2.2.3 - Outline how a clinical would undertake a comprehensive assessment of a child presenting with features suggestive of oppositional defiant disorder

Question 1

DSM-5 criteria for ODD

Answer 1

A. A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months as evidenced by at least four symptoms from any of the following categories, and exhibited during interaction with at least one individual who is not a sibling.

Angry/Irritable Mood

1. Often loses temper.
2. Is often touchy or easily annoyed.
3. Is often angry and resentful.

Argumentative/Defiant Behavior
4. Often argues with authority figures or, for children and adolescents, with adults.
5. Often actively defies or refuses to comply with requests from authority figures or
with rules.
6. Often deliberately annoys others.
7. Often blames others for his or her mistakes or misbehavior.

Vindictiveness
8. Has been spiteful or vindictive at least twice within the past 6 months.

Note: The persistence and frequency of these behaviors should be used to distinguish a behavior that is within normal limits from a behavior that is symptomatic. For children younger than 5 years, the behavior should occur on most days for a period of at least 6 months unless otherwise noted (Criterion A8). For individuals 5 years or older, the behavior should occur at least once per week for at least 6 months, unless othenwise noted (Criterion AS). While these frequency criteria provide guidance on a minimal lev­ el of frequency to define symptoms, other factors should also be considered, such as whether the frequency and intensity of the behaviors are outside a range that is nor­ mative for the individual’s developmental level, gender, and culture.

B. The disturbance in behavior is associated with distress in the individual or others in his or her immediate social context (e.g., family, peer group, work colleagues), or it impacts neg­ atively on social, educational, occupational, or other important areas of functioning.

C. The behaviors do not occur exclusively during the course of a psychotic, substance use, depressive, or bipolar disorder. Also, the criteria are not met for disruptive mood dysregulation disorder.

Question 2

Mnemonic for Sx of ODD

Answer 2

AVA (like AVO)
Argumentative
Vindictive
Angry

Question 3

What type of assessment should you use?

Answer 3

Multistage

FIRST STAGE:
Start with a clinical interview with parents - to ascertain type, severity and impairment

Family factors have been found to be relevant to the development and maintenance of behavioural problems

Other questions can be asked to determine comorbidity with ADHD, depression, Reading disorders, screening for cognitive deficits

SECOND STAGE:
Use focused measures based on what you found in the interview.

BEHAVIOURAL Assessment and observation in child’s environment would be idea.

Some measures can also be helpful - e.g. the ASEBA - Aggressive Behaviour vs Rule-breaking behaviour)