptive behaviour disorders appear to be more
common in boys than in girls, and they are more
common in urban than in rural areas.
 Between 5% and 15% of school-aged children have
Oppositional Defiant Disorder (ODD). A little over 4% of
school-aged children are diagnosed with Conduct
Disorder (CD).
When and for how long does this
last?
 Behaviours that may signal the beginnings of ODD or CD
can be identified in preschoolers. Most children with
ODD symptoms “grow out of it” with treatment.
 Some may go on to develop Conduct Disorder. Children
and adolescents with CD whose symptoms are not
treated early are more likely to fail at school and have
difficulty holding a job later in life. They are also more
likely to commit crimes as young people and as adults
Often comorbid with other
disorders
Anxiety
Disorder
ADHD
Depression
Conduct
Problems
(including
ODD and
CD)
Conduct Disorder Vs. ODD
Debate
 In a study assessing the diagnoses of 108 children using
DSM-III-R criteria, Reeves et. al (1987) found only four
children with a conduct disorder diagnosis
unaccompanied by any other diagnosis, and only two
children had an ODD diagnosis alone.
 In a comparison of clinically diagnosed children and a
control group of normal children Reeves et. al (1987)
found that children with ADD and conduct disorder had a
much higher frequency of adverse family backgrounds
and were characterized by fathers with lower education
levels, family alcoholism, and fathers with antisocial
personalities. These children did not differ significantly
from the normal group in terms of marital adjustment of
parents or parental strife observed by the child
Conduct Disorder Diagnosis
Criteria
 has stolen without
confrontation of a victim
on more than one
occasion
 has deliberately destroyed
others' property
 has run away from home
overnight at least twice
while living in parental or
surrogate home
 has forced someone to
have seual activity with
him or her
 has been physically cruel
to animals
 often lies
 has used a weapon in
more than one fight
 has deliberately engaged
in fire setting
 often initiates physical
fights
 is often truant from school
 has stolen with
confrontation of a victim
 has broken into someone
else's house, building, or
car
 has been physically cruel
to people
Difference between conduct
problem disorders
Antisocial
Personality
Disorder
Conduct
Disorder
Childhood Onset
Primarily
Impulsive Type
CallousUnemotional
Type
OPPOSITIONAL
DEFIANCE
DISORDER
Adolescent
Onset
Subtype 1 of conduct disorders
Absence of
guilt and
empathy
More sever
and
aggressive
behaviour
Callous
Unemotional
Type
More of a
genetic
basis
Associated
with APD
and
psychopathy
Subtype II of conduct disorders
Likely to be
rejected by
their peers
Deficit in
social
information
processing
Primarily
Impulsive
Type
Comorbid
ADHD more
common
High rates of
dysfunctional
home life
What can ODD lead to?
ODD
Conduct
Disorder
Antisocial
Personality
Disorder
Psychopathy
Conduct
Disorder vs.
ODD
Stealing
Conduct
Disorder
Oppositional
Defiance
Disorder
Treatment
 Really needs to be tailored to the individual child
Parent training programs
 Individual therapy
 Social skills therapy
 Cognitive psychology therapy
 relaxation training
 thought stopping
 replacing upsetting thoughts with calming thoughts
 self-selected time-outs
Often cited as the most
successful method of treatment:
Social Learning/ Family therapy
 addressing the multiple systems involved, including parents,
siblings, school personnel, and others
 effective therapeutic intervention skills which include impacting the
environment and establishing positive expectations for change
 developing self-control skills for the entire family such that parents
and children have alternatives to explosive or depressive behaviour
 defining disciplinary approaches that lead to positive changes for all
family members
 social enhancement methods for increasing prosocial behaviours
 maintenance skills for continuing change once it has occurred
Neuroscience behind it all
 Adrenal androgens levels higher
 Lower baseline heartrates
 Median cortisol levels are lower on average
 Lower levels of 5-Hidroxyindoleacetic acid (5-HIAA) and
Homovanillic acid (HVA)
 Postsynaptic serotoninergic receptor is oversensitive
(may be related more to ADHD)
Teaching Strategies
1.) Establish clear behaviour goals with the student
2.) Monitor their progress towards these goals
3.) Positive reinforcement
4.) Consistent consequences for inappropriate behaviour
5.) When possible change behaviour antecedents
6.) Find out what punishments will work best with the
student
1.) Establish clear behaviour
goals with the student
 Have a meeting with the student and their parents to
determine SMART goals
 gather information about cognitive/emotional reactions
 gather information about sequences and patters
 Think about situations that could arise and give the
student alternatives to acting out
 break complex problems into manageable units
2.) Monitor their progress
towards these goals
 Set up a behaviour log
 Set up weekly meetings to monitor progress
 Send progress reports home
3.) Positive reinforcement
4.) Consistent consequences for
inappropriate behaviour
5.) When possible change
behaviour antecedents
 communicate empathy
 provide reassurance and normalize problems
 use self-disclosure
 define everyone as a victim
 emphasize positive expectations for change
 match your communication style to the family
 use humour use open-ended questions
 share the agenda
 deal with one issue or task at a time
 break complex problems into manageable units
 end sidetracking
 give everyone a chance to participate
6.) Find out what punishments
will work best with the student
 Ignoring
 giving commands
 time-out procedure
Caution: as with any child, extensive punishment sets up
escape and avoidant behaviours that may be more harmful
to the relationship between teacher/parent and child than is
the behaviour being punished
Resources to help!
BOOKS
-
Treating Conduct and Oppositional Defiant Disorders in Children
-
Children with Conduct Disorders, A Psychotherapy Manual
-
No More Misbehavin': 38 Difficult Behaviors and How to Stop Them
-
Kids are worth it! Revised Edition: Giving Your Child the Gift of Inner
Discipline
-
The Difficult Child
-
How to Behave so your Children Will
-
Your Defiant Child: Eight Steps to Better Behaviour
-
Discipline: The Brazelton Way
-
Making Children Mind without Losing Yours
-
Raising your Spirited Child: A Guide for Parents Whose Child is more
Intense, Sensitive, Perceptive, Persistent and Energetic
-
Rage, Rebellion and Rudeness: Parenting in the new Millennium
Websites

American Academy of Child and Adolescent Psychiatry
**www.aacap.org/publications/factsfam**

Canadian Paediatric Society
**www.caringforkids.cps.ca/behaviour**

Canadian Mental Health Association
www.cmha.ca

Children’s Mental Health Ontario
www.kidsmentalhealth.ca

Centre for Addiction and Mental Health
www.camh.net

The ABCs of Mental Health – a Teacher Resource
www.brocku.ca/teacherresource/ABC

When Something’s Wrong: Ideas for Teachers
www.cprf.ca