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

Normal to moderate oppositional behaviour

Adolescent with ODD

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

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 run away from home overnight at least twice while living in parental or surrogate home

often lies has deliberately engaged

in fire setting is often truant from school has broken into someone

else's house, building, or car

has deliberately destroyed others' property

has been physically cruel to animals

has forced someone to have seual activity with him or her

has used a weapon in more than one fight

often initiates physical fights

has stolen with confrontation of a victim

has been physically cruel to people

Difference between conduct problem disorders

Subtype 1 of conduct disorders

Subtype II of conduct disorders

What can ODD lead to?

Conduct Disorder vs. ODD

Stealing

Treatment

Really needs to be tailored to the individual childParent 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 therapyaddressing the multiple systems involved, including parents, siblings, school personnel, and otherseffective therapeutic intervention skills which include impacting the environment and establishing positive expectations for changedeveloping self-control skills for the entire family such that parents and children have alternatives to explosive or depressive behaviourdefining disciplinary approaches that lead to positive changes for all family memberssocial 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 Associationwww.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