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Oppositional Defiant Disorder By Jessica Nichols, University of Pittsburgh, Fall 2008 What is Oppositional Defiant Disorder (ODD)? According to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (text revision, 2000), “the essential feature of Oppositional Defiant Disorder (ODD) is a recurrent pattern of negativistic, defiant, disobedient, and hostile behavior toward authority figures” (Section 313.81, Diagnostic Features). Exhibited behaviors of this disorder in children include: arguing with adults and disrespecting authority, repeated failure to comply with adult directives and/or rules, stubbornness, testing of boundaries, and other negativistic actions (Mental Health: A Report of the Surgeon General, 2008). There is not one specific cause known for ODD as it is thought to derive from a combination of social, biological, and psychological factors. Biologically speaking, ODD does tend to occur in families with a history of Attention Deficit Hyperactivity Disorder (ADHD), substance use disorders, and/or mood disorders (American Academy of Child and Adolescent Psychology, Oppositional Defiance Resource Center, 2008). According to the Surgeon General’s Report of Mental Health, marital discord, disrupted child care, and inconsistent, unsupervised child-rearing may also contribute to the development of ODD (2008). Additionally, from onethird, up to as many as one-half, of children diagnosed with ADHD also have ODD (National Institute of Mental Health, 1996). Nichols 1 Prevalence of the disorder The DSM-IV text revision, states that “rates of Oppositional Defiant Disorder from 2% to 16% (of a population) have been reported, depending on the nature of the population sample and methods of ascertainment” (Section 313.81, Prevalence). In other words, 2%-16% of a specific sample population has been identified as having ODD. In addition, this disorder is seen to be more prevalent in populations of preschool children who have problematic temperaments or high motor activity (Diagnostic and Statistical Manual of Mental Disorders, fourth edition -text revision, 2000). What are the diagnostic criteria of the disorder? In order for criterion to be met, children must be observed demonstrating these behaviors more frequently than those of their peers at the same age and approximate developmental level. Specific criteria for diagnosis include: pattern of negativistic, hostile, and defiant behavior lasting at least 6 months, the disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning, the behaviors do not occur exclusively during the course of a Psychotic or Mood Disorder, and criteria are not met for Conduct Disorder, and, if the individual is age 18 years or older, criteria are not met for Antisocial Personality Disorder ( Diagnostic and Statistical Manual of Mental Disorders, fourth edition -text revision, 2000). In relation to gender, ODD is more commonly diagnosed in males than females before puberty, but rates begin to even out after puberty. Furthermore, ODD may be a precursor for Nichols 2 the more severely defiant conduct disorder (Mental Health: A Report of the Surgeon General, 2008). What are the symptoms and behaviors of the disorder? Children with ODD are often very difficult to work with. They do not accept direction from authority well, often resist demands, and engage in argument with adults. Additionally, they can be unwilling to compromise with adults or peers and demonstrate persistent stubbornness. In some cases, children can become aggressive and hostile toward particular authority figures. When confronted with their actions, children with the disorder often claim they are just “responding to unreasonable demands or circumstances” (blaming others for their mistakes) (Diagnostic and Statistical Manual of Mental Disorders, fourth edition-text revision, 2000). According to the American Academy of Child and Adolescent Psychology (1999), the symptoms of the disorder are not a direct result of a conflict with a particular authority figure, but are seen in multiple settings including home and school. When the defiance begins to seriously interfere with a child’s day to day functioning, the child may be recommended for diagnosis of the disorder. What are treatments for the disorder? Both medicinal and counseling therapies (both personal and family) are applicable treatments for children with ODD. Sometimes the most effective methods are a combination of the two therapies (The American Academy of Child and Adolescent Psychology, 2008). Nichols 3 However, treatment plans are most effective when individualized to the particular child and their family. Counseling Methods of Treatment The American Academy of Child and Adolescent Psychology (2008) suggests that individual approaches in the form of problem-solving skills training and family interventions in the form of parent management training have been proven most effective. For the individual, approaches are based on the specific child’s condition (circumstance, severity, etc.), age, and gender. These behaviorally based treatments focus on helping the child acquire problemsolving skills. Family interventions are recommended in the forms of formal parent training programs and family therapy. In parental training programs, parents learn strategies for managing their child’s behavior and are taught negotiating skills. In addition, families with a child displaying symptoms of ODD have greater conflict, anger, and aggression, as well as negative communications (Lewis, 2002). Due to these findings, family therapy sessions are suggested. These family therapy sessions address issues existing in family interactions (dealing with the stress of ODD, family structure, how to handle difficulties, etc.)(Lewis, 2002). Medicinal Therapies There is no single medication specifically formulated to treat ODD but because ODD so often occurs with other mental health disorders. However, medication may be used to treat specific symptoms or to treat the coexisting conditions (American Academy of Child and Nichols 4 Adolescent Psychology, 1999). For example, Ritalin (a medication used to treat symptoms of ADHD) may be utilized to treat the child’s co-existing disorder of and symptoms of ADD. Educational Implications As an educator, one will most likely encounter a student with ODD in their classrooms at some point throughout their career. It is important that educators be familiar with the disorder so that they may better understand the needs of this particular population of students. In addition, educators may have a hand in identifying the disorder and recommending a student for diagnosis and evaluation. When teaching a student who is defiant, a teacher might employ a variety of strategies including, defensive management by Fields (2003), high-probability request sequences (Hildebrand, Hua, & Lee, 2007), and/or effective commands by Matheson & Shriver (2005). Additional Online Resources for Educators 1. http://www.disciplinehelp.com/teacher/ Describes specific actions to take with “the defier” in your classroom. 2. http://education.osu.edu/gcartledge/urbaninitiative/compliance.htm This is a multi-faceted website with several useful aspects relating to the subject of student noncompliance. Sections of this source include: “getting your message across,” ”stop power struggles,” “conflict resolution,” “managing explosive situations,” and “games/strategies for dealing with noncompliance.” Each section provides explanation in detail for the specific theory cited. In addition, it provides additional sources and tips for teachers and parents with defiant students. Nichols 5 Resources American Academy of Child and Adolescent Psychology (1999) Children with oppositional defiant disorder: Facts for families. Retrieved September 22,2008 from http://www.aacap.org/cs/resource_center/odd_faqs. American Academy of Child and Adolescent Psychology (2008). Oppositional defiant resource center. Retrieved September 22, 2008 from http://www.aacap.org/cs/resource_center/odd_faqs. American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, fourth edition (text revision). Washington, DC: Author. Accessed September 23, 2008 via STAT!Ref at http://online5.hsls.pitt.edu:2205/TOC/ TOC.aspx?FxId=37&SessionId=D6270DJPJNVIKOSV. Fields, B. (2004). Breaking the cycle of office referrals and suspensions: Defensive management. Educational Psychology in Practice, 20, 103-116. Hildebrand, K.E., Hua, Y., Lee D.L. (2007). Dealing with noncompliance in the classroom. Retrieved September 23, 2008 from http://www.cec.sped.org. Lewis, Melvin (Ed.). (2002). Child & adolescent psychiatry: A comprehensive textbook. Matheson, A.D., Shriver, M.D. (2005). Training teachers to give effective commands: Effects on student compliance and academic behaviors. School Psychology Review, 34, 202-219. Mental Health: A Report of the Surgeon General (2008). Other mental disorders in children and adolescents. Retrieved September 22, 2008 from http://www.surgeongeneral.gov/library/mentalhealth/chapter3/sec6.html. National Institute of Mental Health (1996). Attention deficit hyperactivity disorder. Retrieved September 22, 2008 from http://www.nimh.nih.gov/health/publications/adhd/nimhadhdpub.pdf . Nichols 6