Oppositional Defiance Disorder

1. Oppositional Defiance Disorder What is it and how do we survive it in the classroom?

2. What is it? Definition: Diagnostic and Statistical Manual of Mental Disorders (DSM) as an ongoing pattern of disobedient, hostile and defiant behaviour toward authority figures which goes beyond the bounds of normal childhood behaviour.

3. Behaviours associated with ODD • out of seat often • disruptive noises • does not listen • rummages shelves/cupboard • hits, kicks, shoves • giggles in silly way • cries over small matters • argues in angry way • destroys property • forces someone to do something they don't want to do • takes something from another child • defies teacher • throws an object at someone • refuses to share • curses • speaks out of turn • Interrupts • repeatedly asks same question • makes fun of another • forces someone to do something they don't want to do

4. How do we know if it is not just typical adolescent behaviour? Typical Adolescent Adolescent with ODD EXTREME oppositional behaviour • Normal to moderate oppositional behaviour

5. What is the cause of ODD? Biological: 1.) Possibly defects in or injuries to certain areas of the brain 2.) Abnormal amounts of special chemicals in the brain called neurotransmitters. 3.) Also have other mental illnesses, such as ADHD, learning disorders, depression, or an anxiety disorder. Genetics:Frequently family members with mental illnesses, including mood disorders. Environmental:Dysfunctional family life

6. How common is this? • Disruptive behaviour disorders appear to be more common in boys than in girls, and they are more common in urban than in rural areas. • Between 5% and 15% of school-aged children have Oppositional Defiant Disorder (ODD). A little over 4% of school-aged children are diagnosed with Conduct Disorder (CD).

7. When and for how long does this last? • Behaviours that may signal the beginnings of ODD or CD can be identified in preschoolers. Most children with ODD symptoms “grow out of it” with treatment. • Some may go on to develop Conduct Disorder. Children and adolescents with CD whose symptoms are not treated early are more likely to fail at school and have difficulty holding a job later in life. They are also more likely to commit crimes as young people and as adults

8. Often comorbid with other disorders

9. Conduct Disorder Vs. ODD Debate • In a study assessing the diagnoses of 108 children using DSM-III-R criteria, Reeves et. al (1987) found only four children with a conduct disorder diagnosis unaccompanied by any other diagnosis, and only two children had an ODD diagnosis alone. • In a comparison of clinically diagnosed children and a control group of normal children Reeves et. al (1987) found that children with ADD and conduct disorder had a much higher frequency of adverse family backgrounds and were characterized by fathers with lower education levels, family alcoholism, and fathers with antisocial personalities. These children did not differ significantly from the normal group in terms of marital adjustment of parents or parental strife observed by the child

10. Conduct Disorder Diagnosis Criteria • has stolen without confrontation of a victim on more than one occasion • has run away from home overnight at least twice while living in parental or surrogate home • often lies • has deliberately engaged in fire setting • is often truant from school • has broken into someone else's house, building, or car • has deliberately destroyed others' property • has been physically cruel to animals • has forced someone to have seual activity with him or her • has used a weapon in more than one fight • often initiates physical fights • has stolen with confrontation of a victim • has been physically cruel to people

11. Difference between conduct problem disorders

12. Subtype 1 of conduct disorders

13. Subtype II of conduct disorders

14. What can ODD lead to?

15. Conduct Disorder vs. ODD Stealing

16. Treatment • Really needs to be tailored to the individual childParent training programs • Individual therapy • Social skills therapy • Cognitive psychology therapy • relaxation training • thought stopping • replacing upsetting thoughts with calming thoughts • self-selected time-outs

17. Often cited as the most successful method of treatment: Social Learning/ Family therapy • addressing the multiple systems involved, including parents, siblings, school personnel, and others • effective therapeutic intervention skills which include impacting the environment and establishing positive expectations for change • developing self-control skills for the entire family such that parents and children have alternatives to explosive or depressive behaviour • defining disciplinary approaches that lead to positive changes for all family members • social enhancement methods for increasing prosocial behaviours • maintenance skills for continuing change once it has occurred

18. Neuroscience behind it all • Adrenal androgens levels higher • Lower baseline heartrates • Median cortisol levels are lower on average • Lower levels of 5-Hidroxyindoleacetic acid (5-HIAA) and Homovanillic acid (HVA) • Postsynaptic serotoninergic receptor is oversensitive (may be related more to ADHD)

19. Teaching Strategies 1.) Establish clear behaviour goals with the student 2.) Monitor their progress towards these goals 3.) Positive reinforcement 4.) Consistent consequences for inappropriate behaviour 5.) When possible change behaviour antecedents 6.) Find out what punishments will work best with the student

20. 1.) Establish clear behaviour goals with the student • Have a meeting with the student and their parents to determine SMART goals • gather information about cognitive/emotional reactions • gather information about sequences and patters • Think about situations that could arise and give the student alternatives to acting out • break complex problems into manageable units

21. 2.) Monitor their progress towards these goals • Set up a behaviour log • Set up weekly meetings to monitor progress • Send progress reports home

22. 3.) Positive reinforcement

23. 4.) Consistent consequences for inappropriate behaviour

24. 5.) When possible change behaviour antecedents • communicate empathy • provide reassurance and normalize problems • use self-disclosure • define everyone as a victim • emphasize positive expectations for change • match your communication style to the family • use humouruse open-ended questions • share the agenda • deal with one issue or task at a time • break complex problems into manageable units • end sidetracking • give everyone a chance to participate

25. 6.) Find out what punishments will work best with the student • Ignoring • giving commands • time-out procedure Caution: as with any child, extensive punishment sets up escape and avoidant behaviours that may be more harmful to the relationship between teacher/parent and child than is the behaviour being punished

26. Resources to help! BOOKS • Treating Conduct and Oppositional Defiant Disorders in Children • Children with Conduct Disorders, A Psychotherapy Manual • No More Misbehavin': 38 Difficult Behaviors and How to Stop Them • Kids are worth it! Revised Edition: Giving Your Child the Gift of Inner Discipline • The Difficult Child • How to Behave so your Children Will • Your Defiant Child: Eight Steps to Better Behaviour • Discipline: The Brazelton Way • Making Children Mind without Losing Yours • Raising your Spirited Child: A Guide for Parents Whose Child is more Intense, Sensitive, Perceptive, Persistent and Energetic • Rage, Rebellion and Rudeness: Parenting in the new Millennium

27. Websites • American Academy of Child and Adolescent Psychiatry**www.aacap.org/publications/factsfam** • Canadian Paediatric Society**www.caringforkids.cps.ca/behaviour** • Canadian Mental Health Associationwww.cmha.ca • Children’s Mental Health Ontario www.kidsmentalhealth.ca • Centre for Addiction and Mental Health www.camh.net • The ABCs of Mental Health – a Teacher Resource www.brocku.ca/teacherresource/ABC • When Something’s Wrong: Ideas for Teachers www.cprf.ca