Prepared by: Tracy Huckell & Tammy Taypotat

1. Prepared by: Tracy Huckell & Tammy Taypotat Oppositional Defiant Disorder

2. Definition Characteristics Diagnosis Criteria Causes & Commonly Co-Occuring Disorders Treatment Pre-Assessment Activity Strategies for School Success Overview 2 We Belong We Are Responsible We Nurture We Respect We Learn

3. Pre-Assessment – What do you know about ODD?

4. Definition of ODD Oppositional Defiant Disorder, or ODD, is a childhood mental disorder characterized by a pattern of disobedient, hostile, and defiant behavior towards authority figures. To fit the diagnosis, the behavior must persist for at least six months and occur more often than might be expected for the child's age and developmental stage, as some oppositional behavior is to be expected as a child grows.

5. Common Characteristics of ODD • Excessive, often persistent anger, frequent temper tantrums or angry outbursts, as well as disregard for authority. • Often purposely annoy others, blame others for their own mistakes, and are easily disrupted. • Parents often observe more rigid and irritable behaviors than in siblings. • May appear resentful of others - when someone upsets them, they prefer taking revenge more than considering sensitive solutions.

6. DSM-IV Criteria for Diagnosis Signs and symptoms must last longer than 6 months and be considered beyond normal child behavior to fit the diagnosis. The child must exhibit at least 4 of the 8 signs and symptoms below in order to meet the DSM-IV-TR diagnostic threshold for oppositional defiant disorder: • Actively refuses to comply with majority's requests or consensus-supported rules • Performs actions deliberately to annoy others • Angry and resentful of others • Argues often • Blames others for his or her own mistakes • Often loses temper • Spiteful or seeks revenge • Touchy or easily annoyed • Generally, these patterns of behavior will lead to problems at school and other social venues.

7. Causes of ODD The exact cause of ODD is not known, but it is believed that a combination of biological, genetic, and environmental factors may contribute to the condition. Biological: Some studies suggest that defects in or injuries to certain areas of the brain can lead to serious behavioral problems in children. In addition, ODD has been linked to abnormal amounts of certain types of brain chemicals, or neurotransmitters. Neurotransmitters help nerve cells in the brain communicate with each other. If these chemicals are out of balance or not working properly, messages may not make it through the brain correctly, leading to symptoms of ODD, and other mental illnesses. Further, many children and teens with ODD also have other mental illnesses, such as ADHD, learning disorders, depression, or an anxiety disorder, which may contribute to their behavior problems.

8. Causes of ODD Continued… Genetics: Many children and teens with ODD have close family members with mental illnesses, including mood disorders, anxiety disorders, and personality disorders. This suggests that a vulnerability to develop ODD may be inherited. Environmental: Factors such as a dysfunctional family life, a family history of mental illnesses and/or substance abuse, and inconsistent discipline by parents may contribute to the development of behavior disorders. Children of alcoholic parents, or whose parents have "been in trouble with the law" run an 18% chance of developing ODD, beginning very early in age

9. Commonly Co-Occurring Disorders • ODD often occurs with: • ADHD • Anxiety Disorders • Depression • Tourette Syndrome • Obsessive-Compulsive Disorder • Developmental Disabilities • Learning Disabilities

10. Treatment • Treatment for ODD is determined based on many factors, including the child's age, the severity of symptoms, and the child's ability to participate in and tolerate specific therapies. Treatment usually consists of a combination of the following: • Psychotherapy (a type of counselling) is aimed at helping the child develop more effective coping and problem-solving skills, and ways to express and control anger. A type of therapy called cognitive-behavioral therapy aims to reshape the child's thinking (cognition) to improve behavior.

11. Treatment Continued… • Family therapy may be used to help improve family interactions and communication among family members. A specialized therapy technique called parent management training (PMT) teaches parents ways to positively alter their child's behavior. Behavior management plans also often involve developing contracts between parent and child that identify rewards for positive behaviors and consequences (punishments) for negative behaviors. • While there is no medication formally approved to treat ODD, various drugs may be used to treat some of its distressing symptoms, as well as any other mental illnesses that may be present, such as ADHD or depression.

12. Thumbs Up or Down #1 “The rule says if you’re not completing your work, you go to Mr. Parmar’s office.”

13. Thumbs Up or Down # 2 “You broke the rule and I’m so disappointed in you for your comment.”

14. Thumbs Up or Down #3 “That answer was dead on! Thank you! You’re amazing!

15. Thumbs Up or Down #4 “Good answer”

16. Thumbs Up or Down #5 “Johnny, what does the schedule say?”

17. Working with Oppositional Students Strategies for School Success

18. Establishing Expectations Teachers should clearly state their behavioral expectations and practice with both examples and non-examples. Do not assume that students understand common classroom expectations (e.g., waiting turns, raising hand, talk-outs). Provide praise - Students with ODD often act as though they don’t care about others. However, using praise when appropriate in matter of fact way can be effective.

19. Establishing Expectations • Establishing clear expectations avoids confusion and helps inform students what good behavior looks like. • To establish expectations: • Use a calm but firm tone of voice – “You’re expected to complete these 10 questions.” • Use ‘first/then’ • Outline consequences so students are clear with what will occur if they follow/don’t follow through

20. Provide Consequences All students require a clear understanding of limits and consequences for inappropriate behavior. Consequences should not be a surprise. Consequences should be appropriate, meaningful, and implemented consistently. They must be something the student wishes to avoid. Consequences will only be effective if used in conjunction with a class-wide and individualized system of positive behavior interventions and supports.

21. Implementing Consequences • Use calm tone of voice – control verbal and non-verbal cues – NVCI strategies (don’t engage emotionally) • Restate expectations, limits, consequences in a matter of fact tone • Avoid negotiating consequences • Don’t hold a grudge – allow the student a fresh start after the consequence • Avoid reminders/threats of misbehaviour - don’t say, “you don’t want to get another detention, do you?”

22. Building Positive Relationships • Listen to the student • Take interest in their interests • Set up time for fun • Interact neutrally • Be a positive role model • Avoid damaging words • “People will forget what you said & what you did, but they will never forget how you made them feel.” Maya Angelou

23. Reinforce Desired Behavior • This is your key to getting things back on track – catch students being good • Be optimistic and look for what the student does well • Ask the student what YOU are doing well – turn the tables. Asking for feedback further develops your relationship with the student.

24. Behavior Contracts • A written or spoken statement outlining behaviors and consequences that: • Clearly states expectations and consequences • Helps develop relationships through team work • Defines positive and negative behaviors and corresponding consequences • Agreement of contract terms – sign and/or shake on it • Allows staff to react consistently and be clear on how they should follow through • Needs to be revisited frequently and revised as needed

25. Organization of Classroom Children with attention problems do not do well in cluttered, visually “busy” classrooms. The layout and organization of the class should suggest order, structure and purpose. The main part of the classroom – where direct instruction is provided – should be as free of distractions as possible (no dangling mobiles, student artwork gallery, etc). Stimulating, enriching activities can be confined to well-defined areas.

26. Seating Arrangement Do not seat near distracting stimuli (windows, fish tank, hallway) or other traffic patterns. Desk should be at the front of a row so other students are out of visual field and the student is close to the teacher when information is presented. The teacher can then conveniently provide subtle gestures and prompts as needed. The child should also be seated next to students who are typically on task and well organized.

27. Daily Schedule • Visually reminds students what they need to be doing. In contrast, verbal directives may set them off. • When off-task, the child can look to the daily schedule for a self-generated redirection or the teacher can prompt them to look at the schedule when needed. • ie - “Justin, what does the schedule say?”

28. Work Structure • Many children who are oppositional also have attention problems. For these children, the materials in and on their desks often get them off task. • Provide an organizational system, depending on age and developmental level (work baskets, colored notebooks, binders with tabs). For each class, they should be provided with a visual representation (symbols or words) indicating what needs to be done (with clear expectations), when it needs to be finished, and what comes next.

29. Tasks Non-compliance and defiance often occur because the presented task is either too hard, lacks visual clarity, or has no clear finish. Therefore, the following should be considered: Appropriate Developmental or Academic Level - if an oppositional child looks at a task and arent’ sure how to get started or feel it’s too hard, they almost certainly will react negatively.

30. Tasks Continued… Visual Clarity – The child should be able to look at the task and know what needs to be done, with minimal verbal directions. If oppositional children look at a task and do not immediately see what is to be done, they will usually act out. Clear Finish – The task needs to have a clear finish. The child should be able to determine when the task is complete simply by looking at it. For tasks that do not have a clear finish (project work), the teacher may use a timer to inform the student how long the session will be.

31. Tasks Continued… One Response Set – Many children have difficulty switching from one response set to another and usually need a directive from the teacher to initiate this shift. However, oppositional children do not respond well to verbal directives, therefore teachers should minimize the number of tasks required on one page of work.

32. Rule-Centered Classroom with “Padded” Boundaries • These students most often respond best to a rule-centered (vs. authority-centered) classroom. This allows the educator and the student to defer to the power of the rules and avoid power struggles. ‘The rule says....’ • Rules must be applied consistently to allow the student to focus on his/her behavior rather than on the educator’s behavior. At the same time, unduly harsh limit setting (i.e. yelling, backing student into a corner) will activate a ’fight or flight’ response in many of these students. • Limit setting that is calm, clear, firm, and supportive will have the greatest positive impact.

33. Consistency Across Environments • Consistency is the same expectations, limits and consequences across different settings and staff members. • It’s confusing to students when they have different rules in different settings – this doesn’t set them up for success and reinforced ‘boundary testing’. • Allows educators to team in teaching the student appropriate behavior. Educators that don’t know the expectations and limits may accidentally reinforce negative behavior from the student • ie - Following through with consequences for non-compliance • Ignoring certain behaviors

34. Check In/Check Out • Check-in is used to see how things are going for them at the beginning of the day and to remind them of expectations and strategies they can use. • Check-out is used to review how the day went...what worked, what didn’t, what to focus on the next day, to reflect on the choices made and related consequences etc.

35. Time Out • Self-imposed time-outs give students time to cool down and/or regain perspective. • They should not be used as a punishment or threat, but rather as an opportunity offered when staff see early signs of agitation or escalation. • If incorporating a time-out option, staff should meet with the student proactively to discuss logistical details (where it will be, how to access it appropriately, how long he/she can stay there, what he/she can do there, etc.)

36. Differentiating Allow student to choose order of assignments – what to do first. This allows them to control something in their day. Alternate choice – they choose what to do, then you get a choice, then they choose the next activity etc. – shared control and choice Work with student to set up their daily schedule When possible, allow student to choose topic when writing etc. to motivate and engage them

37. Avoiding Conflict • Reduces the chance of bigger problems • Oppositional students often thrive on conflict • Stop talking and actively listen for 30 seconds – they may just need to be heard • Minimize emotional reactions to student choices – remain neutral even if you are disappointed in their choice • Sometimes they are looking to get a reaction out of you so retain your calm tone of voice and body language • Don’t get pulled into a power struggle • Try to view your student with compassion – understand they have not developed necessary skills and strategies to cope with frustration • Avoid taking things personally • Think of whether your words/actions will escalate or de-escalate the behavior

38. Managing the Daily Antecedents • Antecedentsrefer to the events that occur just before a particular behaviour is displayed. Not all antecedents can be environmentally controlled. • Two categories: • those that increase the likelihood of oppositional and defiant behaviour • those that increase the likelihood of appropriate behaviour

39. Managing the Daily Antecedents Continued… • Antecedents to Avoid for Students with ODD: • Someone saying no • Hearing a directive to stop doing something • Hearing a sharply worded directive to do something • Seeing any gesture, facial grimace, or body language that conveys disapproval • Having idle time

40. Responses to Avoid • Avoid body language/non verbal cues that set up or increase conflict: • Crossed arms, staring, glaring, finger-pointing • Avoid inappropriate verbal communication: • Authoritative tone of voice, ultimatums or empty threats, blaming, tone of voice • Inappropriate communication... • “You should know better,” or “I’m going to get the principal who will likely suspend you.”

41. Review Past Situations • When done carefully, this can help students learn from past situations to make better choices in the future • Timing is important – not too soon (when emotions are still high) or too late (student may not remember or care) • Review and teach new skills as soon as student seems open to learning from a past situation • Review situation objectively - be sure not to cast blame. Focus on how the student can cope with a situation better next time....”Did you like how that situation ended up? What can you try differently next time to make the situation better?” • Reference previously taught skills that can be used the next time. Write a list of more appropriate options that can be tried next time.

42. Opportunities to Practice Generosity Provide ample opportunities to practice generosity. Without opportunities to give to others, young people do not develop as caring individuals. Strategies to support and help students with ODD must combine both behavioral intervention and efforts to enhance moral development.

43. Exit Activity Concept Map – What did you learn?