Childhood Externalizing Disorders Lori Ridgeway PSYC 3560

What are they? Disorders you can “________” Oppositional Defiant Disorder (ODD) Conduct Disorder (CD) Attention Deficit / Hyperactivity Disorder (ADHD)

Oppositional Defiant Disorder Negative, _____________, defiant behavior –Losing temper –Arguing –Noncompliance –Deliberately annoy/blame others –Angry/resentful or spiteful At least _____________

Age & Gender More common in __________ before puberty Generally similar Sx’s –Exceptions Males more confrontational Males more persistent Sx’s Number of Sx’s __________ with age

Families & ODD Hx of mood disorder, ODD, CD, ADHD, Antisocial Personality, substance-use disorders Maternal _____________ Marital discord Inconsistency/harsh parenting

Treating ODD Parent management training –Principles of reinforcement & learning –_____________ –Behavior charts/token economies –Praise for incompatible behaviors School consultations

Parent-Child Interaction Therapy (PCIT) Principles of learning & ____________ theory Approx. 20 weeks In vivo treatment Two phases –Child Directed Interaction (CDI) –Parent Directed Interaction (PDI)

Child Directed Interaction Focus on positive parenting skills _____________ –_____________ –Reflection –Imitation –Description –Enthusiasm

CDI, cont’d… Avoid –_____________ –Questions –Criticisms Purpose = relationship building 5-minute practice daily Criteria to move on

Parent Directed Interaction _____________ phase Teach effective commands –Consistency –Simple –Clear –Direct

PDI, cont’d… Teach behavior management –Behavior _____________ –Consistent consequences –Selective attention –Time-out Gradual = home to public Criteria to complete treatment

PCIT Outcomes Significant decreases in ODD Sx’s Gains persist for up to 6 years Reduces re-reports of _____________ Group format Foster parents, Head Start, ADHD

Conduct Disorder Violate societal norms & _________ of others –Aggression to people/animals –Destruction of property –Deceitfulness or theft –Serious rule violations (running away/truancy) 3 in 12 months (with 1 in 6 months)

Subtypes: Childhood-Onset 1 Sx prior to _____________ Aggressive & poor peer relations Usually male ODD as young children Full criteria by puberty Persistent/chronic course Antisocial Personality Disorder

Subtypes: Adolescent-Onset No Sx’s before _____________ Less aggressive & better peer relations Ratio of males to females lower Less chronic course Better outcomes

Culture, Age, & Gender Settings where Bx is protective Progress in severity over time Early severity = worse outcomes Males = confrontation Females = non-confrontation

Families & CD Genetic & environmental influences Adoptive or biological parent with ____ Sibling with CD Biological parents with alcohol dependence, mood d/o, schizophrenia, ADHD, CD

Treating CD Parent management training _____________ treatment Multi-systemic Therapy –60-70% success rate –Intensive intervention within social system –Low case load & high burn out –On-call 24/7