Oppositional Defiant Disorder Overview

Conduct Problems in Children and Adolescents

• Conduct problems are a concern for caregivers and authority figures; they disrupt relationships with parents and teachers.
• Actions that violate societal standards and the rights of others.
• These actions negatively affect a child's behavioral and socio-emotional development.
• This increases the risk of interpersonal and occupational problems.
• An alarming 50% of children referred for mental health treatment also suffer from conduct problems.

Types of Conduct Problems

• DSM-5 categorizes conduct problems into three types:
  • Conduct disorder
  • Oppositional defiant disorder (ODD)
  • Intermittent explosive disorder (IED).

Oppositional Defiant Disorder (ODD)

• Characterized by a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness.
• Symptoms must last for at least 6 months and occur during interaction with at least one individual who is not a sibling.
• Angry/irritable mood: often loses temper, is often touchy or easily annoyed, is often angry and resentful
• Argumentative/defiant behavior: often argues with authority figures, actively defies or refuses to comply with requests, often deliberately annoys others, often blames others for his or her mistakes or misbehavior
• Vindictiveness: has been spiteful or vindictive at least twice within the past 6 months.
• The disturbance negatively affects the individual and others, impacting social, educational, occupational and other important areas of life.
• The behaviors do not occur exclusively during the course of a psychotic, substance use, depressive, or bipolar disorder.

Distinction with Normative Child Behavior

• Developmental increases in oppositional and defiant behavior during toddler and preschool age are generally normal.
• Two categories of clinically significant behaviors are:
  • Number and frequency of disruptive behaviors.
  • A child's overall developmental context.
• Children with ODD display significantly more problematic behaviors and with greater frequency than children without it.

Diagnostic Criteria for Oppositional Defiant Disorder

• A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months.

• Symptoms must occur during interaction with at least one individual who is not a sibling.

• Examples of symptoms

  • Angry/Irritable mood: Often loses temper, Is often touchy or easily annoyed. Is often angry and resentful.
  • Argumentative/Defiant behavior: Often argues with authority figures, Actively defies or refuses to comply with requests from authority figures or with rules. Often blames others for his or her mistakes or misbehavior.
  • Vindictiveness: Has been spiteful or vindictive at least twice within the past 6 months.

• The behaviors negatively impact the individual or others in the immediate social context.

• The behaviors do not occur exclusively during the course of a psychotic, substance use, depressive, or bipolar disorder.

Diagnosis

• DSM-5 guidelines are for determining whether disruptive symptoms are recurrent enough in children to merit a diagnosis.
• Most ODD symptoms occur daily in preschoolers and weekly in adolescents.
• Children must have displayed mean, oppositional behavioral problems or vindictiveness for 6 months for a diagnosis of ODD
• Elevated nor-mreferenced behavioral ratings beyond 93rd and 95th percentiles signify severe symptoms.
• ODD symptoms: anger/irritable mood, argumentative/defiant behavior, and vindictiveness. differentiate between the three types of symptoms.
• Factors may contribute to problems
  • Angry/irritable mood: Predicts depression
  • Argumentative/defiant behavior: Usually consistent with comorbid ADHD.
  • Vindictiveness: May arise in conduct problems
• Symptoms that occur in one setting may still qualify for ODD.

Conduct Disorder (CD)

• Characterized by a repetitive and persistent pattern of violating the rights of others or societal norms.
• At least three of fifteen criteria must be present in the past 12 months, with one present in the past six months.

Aggression to people or animals Characterized by:

• Bullying, threatening, intimidating others

• Initiating fights

• Using weapons to harm others

• Physical cruelty towards people or animals

• Stealing while confronting a victim

• Forcing someone into sexual activity.

• Destruction of property

• Deliberately starting fires

• Deliberately destroying others' property

• Deceitfulness or theft

• Breaking and entering

• Lying to obtain goods or favors

• Stealing without confronting a victim

• Serious rule violations

• Running away from home

• Truancy (skipping school)

• Staying out overnight despite parental prohibitions

• Severe violations of rules, which are a threat to the well-being of others, are considered serious conduct problems.

Intermittent Explosive Disorder (IED)

• A DSM-5 disorder characterized by repeated angry outbursts.
• Outbursts result in verbal and/or physical aggression.
• Recurrent behavioral outbursts, at least one involving property damage or physical aggression.
• Outbursts are out of proportion to the provocation.
• Outbursts are not planned or premeditated.
• Aggression causes significant distress or impairment in functioning, or has legal implications
• Occurring at least 6 years old
• Not caused by other mental disorders, or attributed to medical conditions or substance use.

Case Study: Davidson or Lucas

• Case Studies often highlight specific examples of conduct disorders
• Examples include common behaviors, and parent interactions.
• Data collected and analyzed.
• Potential interventions to discuss

What Works, What Doesn't

• Effective interventions for conduct disorders frequently involve families and diverse approaches, not just one intervention.

Treatment Methods

• Parent Management Training (PMT)
• Parent-Child Interaction Therapy (PCIT)
• Video-taped modeling (Incredible years)
• Problem-solving skills training (PSST)
• Aggression Replacement Training (ART)
• Multisystemic therapy (MST).
• Medication (methylphenidate or risperidone)

Prevalence

• Specific prevalences for ODD, CD, and IED in boys and girls. Detailed data based on a variety of sources and study findings may be presented.

Associated Disorders

• Co-occurring mental health disorders like ADHD, depression and substance abuse may be associated with conduct problems.

Causes

• Genetic factors (40-50% of the variance)
• Shared environment factors
• Difficult temperament & emotional regulation problems
• Hostile parenting behavior
• Low parental monitoring
• Parent's cognitions & mental health
• Peers & neighborhoods (selective affiliation, deviancy training, lack of resources, inadequate supervision, high crime)
• Physiological underarousal and punishment insensitivity, which influences children's behavior, and response to learning consequences.