The Oppositional Defiant Child What underlies the behavior? Douglas McCollum, Ph.D. Lori O’Dell McCollum, Ph.D.

Definition- DSM-IV A pattern of negativistic, hostile, and defiant behavior lasting at least 6 months, during which 4 or more of the following occur: 1. Often loses temper 2. Often argues with adults 3. Often actively defies or refuses to comply with adults’ requests or rules. 4. Often deliberately annoys people. 5. Often blames others for his or her mistakes or misbehavior. 6. Is often touchy or easily annoyed by others. 7. Is often angry and resentful. 8. Is often spiteful or vindictive

Definition: DSM-IV The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning. The behaviors do not occur exclusively during the course of a psychotic or Mood Disorder. Criteria are not met for Conduct Disorder, and, if the individual is age 18 years or older, criteria are not met for Antisocial Personality Disorder.

Other ODD Symptoms Poor problem solving skills Need to control others Low tolerance for frustration Self-centered Poor emotional control Poor mental control (executive functioning) Delayed moral development

Super Nanny super nanny minyon family 16:42 to 19:45

Why is a clear diagnosis important? Diagnosis helps understand causality, and we can learn from research how to prevent the disorder. Helps to plan treatment options that have been proven effective. Helps predict how the child will act in the future because professionals have seen many other children with the same condition and we have research about course of the condition. Helps professionals communicate with each other because they all use the same criteria to diagnose the condition.

Syndrome vs. Disorder Syndrome means a collection of symptoms that don’t always follow the same trajectory. Disorder is more predictable and implies an underlying cause. It is also a separate category that doesn’t overlap with many other conditions. In the case of ODD it seems more like a syndrome than a disorder and this is important because we diagnose and treat syndromes differently than disorders.

ODD does not occur in a vacuum

Multi-factored Causes Learned behavior Inherited traits Co-existing disorders Systemic Component – Culture – Parenting – Family Systems

Learned Modeling of Parent Anger

Nagging and Poor Parent Response Simpson Clip from DVD

Sibling Rivalry within Family Systems

Blended Family and Teen Disrespect Super Nanny Atkinson Family 3:55 to 6:30

Cultural Changes Self-esteem generation Quick fixes and immediate gratification Consumerism Self-centered culture Less connected to family and community Fewer chores and responsibilities

Criteria are too subjective Different adults may have varying standards of what they consider defiant. Cultures define defiance differently. “Normal” changes over time. – 1950’s defiance vs. today

Behaviors vary between settings. Home School Community Is the child ODD if he or she only acts out in one setting, or does that suggest that the problem is part of something else?

Behaviors vary between age groups. ODD behavior often peaks at certain ages. Terrible Twos The first adolescence (age 4) The teen age years

Overlapping Conditions We believe that many children with ODD actually have underlying conditions that contribute to the ODD profile. Until those underlying conditions are diagnosed and treated, it is hard to reduce the ODD symptoms.

Subtypes of ODD Overlapping Conditions ADHD Trauma Attachment Anxiety Autism Spectrum/Sensory Disorder Learning Disorder Mood Disorders Pre-delinquent Health/Brain-based conditions

ADHD Inattention, impulsivity and hyperactivity Inability to delay gratification Poor executive functioning – Planning, maintaining attention, inhibiting behavior, organizing skills. Triggers for ODD Behaviors: Listening demands, transitions, time demands, organizational demands, asking them to wait.

Trauma Abuse, witnessing domestic violence, war, violence in a neighborhood, death, illness, etc. PTSD: hypervigilance, memories/nightmares, avoidance of reminders Triggers for ODD Behaviors: Startling them, anything that reminds them of the trauma, ongoing interactions with a perpetrator or traumatic situation.

Attachment Disorders Poor bonding at birth or poor attachment to caregivers leading to trust issues Behaviors include: – Stealing and lying – Poor cause and effect thinking – Consequences don’t work consistently – Lack of desire to please, – Operate in survival mode,

Attachment Disorders Behaviors include: – Poor communication skills – Inability to self-regulate – Limited sense of identity – Poor problem solving skills Triggers for ODD Behavior: Demands for closeness, honesty, or trusting an adult. Situations that are out of their control.

Anxiety Disorders Social Anxiety, Separation Anxiety, OCD Irritability High arousal, panic Demanding behavior Involving parents in OCD rituals Triggers for ODD Behaviors: Separation from caregivers, use of a babysitter, stopping them from doing a ritual, transitions, bad weather, bedtime, going to school, etc.

Separation Anxiety Super Nanny Atkinson Family 18:50 – 21:46

Autistic Spectrum Disorder Verbal Deficits Stereotypical behaviors, Rituals Social difficulties Sensory issues Triggers for ODD Behaviors: Sensory overload, transition points, verbal or social demands, interrupting their rituals

Learning Disorders Memory issues Processing speed deficits Specific academic deficits Triggers for ODD Behaviors: Homework, memory demands, asking them to hurry, academic pressure, testing, comparisons to siblings or friends.

Mood Disorders Depression in kids looks like irritability and anger Bipolar Disorder Situational depression Sleep problems Triggers for ODD Behaviors: Forcing withdrawn kids to interact, manic episodes, chronic conflict, lack of sleep, etc.

Pre-delinquent Children Conduct Disorders – Early onset vs. Adolescent onset Stealing, lying, lack of conscience, immediate gratification Triggers for ODD Behavior Rules or structure, demanding compliance, an adult in a position of authority, etc.

Health/Brain-based Conditions Sleep deprivation Hunger and dietary Hearing loss (frustration, poor comprehension) Diabetes (high or low blood sugars) Drug exposed prenatally (neurological abnormalities) Lead exposure (leads to hyperactivity and learning problems) Triggers for ODD Behaviors: Compliance demands during periods of pain, confusion or frustration.

Treatments Behavioral – Positive and negative interventions Counseling – Build emotional awareness and control – Build communication skills – Build problem solving skills – Build social skills – Build moral reasoning – Cognitive behavioral therapy

Super Nanny Super Nanny Minyon family 14:55-16:42

Treatments Parent Training – Setting rules – Type that works best: authoritative – Effective use of time out – Chores and responsibilities Family Systems – Is the child acting out for the family? – Marital or divorce issues, substance abuse, etc. Treatment for coexisting conditions – Medication, sensory treatments, school interventions

Authoritative Parenting Types: Authoritarian, Laissez Faire, Authoritative BEST: Authoritative Parenting Place limits and have high expectations Listen to the child Fair and consistent discipline Warm and nurturing with calm demeanor Encourage children to discuss options and express their opinions Encourage independence

The Compliant Child Respectful – Accepts authority Responsible and independent Able to attach and trust others Pro-social skills Appropriate communication skills Identity development Problem solving skills

The Compliant Child

Parent Readings Several books by John Rosemond The Defiant Child by Russell Barkley Transform your Child by James Lehman Raising the Spirited Child by Mary Kurcinka 1,2,3 Magic by Thomas Phelan SOS - Help for Parents by Lynn Clark Have a New Kid by Friday by Kevin Levine