Working with Oppositional and Defiant Children:
Working with Oppositional and Defiant Children: A School Counselor’s Guide to ODD Kathryn Casey The University of Arizona A Case Example Outline What is ODD? Identifying ODD children Examples of ODD behaviors vs. age appropriate behaviors Differential Diagnoses Statistics Prognosis Correlates Intervention Strategies ASCA Standards Ethical Considerations Additional Information and Resources Conclusion and Questions What is ODD? Definition “A recurrent pattern of developmentally inappropriate levels of negativistic, defiant, disobedient, and hostile behavior toward authority figures” (Hamilton & Armando, 2008) Diagnostic Criteria Argues with adults Deliberately annoys others Refuses to comply Four or more symptoms must be present for at least 6 months Spiteful and vindictive Often angry and resentful Blames others Easily annoyed or frustrated (American Psychiatric Association, 2000) Diagnostic Criteria These behaviors must cause significant impairment in social, academic, or occupational functioning The behaviors are not due to a psychotic or mood disorder Criteria are not met for Conduct Disorder or Antisocial Personality Disorder (18+ only) (American Psychiatric Association, 2000) At one time or another couldn’t every child be considered oppositional defiant? ODD vs. Age Appropriate Behaviors Infancy More likely to have been fussy, colicky, or difficult to soothe when compared to other infants (American Academy of Child & Adolescent Psychiatry, 2010) ODD vs. Age Appropriate Behaviors Toddlers More extreme temper tantrums surrounding major power issues such as toilet training, eating, and sleeping Much worse than what one would expect in the Terrible Twos (American Academy of Child & Adolescent Psychiatry, 2010) ODD vs. Age Appropriate Behaviors School age More likely to procrastinate, dawdle, or claim they did not hear the teacher More likely to be set on winning at all costs Even willing to lose privileges just to be “right” Power struggles center on homework, cleaning up, and bathing/grooming Has little insight or ability to admit their troubles, instead they blame others (American Academy of Child & Adolescent Psychiatry, 2010) ODD vs. Age Appropriate Behavior Teenagers Power struggles center on curfew, obscene language, attending school, cleaning up May get into trouble with the police Question authority and break rules Different from Conduct Disorder (CD) (American Academy of Child & Adolescent Psychiatry, 2010) ODD vs. Conduct Disorder Conduct disorder More severe than ODD Physical aggression toward people or animals Examples: assault, bullying, muggings, forced sexual activity Destruction of property Examples : arson, vandalism Deceitfulness Examples: shoplifting, forgery Serious or theft violation of rules Examples: truancy, running away from home (American Psychiatric Association, 2000) Differential Diagnoses Conduct disorder ADHD Impaired Language Comprehension Mental Retardation Mood disorders and psychotic disorders Normal individualization School Counselors do not diagnose! (Hamilton & Armando, 2008) Statistics ODD is one of the most diagnosed mental health disorders in childhood (Hamilton & Armando, 2008) 2-16% of children meet criteria for ODD (Turgay, 2009; Sprague &Thyer, 2003) Tends to be diagnosed more often in boys(Waschbusch & King, 2006) Girls often display aggression more covertly (Hamilton & Armando, 2008) Symptoms are often present for 2-3 years before diagnosis (Hamilton & Armando, 2008) Statistics Co-occurring disorders are common with ODD (Heflinger & Humphreys, 2008) 50% diagnosed with another psychiatric disorder ADHD and mood disorders are most common Children with dual diagnosis of ADHD and ODD are more likely to develop CD and/or antisocial personality disorder later in life (Dickstein, 2010) Prognosis Academic Homework completion, classroom time Social Difficulties Poor social skills (i.e. aggression) Career Difficulties Following rules and authority Emotional Difficulties Problems More likely to develop depression or bipolar disorder Higher risk for suicidal ideation and attempts (Dickstein, 2010) Correlates Dysfunctional or maladaptive family dynamics (Cunningham, & Boyle 2002) Trauma, abuse and/or domestic violence (Ford, Thomas, & Racusin, et al. 1999) Low SES (Boden, Fergusson, & Horwood, 2010) Lower cognitive ability (Boden, Fergusson, & Horwood, 2010) Association groups with deviant peer (Boden, Fergusson, & Horwood, 2010) Intervention Strategies Parents and Caregivers Teachers Interventions are most effective when -Behavior Plans -Skills training -Classroom -Family Parents, Teachers, management Therapy support work -Resources and Counselors -Referrals, CST and Referrals together! School Counselor -Boundaries -Communication -Effective Discipline -Social Modeling -Effective Discipline -Establish positive relationship -Establish clear expectations -Skills groups -Individual counseling -Establish positive relationship (Lanza, & Drabick 2011; Milne, Edwards, & Murchie, 2001; Sprague & Thyer 2003; Turgay, 2009 ) Applying the ASCA National Model (American School Counselor Association, 2012) Ethical Considerations School Counselors do not diagnose Avoid over-identifying “problem” children Symptoms can be ambiguous Coordination Confidentiality Skills of care Competency Making appropriate referrals when needed (Studer, 2005) Case Study Follow Up Additional Resources The Oppositional Defiant Disorder Resource Center http://www.aacap.org/cs/ODD.ResourceCenter The Total Transformation Program by James and Janet Lehman http://www.thetotaltransformation.com/ Bright Hub Education: Strategies for Teaching Children with ODD http://www.brighthubeducation.com/specialed-behavioral-disorders/26631-strategies-for-teachingchildren-with-oppositional-defiant-disorder/ The Defiant Child by Dr. Douglas A. Riley, Child and Adolescent Psychologist Oppositional Defiant Disorder and Conduct Disorder in Children by Walter Matthys and John Lochman Educating Oppositional and Defiant Children by Phillip Hall and Nancy Hall Solutions to Oppositional Defiant Disorder by Marilyn Adams, LMFT http://www.guidancefacilitators.com/odd2.html References American Academy of Child & Adolescent Psychiatry. (2010). Your ChildOppositional Defiant Disorder. Retrieved from htt://www.aacap.org/cs/root/publications/store/your child oppositional defiant disorder American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.). Washington, DC: Author. American School Counselor Association. (2012). ASCA National Model: A Framework for School Counseling Programs, Third Edition. Alexandria, VA: Author. Boden, J., Fergusson, D., & Horwood, J. (2010). Risk Factors for Conduct Disorder and Oppositional/Defiant Disorder: Evidence from a New Zealand Birth Cohort. Journal of the American Academy of Child and Adolescent Psychiatry, 49(11), 1125-1133. Cunningham, C., & Boyle, M. (2002). Preschoolers at Risk for Attention-Deficit Hyperactivity Disorder and Oppositional Defiant Disorder: Family, Parenting, and Behavioral Correlates. Journal of Abnormal Child Psychology, 30(6), 555-569. Dickstein, D. (2010). Oppositional Defiant Disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 49(5), 435-436. Ford, J., Thomas, J., Racusin, R., Daviss, W., Ellis, C., Rogers, K., Reiser, J., Schiffman, J., Sengupta, A. (1999). Trauma Exposure Among Children With Oppositional Defiant Disorder and Attention Deficit-Hyperactivity Disorder. Journal of Consulting and Clinical Psychology, 67(5), 786-789. References Continued Hamilton, S., & Armando, J. (2008) Oppositional Defiant Disorder. American Family Physician, 78(7), 861-866. Heflinger, C., & Humphreys, K. (2008). Identification and Treatment of Children with Oppositional Defiant Disorder: A Case Study of One State’s Public Service System. Psychological Services, 5(2), 139-152. Lanza, I., & Drabick, D. (2011). Family Routine Moderates the Relation Between Child Impulsivity and Oppositional Defiant Disorder Symptoms. Journal of Abnormal Child Psychology, 39, 83-94. Markward, M., & Bride, B. (2001). Oppositional Defiant Disorder and the Need for Family-Centered Practice in Schools. Children & Schools, 23(2), 73Milne, J., Edwards, J., & Murchie, J. (2001). Family Treatment of Oppositional Defiant Disorder: Changing Views and Strength-Based Approaches. The Family Journal: Counseling and Therapy for Couples and Families, 9(1), 17-28. Sprague, A. & Thyer, B. (2003). Psychosocial Treatment of Oppositional Defiant Disorder. Social Work in Mental Health, 1(1), 63-72. Studer, J. (2005). The Professional School Counselor: An Advocate for Students. Belmont, CA: Brooks/Cole. Turgay, A. (2009). Psychopharacological Treatment of Oppositional Defiant Disorder. CNS Drugs, 23(1), 1-17. Waschbusch, D., & King, S. (2006). Should Sex-Specific Norms Be Used to Assess Attention-Deficit/Hyperactivity Disorder or Oppositional Defiant Disorder? Journal of Consulting and Clinical Psychology, 74(1), 179185. Questions?
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