Engaging and Treating Youth with Oppositional Defiant Disorder and Conduct Disorder (and their Parents) John Sommers-Flanagan, Ph.D. Department of Counselor Education University of Montana On behalf of Western Montana Addiction Services – 6/10/14 For more information Blog: johnsommersflanagan.com

Learning Objectives & Plan Briefly review ODD and Conduct Disorder Diagnoses Identify and describe two evidence-based relationship strategies for engaging young clients with ODD and/or CD and their parents Identify and describe two evidence-based approaches (techniques and models) to treating ODD and CD Provide an overview/summary of essential ingredients for “best” practice

Remember ODD Diagnosis Involves a pattern of... 1.angry/irritable mood 2.argumentative/defiant behavior, or 3.vindictiveness It lasts at least 6 months as evidenced by at least four symptoms from DSM-5

Remember CD Diagnosis is a repetitive and persistent behavior pattern in which basic rights of others or societal rules are violated. Three symptoms are needed over the past 12 months involving: 1. Aggression to People and Animal 2. Destruction of Property 3. Deceitfulness or Theft 4. Serious Violations of Rules

These are “Tough Kids” right? Yes, but... The evidence is clear: If we think of these as tough, difficult, or resistant youth, our outcomes are likely to be poorer This is because positive outcomes are based more on relational connection with these youths than specific techniques And so, before you get in the room, get straight about...

... Your Attitude The “kids” are not tough – the situation is tough Young people can track the scent of blame... and so unless we ALREADY HAVE a strong and influential relationship... Pushing youth to accept responsibility too soon can increase defensiveness You really have to battle culture here Undeveloped brains Bad attitudes Disrespectful Emotionally unstable

Use These EB Relational Ideas Radical Respect – Satanic Golden Rule Radical Acceptance – Rogers and Linehan and 30 min of profanity Collaboration – Punching example Be transparent (genuine) and non- threatening – This is what I want/know

Questions and Comments Now, as we transition from the EB- Relationship factors to EB-Techniques, is a good time for you to pose questions or make comments

Use These EB Techniques Self-Disclosure and Feedback Problem-Solving Brainstorming Consequential Thinking Methods for achieving goals using prosocial means Asset Flooding Parenting Interventions Passionate reinforcement Boring consequences Character feedback Limit-setting, natural consequences, Regular affection or child-centered play

EST Models ( require training) The Incredible Years: Multisystemic Family Therapy: Functional Family Therapy: Parent Management Training: /

EST Models (cont.) Overall, jury is out on working most effectively with youth who have ODD and CD diagnoses It may be especially important to address the more “treatable” symptoms first (e.g., trauma, clinical depression, substance-related disorders)

Overview/Summary EBRs are the foundation for the success of all therapies with these populations EBTs can be used separately and in conjunction with EBRs EST models are great, but require specialized training

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