Oppositional defiant disorder Flashcards
Diagnostic criteria
Oppositional defiant disorder (ODD) is a pattern of negativistic, hostile, and defiant behavior
lasting at least 6 months during which four or more of the following criteria are present (a
criterion is met only if the behavior occurs more frequently than typically observed in people of
comparable age and developmental level):
a. Often loses temper
b. Often argues with adults
c. Often actively defies or refuses to comply with adults’ requests or rules
d. Often deliberately annoys people
e. Often blames others for his or her mistakes or misbehavior
f. Is often touchy or easily annoyed by others
g. Is often angry and resentful
h. Is often spiteful or vindictive
OT Tx plan (Behavioral therapy for ODD)
a. Consistent expectations and consequences
b. Use of the same behavior program both in the home and at school
c. Positive reinforcement system
Focus of occupational therapy intervention: functional outcomes for the client within context
(e.g., home, school, day care, job)
a. Following classroom or work rules
b. Taking direction from other people
c. Following society’s rules
d. Ameliorating skill deficits (most pronounced during times of stress)
e. Using coping strategies to more successfully engage in everyday occupational pursuits
f. Using self-management strategies such as relaxation techniques (deep breathing) or visualization techniques
Tx plan (Five characteristics of optimal treatment)
a. Instructions or requests are clear and simple.
b. Time-ins are used to increase pleasant social and physical contact.
c. Time-outs are used to decrease pleasant social and physical contact.
d. Clients practice positive behaviors in brief, intensive practice sessions.
e. Incidental teaching involves catching the client being compliant and rewarding him or her
to reinforce the desired behavior
Interventions to improve social skills, problem solving, and anger management
a. Videotaped modeling and role plays of conflict situations
b. Reading and discussion of stories about children who encounter and deal with social problems
c. Child-centered intervention, in which the child initiates and directs the activities and the therapist supports the child
d. Formation of groups of clients with similar interests to help them cope and practice social interaction
e. Socratic questioning to encourage the child to articulate a rationale for his or her decisions
f. Behavior management techniques such as recording progress on charts, time-outs, and alternating preferred and non-preferred activities
Interventions for parents
a. Teaching parents to attend to and praise their child’s appropriate behaviors and to provide
simple and clear commands and use time-outs
b. Teaching parents to use “labeled praise” to reinforce to the child the behaviors that are appropriate
c. Role-playing with parents to handle situations at home and in the community (e.g., grocery
store)
d. Teaching parents stress management skills
Interventions in the environment
a. Modification of the environment to limit distractions and promote the child’s self-regulation and attention
b. Emphasis on structure and routines
Assessment
- Clients who have experienced failure may not be receptive to engaging in a formal assessment process. The practitioner should take care not to reinforce a sense of failure by pushing the client to take on challenging tasks or encouraging the client to continue an activity when the practitioner notes signs that the client is fatiguing or becoming frustrated
- People with ODD are not always truthful and generally do not have insight into their oppositional behavior. They are unlikely to be able to articulate an accurate picture of their
behavior - Informal evaluation strategies, such as observing the client in his or her natural environment and interviewing the parent or caretaker, are often most appropriate for clients with ODD.
