Week 4: ODD and CD Presentation Flashcards
Core symptoms of disruptive behavioral disorders
Age-inappropriate actions and attitudes that violate family expectations, societal norms and personal or property rights of others
Big range of behaviors
Some can be minor like arguing or defiance, others can be major like sexual assault or murder
What diagnosis are there for disruptive behavioral disorders?
Oppositional Defiant Disorder (ODD)
Conduct Disorder (CD)
2 axis of disruptive behavioral disorders
Destructive - nondestructive
Covert-overt
Sometimes it can be hard for adults to know the covert ones are going on
Oppositional Defiant Disorder: Main Symptoms
-Age-inappropriate anger/irritability, argumentative/defiant
behavior, or vindictiveness
- Angry/irritable mood
(1) Often loses temper
(2) Is often touchy or easily annoyed
(3) Is often angry or resentful - Argumentative/defiant behavior
(4) Often argues with adults
(5) Often actively defies or refuses to comply with requests from adults or with rules
(6) Often deliberately annoys others
(7) Often blames others for his or her mistakes or misbehavior - Vindictiveness
(8) Has been spiteful or vindictive at least twice in the last 6 months
Oppositional Defiant Disorder: Diagnostic Criteria
and modulating diagnosis based on age
Diagnostic Criteria
(1) Four of the behaviors are present
Note that child has to be engaging in behavior more than is normative for children of their developmental
level. This can be really hard to judge in preschoolers because they are frequently angry and throw tantrums
- For children younger than 5-years-of age, behavior should be occurring on most days for a period of a least six months
- For children 5-years-of-age or older, the behavior should be occurring at least once a week for a period of six months or really severe (Like hitting with objects)
Oppositional Defiant Disorder: Severity
Mild – occurs in only one setting
Moderate – occurs in two settings (typically home and school but maybe is ok with grandparents)
Severe – occurs in three more settings
“Exhibited in interaction with at least one person who is not a sibling”
Siblings
Fighting between siblings is common
During the preschool years, siblings fight once every 10 minutes
35% of 6 to 17 year olds report that they were hit by a sibling in the last year
40% of parents report that one of their children hit a sibling with an object
in the last 12 months
BUT there is mounting evidence that sibling aggression is harmful
- Sibling conflict, hostility, and negatively uniquely predict greater emotional and behavioral problems over time
- Conflict with siblings may lead to maladaptive behavior problems in other relationships
- Markers differentiative normative from pathogenic aggression towards a sibling
- May be that aggression towards a sibling has to be more frequent and severe than aggression towards other children
Conduct Disorder: Basics
Conduct Disorder (CD)
-A repetitive and persistent pattern of violating basic rights of others and/or age-appropriate societal norms or rules, including:
-Aggression to people and animals
Symptom: Often initiates physical fights
Symptom: Has been physically cruel to animals
-Destruction of property
Symptom: Has deliberately engaged in firesetting with intention of causing damage
-Deceitfulness or theft
Symptom: Has broken into someone else’s house, car, or building
-Serious violations of rules
Symptom: Has run away from home overnight twice while living at home, or once without returning for a lengthy period
Conduct Disorder: Diagnostic Criteria
Diagnostic Criteria
3 or more of the behaviors within the past 12 months, with at least one present in the last six months
There are many possible combinations of symptoms
Often bullies, threatens or intimidates others, initiates physical fights, truant from school beginning before 13 years of age
Physically cruel to animals, forced someone into sexual activity, used a weapon that can cause serious physical harm
Conduct Disorder: Onset Categories (2)
Childhood-onset = Onset of at least one symptom before age 10
Adolescent-onset
Conduct Disorder: Severity
Mild – few if any symptoms in excess of those required to meet diagnostic criteria, symptoms are causing mild impairment and harm to others (e.g., lying, truancy)
Moderate – number of conduct problems and impact on others is in between mild and severe (e.g., vandalism, stealing without confronting a victim)
Severe – many conduct problems in excess of those required to make a diagnosis are present, or the behaviors are causing serious harm (e.g., forcing someone into sexual activity, use of a weapon)
Conduct Disorder: Limited Prosocial Emotions/Callus-unemotional (CU) traits
Callous-unemotional (CU) traits
2% to 6% of youth with Conduct Disorder have significant CU traits
When CU is present, CD is earlier onset, aggression is more severe and more instrumental (used to get what they want)
CU associated with insensitivity to punishment
Harder to treat
CD vs ODD
In DSM-IV, CD subsumed ODD but
THEY ARE NOTTHE SAME THING
In DSM-5, they can be diagnosed at the same time
Nearly half of all children with CD have not been diagnosed with ODD, if one was a less severe form of the other, you would expect most to have started earlier with ODD
Most children with ODD do not progress to more severe C
Conduct Disorder: Assessment
In what disorder are youth more important to talk to when diagnosing?
Interviews and Checklists
Parents, teachers, youth
CD – youth are an important informant, because behaviors may be hard for other people to see, particularly for adolescents
ODD – not clear how much youth report adds to parent and teacher
report
Conduct Disorder: Assessment of Limited Prosocial Emotions
Example of a way of assessing this
Give examples of the types of items
DO we require examples and if so, why?
Assessments in development but not here yet. Very hard sometimes to puzzle this out.
-Clinical Assessment of Prosocial Emotions (CAPE)
Is a Semi-structured interview
Which requires multiple information sources
e.g.
Do you care about other people’s feelings?
Please give some examples
Do you find it easy to admit to being wrong? Do you take responsibility for your actions and apologize to people you have hurt?
Please give some examples
The examples allow you to assess whether you believe the story and is it a good enough example to be indicative of a symptom (or lack thereof)
