John Sommers-Flanagan, Ph.D. Department of Counselor Education University of Montana

1. 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 Email: John.sf@mso.umt.edu Blog: johnsommersflanagan.com

2. 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

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

4. 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

5. 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 . . .

6. . . . 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

7. 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

8. 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

9. 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

10. EST Models (require training) • The Incredible Years: http://incredibleyears.com/ • Multisystemic Family Therapy: http://mstservices.com/ • Functional Family Therapy: http://www.fftllc.com/ • Parent Management Training: http://global.oup.com/us/companion.websites/0195154290/

11. 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)

12. 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

13. Additional Info • Johnsommersflanagan.com • Books