Oppositional Defiance Disorder (ODD)

Question 1

What is normal part of development?

Answer 1

• Children age 2 to 3 experience terrible twos

- add to lessons during puberty

Question 2

When does problematic behaviour become a serious concern?

Answer 2

When excessively uncooperative and hostile behaviour affects daily life

Question 3

ODD

Answer 3

Oppositional defiance disorder

• ongoing pattern of disobedient, hostile and defiant behaviour towards authority figures
• A pattern of angry/irritable mood, argumentative/defiant behaviour or vindictiveness lasting at least six months

Question 4

Diagnostic criteria for ODD

Answer 4

At least for symptoms of the following

Angry/irritable mood

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

Argumentative/defiant behavior

1. Often argues with authority figures
2. Often actively defies or if uses to comply with rules or with request from authority figures
3. Often deliberately annoys others
4. Often blames others for his/her mistakes or misbehaviour

Vindictiveness
1. Has been spiteful at least twice

Disturbance in behaviour causes distress in immediate or social life or has other negative impacts of functioning
-not during psychotic, substance use, depressive, or bipolar disorder

Question 5

Severity of ODD

Answer 5

Mild: symptoms within only one setting
Moderate: symptoms are present in two settings
Severe: symptoms are present in three or more settings

Question 6

ODD statistics

Answer 6

1 to 6% of population
AOO: by age 8 years, 13 years the latest
-Most children grow out of it, not clear if exist in adults
-More common amongst boys in early childhood, equal in boys and girls in school aged in preadolescence

Question 7

Comorbidity of ODD

Answer 7

ADHD
Mood disorders
Personality disorders
SUD
Anxiety disorders

Higher risk to develop other disorders if earlier on set, especially if untreated

Question 8

ODD versus conduct disorder

Answer 8

ODD:

• less severe chronic miss behavior
• has earlier on set
• does not involve aggressivity towards other people or animals
• does not involve destruction of property
• does not involve pattern of theft and deceit

Question 9

Psychological dimension of ODD

Answer 9

Difficult temperament:
Negative affect
Lower adaptability

Increase surgency
Decreased level of persistence
Low agreeableness

Question 10

ODD study summary

Answer 10

Aim: examine the association of interpretive understanding (ability to describe a piece of familiar drawing from the dogs perspective) and sympathy (Feel sorry about others being picked on/teased)with ODD symptoms

Children aged 4 to 8
-self report and caregivers report

Those with low interpretive understanding are moderate on the ODD scale
- those with high IU hi on ODD scale if a little sympathy, but low on ODD scale if high sympathy

Sympathy moderates the effects of IU on ODD

Question 11

Genetic basis of ODD

Answer 11

40-60% heredible from twin studies
- higher risk if 1st degree relative has behavioural disorders of SUD

Genotypes in question mixed:

• Serotonin transporter gene: ODD, AGG behaviour
• Dopamine receptor gene: ODD, conduct problems

But genome wide study found no sig association between genes and ODD sympt.

Question 12

Epigenetic effects of ODD

Answer 12

Higher global DNA methylation associated with headstrong, but not irritable aspects common in ODD and ADHD

Question 13

Exposure to neurotoxins and ODD

Answer 13

nicotine and paracetamol effect ODD

Question 14

Neuro volume and ODD

Answer 14

lower volume and amygdala, striatum and PFC

Question 15

Structural brain imaging study and ODD

Answer 15

MRI in 11-17 year old boys

• group 1: ADHD
• group 2: ADHD, ODD, CD
• group 3: typical development

Group one had thicker cortex in some areas

Question 16

Inhibition brain region study and ODD

Answer 16

healthy controls vs. children with ODD

• fMRI and response inhibition task
• age 10 to 12 years old

ODD group

• Lower accuracy rateFor inhibited responses
• Longer stop latency
• More activation in frontal gyri

Question 17

Social dimension of ODD

Answer 17

• Lower SES
• Downward social interest hypothesis
• Negative family dynamics
• Poor quality childcare, Bidirectional with a difficult temperament
• Can be neglected or maltreated

Question 18

Social protective factor of ODD

Answer 18

Parental warmth

Question 19

Developmental theory of ODD

Answer 19

Child’s ability to process thoughts or feelings are limited or delayed

• Children have impaired inhibition, learning, attention, decision-making
• Also affects social learning

Question 20

Learning theory of ODD

Answer 20

Negative experience such as negative parenting leads to ODD

Question 21

Medication/Biological treatment of ODD

Answer 21

Biological mechanisms are unclear

• Methylphenidate
• Atomoxetine
• Risperidone

Medication alone not recommended

Question 22

Methylphenidate

Answer 22

A stimulant
Mostly used for ADHD, Used if ODD coexist with ADHD
- Blocks dopamine transportation And norepinephrine transportation
- Lowers the reuptake of dopamine and norepinephrine which increases their activity

Question 23

Atomoxetine

Answer 23

Non-stimulant, Used for ADHD, Used if ODD coexist with ADHD
- Inhibits the re- up to take
orepinephrine- Less abuse potential than stimulants, But lower responsivity andEfficiency and young children is unknown

Question 24

Risperidone

Answer 24

• Antipsychotic, Mostly used for schizophrenia and irritability
• Block certain dopamine and serotonin receptors
• Lowers the neurotransmission of dopamine insert

Question 25

Effects of Risperidone and methylphenidate

Answer 25

``` Study of children with ADHD and ODD - double blind randomized placebo-controlled -Children 8 to 10 years old -Eat week assessment ``` - G1: MPH + RISP - G2: MPH Significantly lower Oppositional problems by eight week for those taken both, Less hyperactivity, Weight gain, Higher waist circumference

Question 26

Social skills training and ODD

Answer 26

Can work on a adaptive problem-solving skills | - Helps prevent alienation from peers

Question 27

Barkley's Parent training model

Answer 27

- More positive and less frustration | - Uses positive reinforcement of behavior

Question 28

Other important notes for psychotherapy in ODD

Answer 28

- Need to watch for Internet gaming addiction - High-risk for relapseAnd development of conduct disorder, Especially if Parenting quality is poor or parents are alcoholics

Question 29

Summary of study looking at a effects of parent training and medication

Answer 29

Each 6 to 12 years old, Nine week assessment G1: Parents training and stimulant G2: Parent training, stimulant and risperidone Looked at your don't with OCD, ADHD, CD And. Aggression symptoms Greater improvements, Less impairments if medications combine For all groups, Especially ODD