Oppositional Defiant Disorder

DSM-5 Definition of ODD

Onset & Gender differences Age of onset is typically 12 to 13 years of age There are early diagnosis of 2 to 5 years of age According to DSM-IV-TR “ the age of onset is usually evident prior to age 8 and not later than early adolescence” According to Christensen, Baker & Blacher (2013) 50% of youth continue to meet the criteria of ODD 4 years later-indicating a stable disorder There are significant gender differences in teacher reports-where ODD is more prevalent in boys However, most researchers have not found any gender differences Take into consideration how boys behave in a classroom setting vs. how girls behave Christensen, Baker & Blacher (2013)

Comorbidity 40% of children with ADHD meet criteria for ODD and vice versa (Christensen, Baker & Blacher, 2013) Children with ODD are at a greater risk of developing conduct disorder and antisocial personality disorder (Hamilton & Armando, 2008) Conduct disorder is being aggressive and defiant towards authorities-can lead to criminal activities How does Antisocial personality disorder differ from identifying as an introvert? Table 3 found on page 589 in article: Riley, M., Ahmed, S., & Locke, A. (2016). Common questions about oppositional defiant disorder. American Family Physician, 93(7), 586-591

Treatment Both child and parent should attend therapy Multisystemic therapy such as community based interventions in multiple real life settings (home, school) Collaborative problem solving therapy 50% of children no longer met ODD criteria after 6 months (Dickstein, 2010) Cognitive Behavior Therapy According to Dickstein (2010) this type of therapy is the most effect and cost effective for improving child conduct, parental mental health and parenting skills Group CBT for kids demonstrated a decrease in aggressive behaviors Parental management therapy Parent training on how to respond to their child’s behavior Child therapy: develop problem-solving skills and strategies with the child

Treatment continued… If ODD is co-existing with ADHD, stimulant therapy can reduce symptoms of both disorders Such as Ritalin, Adderall and Strattera Studies have not demonstrated that stimulants reduce symptoms of ODD when ADHD is absent (Hamilton & Armando, 2008) According to Riley, Ahmed & Locke (2016, p. 590), 70% of people with Oppositional Defiant Disorder had symptom resolution by 18 years of age

Teacher Strategies Remember: the more controlling the adult appears to be, the more oppositional the student becomes Remain cool, cam and collected Diminish the power struggle: be firm and consistent Have a structured classroom Give simple directives and give choice State pre-determined consequences clearly before problems occur Identify the expected behavior Clearly state the consequences of non-compliant behavior Walk-away before situation gets “heated” Discuss problem with student in private Seat the student near a good role mode Use visual cues for rules in the classroom

Teacher strategies continued Other tips: Strategies for Learning and Teaching: http://www.sess.ie/categories/emotional-disturbance-andor- behavioural-problems/opposition-defiant-disorders/tips-learni Strategies to working with students with ODD: http://havasu.k12.az.us/public_forms/parent_information_network/behavior/BR23%20Strategies %20to%20Work%20with%20Students%20with%20Oppositional%20Defiant.pdf Oppositional Defiant Disorder in children and tips for teachers: http://www.kellybear.com/TeacherArticles/TeacherTip68.html School wide strategies for managing defiance/non-compliance: http://www.interventioncentral.org/behavioral-interventions/challenging-students/school-wide- strategies-managing-defiance-non-complianc

References Christensen, L., Baker, L. B., & Blacher, J. (2013). Oppositional defiant disorder in children with intellectual disabilities. Journal of Mental Health Research in Intellectual Disabilities, 5, 225-244. Dickstein D. P. (2010). Oppositional defiant disorder. Journal of the American Academy of Child & Adolescence Psychiatry, 49(5), 435-436. DSM-5 ODD: http://images.pearsonclinical.com/images/assets/basc- 3/basc3resources/DSM5_DiagnosticCriteria_OppositionalDefiantDisorder.pdf Hamilton, S. S. & Armando, J. (2008). Oppositional defiant disorder. American Family Physician, 78(7), 861-866. Riley, M., Ahmed, S., & Locke, A. (2016). Common questions about oppositional defiant disorder. American Family Physician, 93(7), 586-591. Woolsey-Terrazas & Chavez (2002). Strategies to work with students with oppositional defiant disorder. CEC Today, 8(7), 23-24