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Oppositional Defiance Disorder What is it and how do we survive it in the classroom? What is it? Definition: Diagnostic and Statistical Manual of Mental Disorders (DSM) as an ongoing pattern of disobedient, hostile and defiant behaviour toward authority figures which goes beyond the bounds of normal childhood behaviour. Behaviours associated with ODD out of seat often disruptive noises does not listen rummages shelves/cupboard hits, kicks, shoves giggles in silly way cries over small matters argues in angry way destroys property forces someone to do something they don't want to do takes something from another child defies teacher throws an object at someone refuses to share curses speaks out of turn Interrupts repeatedly asks same question makes fun of another forces someone to do something they don't want to do How do we know if it is not just typical adolescent behaviour? Typical Adolescent Adolescent with ODD Normal to moderate oppositional behaviour EXTREME oppositional behaviour What is the cause of ODD? Biological: 1.) Possibly defects in or injuries to certain areas of the brain 2.) Abnormal amounts of special chemicals in the brain called neurotransmitters. 3.) Also have other mental illnesses, such as ADHD, learning disorders, depression, or an anxiety disorder. Genetics: Frequently family members with mental illnesses, including mood disorders. Environmental: Dysfunctional family life How common is this? Disruptive behaviour disorders appear to be more common in boys than in girls, and they are more common in urban than in rural areas. Between 5% and 15% of school-aged children have Oppositional Defiant Disorder (ODD). A little over 4% of school-aged children are diagnosed with Conduct Disorder (CD). When and for how long does this last? Behaviours that may signal the beginnings of ODD or CD can be identified in preschoolers. Most children with ODD symptoms “grow out of it” with treatment. Some may go on to develop Conduct Disorder. Children and adolescents with CD whose symptoms are not treated early are more likely to fail at school and have difficulty holding a job later in life. They are also more likely to commit crimes as young people and as adults Often comorbid with other disorders Anxiety Disorder ADHD Depression Conduct Problems (including ODD and CD) Conduct Disorder Vs. ODD Debate In a study assessing the diagnoses of 108 children using DSM-III-R criteria, Reeves et. al (1987) found only four children with a conduct disorder diagnosis unaccompanied by any other diagnosis, and only two children had an ODD diagnosis alone. In a comparison of clinically diagnosed children and a control group of normal children Reeves et. al (1987) found that children with ADD and conduct disorder had a much higher frequency of adverse family backgrounds and were characterized by fathers with lower education levels, family alcoholism, and fathers with antisocial personalities. These children did not differ significantly from the normal group in terms of marital adjustment of parents or parental strife observed by the child Conduct Disorder Diagnosis Criteria has stolen without confrontation of a victim on more than one occasion has deliberately destroyed others' property has run away from home overnight at least twice while living in parental or surrogate home has forced someone to have seual activity with him or her has been physically cruel to animals often lies has used a weapon in more than one fight has deliberately engaged in fire setting often initiates physical fights is often truant from school has stolen with confrontation of a victim has broken into someone else's house, building, or car has been physically cruel to people Difference between conduct problem disorders Antisocial Personality Disorder Conduct Disorder Childhood Onset Primarily Impulsive Type CallousUnemotional Type OPPOSITIONAL DEFIANCE DISORDER Adolescent Onset Subtype 1 of conduct disorders Absence of guilt and empathy More sever and aggressive behaviour Callous Unemotional Type More of a genetic basis Associated with APD and psychopathy Subtype II of conduct disorders Likely to be rejected by their peers Deficit in social information processing Primarily Impulsive Type Comorbid ADHD more common High rates of dysfunctional home life What can ODD lead to? ODD Conduct Disorder Antisocial Personality Disorder Psychopathy Conduct Disorder vs. ODD Stealing Conduct Disorder Oppositional Defiance Disorder Treatment Really needs to be tailored to the individual child Parent training programs Individual therapy Social skills therapy Cognitive psychology therapy relaxation training thought stopping replacing upsetting thoughts with calming thoughts self-selected time-outs Often cited as the most successful method of treatment: Social Learning/ Family therapy addressing the multiple systems involved, including parents, siblings, school personnel, and others effective therapeutic intervention skills which include impacting the environment and establishing positive expectations for change developing self-control skills for the entire family such that parents and children have alternatives to explosive or depressive behaviour defining disciplinary approaches that lead to positive changes for all family members social enhancement methods for increasing prosocial behaviours maintenance skills for continuing change once it has occurred Neuroscience behind it all Adrenal androgens levels higher Lower baseline heartrates Median cortisol levels are lower on average Lower levels of 5-Hidroxyindoleacetic acid (5-HIAA) and Homovanillic acid (HVA) Postsynaptic serotoninergic receptor is oversensitive (may be related more to ADHD) Teaching Strategies 1.) Establish clear behaviour goals with the student 2.) Monitor their progress towards these goals 3.) Positive reinforcement 4.) Consistent consequences for inappropriate behaviour 5.) When possible change behaviour antecedents 6.) Find out what punishments will work best with the student 1.) Establish clear behaviour goals with the student Have a meeting with the student and their parents to determine SMART goals gather information about cognitive/emotional reactions gather information about sequences and patters Think about situations that could arise and give the student alternatives to acting out break complex problems into manageable units 2.) Monitor their progress towards these goals Set up a behaviour log Set up weekly meetings to monitor progress Send progress reports home 3.) Positive reinforcement 4.) Consistent consequences for inappropriate behaviour 5.) When possible change behaviour antecedents communicate empathy provide reassurance and normalize problems use self-disclosure define everyone as a victim emphasize positive expectations for change match your communication style to the family use humour use open-ended questions share the agenda deal with one issue or task at a time break complex problems into manageable units end sidetracking give everyone a chance to participate 6.) Find out what punishments will work best with the student Ignoring giving commands time-out procedure Caution: as with any child, extensive punishment sets up escape and avoidant behaviours that may be more harmful to the relationship between teacher/parent and child than is the behaviour being punished Resources to help! BOOKS - Treating Conduct and Oppositional Defiant Disorders in Children - Children with Conduct Disorders, A Psychotherapy Manual - No More Misbehavin': 38 Difficult Behaviors and How to Stop Them - Kids are worth it! Revised Edition: Giving Your Child the Gift of Inner Discipline - The Difficult Child - How to Behave so your Children Will - Your Defiant Child: Eight Steps to Better Behaviour - Discipline: The Brazelton Way - Making Children Mind without Losing Yours - Raising your Spirited Child: A Guide for Parents Whose Child is more Intense, Sensitive, Perceptive, Persistent and Energetic - Rage, Rebellion and Rudeness: Parenting in the new Millennium Websites American Academy of Child and Adolescent Psychiatry **www.aacap.org/publications/factsfam** Canadian Paediatric Society **www.caringforkids.cps.ca/behaviour** Canadian Mental Health Association www.cmha.ca Children’s Mental Health Ontario www.kidsmentalhealth.ca Centre for Addiction and Mental Health www.camh.net The ABCs of Mental Health – a Teacher Resource www.brocku.ca/teacherresource/ABC When Something’s Wrong: Ideas for Teachers www.cprf.ca
