Chapter 16 - ODD/CD

Question 1

What is the difference between internalizing and externalizing disorders?

Answer 1

-Internalizing: focus on the self, inner-directed emotions
-Externalizing: behaviors or symptoms that affect others, outer-directed behaviors
-Diagnosis requires a persistent pattern of behavior that is: atypical for age and developmental level; distress to the child/others or negatively affects functioning

Question 2

What are the DSM-5 Criteria for Oppositional Defiant Disorder (ODD)?

Answer 2

-A: Pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting 6 months, with ≥4 symptoms from any of the following, exhibited with at least one person
who is not a sibling
1. Loses temper
2. Is touchy or easily annoyed
3. Is angry and resentful
4. Argues with authority/adults
5. Actively defies or refuses to comply with requests from authority figures or with rules
6. Deliberately annoys others
7. Blames others for mistakes/misbehaviors
8. Spiteful or vindictive
-B: Cause distress in individual or others in immediate social context, or impair functioning

Question 3

What are the DSM-5 criteria for Conduct Disorder (CD)?

Answer 3

-A: Repetitive, persistent pattern of antisocial behaviors, ≥3 symptoms from any of the following, last 12 months (at
least 1 in past 6 months)
1. Bullies, threatens, or intimidates others
2. Initiates physical fights
3. Used a weapon that can cause serious physical harm to others
4. Physically cruel to people
5. Physically cruel to animals
6. Stolen while confronting a victim
7. Forced someone into sexual activity
8. Deliberately engaged in fire setting with intention to cause damage
9. Deliberately destroyed other’s property
10. Broken into someone’s house, building or car
11. Often lies to obtain goods/favors or to avoid obligations
12. Stolen items of nontrivial value (e.g. shoplifting)
13. Stays out at night despite parental prohibition (before age 13)
14. Run away from home
15. Truant from school (before age 13)
-B: Cause significant impairment in social, academic, or occupational functioning

Question 4

What are the diagnostic specifiers for CD?

Answer 4

-Onset/course: childhood-onset: <10 years; adolescent-onset: 10+
-With limited prosocial emotions (i.e., callous-unemotional traits): ≥2 symptoms in 12 months:
–lack of remorse/guilt
–callous-lack of empathy
–unconcerned about performance
–shallow/deficient affect

Question 5

What are the prevalence rates and sex differences for ODD & CD?

Answer 5

-ODD: 3.3%
-CD: 3.2%
-2-4x higher in males
–sex difference emerge by age 4
–decreases in adolescence

Question 6

What are the characteristics of childhood-onset of CD?

Answer 6

-Chronic course (persistent of
behaviors across development)
-Predominantly males
-More aggressive/violent
-More biological risk factors
-Severe family dysfunction
-ADHD

Question 7

What are the characteristics of adolescent-onset CD?

Answer 7

-Stronger environmental contribution
-More females
-Less violent
-Often do not have ADHD or ODD
-Many desist but some don’t

Question 8

What indicates a poor prognosis (childhood onset)?

Answer 8

-CU traits are a prognostic risk factor for
–greater severity of disruptive behaviours
–less responsive to treatment
–poorer long-term outcomes

Question 9

How do genetics influence ODD & CD?

Answer 9

-Higher genetic influence for CD than ODD
–life course persistent pattern
–CU traits
-Low MAOA activity
-Low fear temperament
-strongly linked with CU traits

Question 10

What is the neurobiology of ODD & CD?

Answer 10

-Lower activation of limbic system (e.g., amygdala)
-Reduced autonomic system activity
-may reduce fear conditioning
-may be associated with need for increased stimulation

Question 11

How does the psychological dimension explain ODD & CD?

Answer 11

-Behavioral theories
–modeling and positive reinforcement
-Cognitive theories
–hostile attribution bias: mistakenly view neutral behaviour as
aggressive/threatening
–expect favorable outcomes from aggression

Question 12

What are the parenting influences?

Answer 12

-Inconsistent parental discipline and harsh parenting
-Coercive cycle of parent-child interactions (Patterson) –operant conditioning
–ex: child believes that screaming loud enough will get them the toy; parent believes that spanking will make the child stop screaming

Question 13

Which social environments are linked with ODD & CD?

Answer 13

-Unpredictability in home and neighbourhood
-Exposure to neighbourhood violence

Question 14

What are the evidence-based treatments for ODD & CD?

Answer 14

-Children: Behavioural Parenting Interventions
–ex: PCIT, Incredible Years, Triple P
-Adolescents: Combined Behavioural Therapy + CBT + Family Therapy
–ex: Multisystemic Therapy (MST), Functional Family Therapy (FFT)

Question 15

How do Behavioural Parenting Interventions work?

Answer 15

-Goals: teach parents skills to reinforce desirable behaviors in children & discourage undesirable behaviors (operant conditioning); improve parent-child relationships
-Skills:
–praise and rewards for good behavior
–consequences for misbehavior
–give effective commands
–set limits
-Group or individual

Question 16

How does Functional Family Therapy work?

Answer 16

-For adolescents with delinquent behaviors
-Family-based intervention
-Goals: build skills for communication, effective parenting, conflict management, decrease dysfunctional patterns of behaviours
-Intensive, usually in the home

Question 17

How does Multisystemic Therapy work?

Answer 17

-For adolescents with serious antisocial/delinquent behavior
-Goal: promote responsible behavior, decrease irresponsible behavior, prevent out-ofhome placement
-Intensive, comprehensive, community-based intervention
-Frequent contact with therapists
-Techniques: CBT, parent training, and family therapy techniques