Oppositional Defiant Disorder & Conduct Disorder

1. Oppositional Defiant Disorder & Conduct Disorder

2. Oppositional Defiant Disorder (313.81) • Pattern of negativistic, hostile, and defiant behavior * (p. 102) • The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning • The behaviors do not occur only during the course of a psychotic or mood disorder • Criteria are not met for either conduct disorder or antisocial personality disorder

3. ODD cont. * 4 or more of the following need to be present • often loses temper • often argues with adults • often actively defies or refuses to comply with adults • often deliberately annoys people • often blames others • often easily annoyed by others • often angry or resentful • often spiteful or vindictive

4. ODD cont. • Parents may present with complaints that client constantly misbehaves; refuses to listen to them; argues • You may notice very poor parent-child interactions • The client may deny all or some of the parents’ assertions, or blame others • There may be swearing, temper tantrums, yelling, and fighting; client may be easily frustrated • There may be co-occurrence of substance or polysubstance use • In school, there may be some of the same problems as at home

5. ODD cont. • More boys than girls (before puberty) • After puberty, genders relatively equal • Boy’s behavior usually more confrontational • Usually evident before 8 and no later than early adolescence • Family history of similar dx., or symptomology (i.e., marital stress)

6. Conduct Disorder 312.81; Childhood-Onset (< 10 y/o)312.82; Adolescent-Onset (> 10 y/o)312.89; Unspecified-Onset (if age is unknown) • There are also severity specifiers • Mild, Moderate, & Severe • This usually refers to the number of conduct problems & type

7. Conduct Disorder, cont. * 3 or more criteria within the following categories within the past 12 months; with at least 1 criteria present in the past 6 months. • Aggression to people and animals • Destruction of property • Deceitful or theft • Serious violation of rules • pp.98-99 lists the criteria

8. Conduct Disorder, cont. • While this may be an appropriate diagnosis, it often carries long term implications • Symptoms (behaviors) can vary with age • The earlier the more destructive behaviors, the worse the prognosis • Generally, the more destructive behaviors emerge last • ODD is often a precursor to CD • More common in boys, especially the childhood onset type • CD often remits in adulthood, although many go on to develop Antisocial Personality Disorder

9. Caveats when considering either ODD or CD as a provisional dx. • Keep in mind who is providing the information (parents, school, physician, law enforcement/courts, the client) • They may have biases • They may be poor historians • They may have an agenda • Many of these behaviors may be transient (especially during developmental periods) • Keep in mind the context • Gather as much information, and from a variety of sources

10. Lets try a few! A 9 y/o boy is brought in by his mother. She relates that he has become more and more sullen. He yells at his older sister; he refuses to clean up his room. Mom says he has always been difficult to control. “A lot of time outs, and I have taken away his Nintendo.” At school, he has gotten two referrals to the office; One was for calling the teacher ‘stupid’ when he got an answer wrong. The other was for pushing another student because “he didn’t throw me the ball.” He has been in ISS several times, since the beginning of the school year. The boy tells you that “people get make me mad.” He also states that nobody likes him.

11. What do you think….? You are asked to interview and assess a 13 y/o girl. She tells you that she has been arrested twice in the past two months. The first time was for fighting another girl at the mall. She related that the girl “asked for it.” The second time was for stealing makeup from a car in her apartment complex She tells you that she knew the owner, and that it was okay to use her makeup. She also tells you that she ran away last month, and smokes “a blunt every now and then.” Last year, she would leave school sometimes to go see her boyfriend at his work.

12. Any thoughts on this client? You interview a 12 y/o boy and his mother. They are referred by the child’s pediatrician. Mother and child appear to have very strong attachments. They both relate that the client has been “angry” lately. He was also kicked off the baseball team for repeatedly throwing his bat and storming off the baseball field. When asked, the client states that “the umpires were out to get me.” Mom tells you that when he gets in trouble, his father gets after him, and accuses her of “babying him.” The client says she will stay in her room all day and that “my parents fight a lot.” “My dad says she takes happy pills.” The client tells you other kids make fun of him for being a little chubby. He says that he really does not care. Mom stated that when he was a baby, he cried “all the time.”