Lectures 4: Oppositional Defiant Disorder Flashcards
Differentiating ODD from CD
Conduct Disorder is a relentless pattern of conduct in which the basic rights of others and key age-appropriate societal norms or rules are violated
***Aggression Criterion – causing harm, antisocial
Oppositional Defiant Disorder is a pattern of negativistic, aggressive and defiant behavior without the more serious violations of the basic rights of others that are seen in conduct disorder
*Aggression NOT needed for diagnosis
(there was almost a specifier with/without aggression)
*in older children, ODD often manifests as disrespect
**ODD -OR- CD diagnosis, never together, though ODD may precede CD
2/3 or children with ODD do NOT go on to develop CD
*CD more likely diagnosed in older child – more access to different settings outside the home: theft, truancy, staying out late
** CD seems to be more biologically-based, whereas ODD is more related to parental conflict and interpersonal style
Intermittent Explosive Disorder
Several discrete episodes of failure to resist aggressive impulses that result in serious assault of acts or destruction of property
The degree of aggressiveness expressed during the episodes is grossly out of proportion to any precipitating psychosocial stressors
The aggressive episodes are not better accounted for by another mental disorder, and are not due to the direct physiological effects of a substance or general medical condition
Dr. Ohr: what is mania in children? Possibly IED
Prevalence of ODD
One of the most common referrals (1/3-2/3 of all child referrals)
2-16% of general population
- 3% of children 6-18
* Prevalence rate varies based on definition
ODD diagnosed equally in preschool, boys more prevalent prior to adolescence but during adolescence rates will increase for both boys and girls
**More boys develop CD
Highly comorbid with ADHD and CD, as well as anxiety and depression
DSM-5 Criteria for ODD
A recurrent pattern of negativistic, hostile [term carefully chosen to be different from “aggressive”], and defiant behavior
Duration of six months or longer
4 or more of the following behaviors observed during action within least one individual that’s not a sibling:
*Angry/Irritable Mood
loses temper
easily annoyed
angry resentful
- Argumentative/Defiant Behavior
- argues with authority figures or adults
- actively defies requests/rules–*important to consider whether child is defiant or scared–e.g. afraid of the dark, won’t sleep; social anxiety, school refusal
- deliberately annoys
- blames others for mistakes or misbehavior
*Vindictiveness
is often spiteful and vindictive
*at risk for externalization, Conduct Disorder and Antisocial Personality Disorder
*lack of remorse, empathy: “you were asking for it”
** This grouping implies different trajectories for child based on research
e.g. enjoy hurting animals, likely to develop CD
hurt animals with no enjoyment–sociopathy
*Negative attention sometimes better than no attention
child feels dysphoria, can’t find a way to feel better– seeing parents unhappy might make them less unhappy
If they genuinely enjoy seeing their parents unhappy, they are more likely to develop CD
Development of Oppositional Behaviors
Average Age of Emergence
age 3– child acts stubborn
age 5 – defies adults, temper tantrums
age 6 – irritable, argumentative, blames others
age 7 – annoys others spiteful and angry
Etiology of ODD
Multiple interacting etiologies
No single factor has been determined to be “the cause”
Rather than finding a single etiological factor, it seems more likely that there are numerous possible combinations of contributing variables that can result in the clinical manifestations of CD and ODD
Family Etiological Factors for ODD
Inconsistent parenting
Authoritarian or harsh parenting
**Parental conflict – divorce
Use of physical aggression
Little involvement in child activities
Family dynamics: interaction of cause-and-effect
**Coercive Cycle of ODD
Conduct problems can evolve from ongoing patterns of coercive parent-child interactions that are characterized by:
Escalating parent and child demands
Escalating negative consequences, Or the person who dispenses the most negative consequence “wins”
Problems with “winning the battle” while “losing the war”
e.g. the parent becomes less demanding in public – wants the child to calm down, causing embarrassment – child gets what they want, reinforced for escalating negative consequences
Dr. Ohr believes that the coercive cycle is the biggest contributor to the development and maintenance of the ODD
Coercive Hypothesis Patterson
Children learn to get their own way and escape or avoid parental criticism by escalating their negative behaviors, which in turn leads to increasingly aversive parent interactions
As this pattern continues over time, the rate and intensity of parent and child aggressive behaviors are increased
Coercive patterns are thought to promote children’s antisocial behavioral development because these patterns provide reinforcement for oppositional, noncompliant behaviors and models of hostile and punitive interpersonal styles
Individual Risk Factors for ODD
Hyperactivity
Impulsivity– Sensation seeking
Difficult temperament
Neuropsychological deficits – learning deficits
Male gender
Association with delinquent peer group as child gets older
Poor interpersonal problem-solving skills
Miscellaneous class notes
Sometimes we may see parents behaving very poorly, but it is important to be respectful, as you don’t know the full story – “you are walking into the middle of the movie”
They may have started out as very good parents trying their hardest with good skills, but by the time they bring their child in for treatment, it is possible that they have just become overwhelmed and simply broken – tired, yelling, giving up and letting the child win.
True ADHD is neurodevelopmental, the child really has challenges, such that traditional parenting just won’t work, leading to frustration and conflict – ADHD & ODD
*Just be careful that ODD not be diagnosed as ADHD
Environmental Risk Factors for ODD
Poverty
Increased parent stress
Single-parent households
Decreased financial and community resources
Increase community dangers, e.g. gangs, drugs
Negative peer influences
Covert/Overt & Destructive/Nondestructive Behaviors Typical of Disruptive disorders
*Covert
stealing
substance abuse
*Overt
aggression
oppositionality
*Destructive
Vandalism
Fighting
*Nondestructive
Truancy
Arguing
Combination Age Progression: Stage 1: ODD
- ODD – Overt & Nondestructive
tantrums, arguing, noncompliance, defiance, annoying
ODD – CD Relationship
Persistent ODD symptoms often proceed and predict early onset of CD
ODD and CD generally emerge at different ages
Achenbach & Edelbrock (1981)
- Youngest children tended to display oppositional behaviors
- at later ages, behavior such as stealing and fire setting increased
- other serious conduct disordered behaviors such as truancy, vandalism, and involvement in substance abuse develop later
