Oppositional Defiant Disorder ODD

What is ODD? Oppositional defiant disorder (ODD) is a persistent behavioral pattern of angry or irritable mood; argumentative, defiant behavior towards authority figures; and vindictiveness. In some children with ODD, these behaviors are only in evidence in one setting—usually at home. In more severe cases they occur in multiple settings. For a diagnosis of ODD, the frequency and intensity of these behaviors must be outside the typical range for a child’s developmental level, gender and culture. https://childmind.org/guide/oppositional-defiant-disorder/what-is-it/

DSM-5 Criteria for ODD Includes at least four symptoms from any of these categories — angry and irritable mood; argumentative and defiant behavior; or vindictiveness Occurs with at least one individual who is not a sibling Causes significant problems at work, school or home Occurs on its own, rather than as part of the course of another mental health problem, such as a substance use disorder, depression or bipolar disorder Lasts at least six months

DSM-5 Criteria for ODD con’t Angry and irritable mood: Often loses temper Is often touchy or easily annoyed by others Is often angry and resentful Argumentative and defiant behavior: Often argues with adults or people in authority Often actively defies or refuses to comply with adults' requests or rules Often deliberately annoys people Often blames others for his or her mistakes or misbehavior Vindictiveness: Is often spiteful or vindictive Has shown spiteful or vindictive behavior at least twice in the past six months

What to look for… ODD is typically diagnosed around early elementary school ages and stops being diagnosed around adolescence. Kids who have ODD have a well-established pattern of behavior problems. Symptoms include: Being unusually angry and irritable Frequently losing their temper Being easily annoyed Arguing with authority figures Refusing to follow rules Deliberately annoying people Blaming others for mistakes Being vindictive

Varying Degrees ODD can vary in severity: Mild. Symptoms occur only in one setting, such as only at home, school, work or with peers. Moderate. Some symptoms occur in at least two settings. Severe. Some symptoms occur in three or more settings

A Classroom Incident “Justin,” the teacher directed, “stop playing with your crayon and get back to work.” Without even giving the teacher a glance, Justin rolled his crayon down his desk and squealed in delight as it fell to the floor. Noticing his teacher’s exasperation, the classroom aide, Mrs. Johnson, put her hand out and pleaded, “Justin, won’t you please give me your crayon?” Justin threw the crayon at Mrs. Johnson, striking her in the forehead. “Justin!” the teacher exclaimed. “That is enough! Mrs. Johnson,” the teacher said to her aide, “take Justin to the office.” When Mrs. Johnson arrived at the office with Justin in tow, the secretary reached for her phone. “Call his mother?” she rhetorically queried. Before Mrs. Johnson could nod her head, Justin pulled out of her grasp, knocked over a chair, and, with the aide in close pursuit, ran back to his classroom.

Causes There's no known clear cause of oppositional defiant disorder. Contributing causes may be a combination of inherited and environmental factors, including: Genetics — a child's natural disposition or temperament and possibly neurobiological differences in the way nerves and the brain function Environment — problems with parenting that may involve a lack of supervision, inconsistent or harsh discipline, or abuse or neglect “Boys are four times more likely than girls to have ODD, which suggests that ODD is either sex-linked or sex-limited. Also, ODD is more prevalent in children who have at least one parent who has a mood disorder, ADHD, problems with substance abuse, or an Antisocial Personality Disorder.” (Hall & Hall, pg. 10)

Risk Factors Oppositional defiant disorder is a complex problem. Possible risk factors for ODD include: Temperament — a child who has a temperament that includes difficulty regulating emotions, such as being highly emotionally reactive to situations or having trouble tolerating frustration Parenting issues — a child who experiences abuse or neglect, harsh or inconsistent discipline, or a lack of parental supervision Other family issues — a child who lives with parent or family discord or has a parent with a mental health or substance use disorder

What Doesn’t Work “Consequences-positive or negative-have little impact on the behavior of children who have oppositional behaviors with ODD.” (Hall & Hall, pg 27) By the age of 10, “most of them resent any attempt by an adult to ‘control’ their behavior, and they actively and forcibly resist all behavior modification plans.” (Hall & Hall, pg. 27)

What Works Avoid verbal directives Arrange the child’s environment so the right response is the easiest response Avoid giving an indication that the student with ODD did something wrong-this can lead to the student becoming defiant and aggressive Create a layout in the classroom that suggests order, structure, and purpose

Antecedents to Avoid Presented task is too hard Presented task lacks visual clarity Presented task has no clear finish Independent work time Disapproval Praise

Antecedents to Enhance Choices Foreshadowing