Oppositional and Defiant + Conduct Disorders

Question 1

What are two examples of boys with conduct disorder but who show different behaviours

Answer 1

Boy 1: when he gets frustrated and someone tells him “no”, he feels angry, and he’ll throw things at his parents and siblings, hit and scream

Boy 2: breaks rules but it’s much less based on experiencing frustration and emotions at the moment and reacting impulsively, he uses aggression more as a tool, more instrumental
- his parents caught him microwaving a baby squirrel he found in the woods

there is DIVERSITY

Question 2

Diagnostic Criteria for Oppositional Defiant Disorder

Answer 2

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.

6 months, four symptoms of any category, at least one individual (not sibling)

vindictive behavior must have occurred at least twice within the past 6 months

Question 3

Explain the different severities of symptoms for ODD:

Answer 3

Mild: Symptoms are confined to only one setting (e.g., at home, at school, at work, with peers).

Moderate: Some symptoms are present in at least two settings.

Severe: Some symptoms are present in three or more settings.

Question 4

is ODD like a flu/cold or diabetes?

Answer 4

we can say flu
- less of a unified construct - just explains behaviour
- many psychologists wouldn’t diagnose this, depends on if the diagnosis would be useful in a certain setting

Question 5

Diagnostic Criteria for Conduct Disorder:

Answer 5

basic rights of others or major age-appropriate societal norms are violated, as manifested by:

3 or more of the following criteria in the past 12 months with at least one criterion present in the past 6 months

Question 6

What are the different onset types?

Answer 6

1. childhood-onset
2. adolescent-onset
3. unspecified onset

Question 7

What do you need to specify the person has or doesn’t have for CD?

Answer 7

limited prosocial emotions
- must have displayed 2 of the following persistently over at least 12 months and in multiple settings

• Lack of remorse or guilt
• Callous—lack of empathy
• Unconcerned about performance
• Shallow or deficient affect

Question 8

what type of onset is more common than the other? which type is associated with a more severe course? (CD)

Answer 8

adolescent onset is more common than childhood-onset

childhood-onset has a more severe course - this level of conduct in a child is NOT a good sign

Question 9

what is the pattern of ODD and CD disorders?

Answer 9

starts with a larger group having ODD, then moves onto a select group of those having CD, then moves onto a smaller select group having psychopathic traits (what we would see in adults)

Question 10

ASEBA - CBCL:

Answer 10

• questionnaire given to parents/caregivers (ages 6-18)
• starts off positive
• has normative data to compare
• they have attempted to be more culturally sensitive (you can pick a norm group that best matches the client)
• there are also versions of this that children + teachers can fill out

Question 11

what happens to the items on the CBSL when looking at the raw scores, T-scores, and percentiles?

Answer 11

the individual child behaviours get combined into subscales (syndromes - items that seem to hang together statistically)

Question 12

What are the categories that the syndrome scales are separated by?

Answer 12

internalizing, externalizing and other

Question 13

What is considered a borderline clinical range?

Answer 13

a T-score that is 1.5 SD’s away from the mean

Question 14

what are ways that the behaviours can be separated into categories for the ASEBA

Answer 14

1. into syndrome scales
2. into internalizing, externalizing, total, and other problems (here the clinical cut-off is lower SD=1.5)
3. DSM oriented scales
4. compared to other raters

Question 15

Why are there generally low correlations between the average agreement of parent-teacher (.23), parent-child (.29) and teacher-child (.19)?

Answer 15

• we behave differently in different settings
• the self has more transparent access to our insides
• it makes sense that they’re not perfect, but there is still a + relationship

Question 16

In the graphs that compare averages, what does NG, NB, RG, RB mean? why are these graphs interesting?

Answer 16

NG = not referred girl
NB = not referred boy
RG = referred girl
RB = referred boy

we would expect for not referred children to endorse the behaviors less than the referred children, but with some behaviors that isn’t true
ex: all of them said they kept secrets
ex: NG and RB screamed the same amount

Question 17

reactive aggression

Answer 17

something doesn’t go your way, you have a strong feeling and then you’re aggressive in response to a stimulus in the environment
ex: hitting when someone says “no”

Question 18

instrumental aggression

Answer 18

using aggression as a tool to achieve a goal

Question 19

explain how there can be tremendous diversity in two people meeting diagnostic criteria for conduct disorder in the psychological sense:

Answer 19

one adolescent may be very instrumental and have a very high IQ (130) but sells drugs in highschool and is very strategic

another adolescent may be more impulsive, and be in the second percentile for intelligence (IQ-70)
- this group can be very vulnerable - look like all the kids your age, but cognitively you operate differently

Question 20

What are gender differences in CD?

Answer 20

more likely to see these problems much more often in boys than girls (continues into adulthood)

Question 21

what is a type of aggression that women/girls engage in in a high degree?

Answer 21

relational aggression
- we see this early on (ex: kindergarten)

Question 22

What do the NICE quidelines siggest for clinical practice with children/ados with ODD+CD? For ages 3-11 and 11-17?

Answer 22

from 3-11 yrs old: individual or group parent training (PMT); also evidence for working with children directly to build relevant skills
- parents are focused for the younger kids because they still have a lot control over younger kids environments

from 11-17 yrs old: multisystemic therapy
- less control on the environment at this age
- parents and kids and school is involved - trying to control the environmental contingencies that are leading to problematic behaviours

Question 23

WHat is a pharmacological intervention that may work for some individuals with ODD or CD?

Answer 23

ADHD medication: methylphenidate or atomoxetime
if they have ADHD as well

risperidone if not responding to psychosocial interventions

Question 24

what role does a parent play for a child?

Answer 24

their boss
- we want them to embody the characteristics of a good boss as the parent and think about how some of the things they do currently resemble a bad boss

Question 25

One-on-One Time

Answer 25

• when you really pay attention to a child and spend time with them, kids take that really well and they think positively
• with little kids, you can narrate what they’re doing like a sports broadcaster

Don’t ask questions, give instructions, criticisms
- asking questions may undermine the positivity of the interaction like
- not the time to teach them something new

Question 26

one-on-one time: praise

Answer 26

• praise is a form of verbal reinforcement (positive reinforcement)
  ex: saying “good job” after every time the child brings their lunch box to the front door

needs to be specific, immediate, consistent

Question 27

scorpion praise:

Answer 27

Adding another comment at the end

ex: “it is great you brought the dishes to the sink, why don’t you do that every night?”

Question 28

Active Ignoring

Answer 28

• opposite of praise
• pretending that you don’t hear or see anything bad, but then giving praise to a behavior that would be adaptive
• stopping the cycle of long explanations after the child misbehaves, and ignoring it instead until the proper behaviour happens