ODD Oppositional Defiant Disorder

1. ODDOppositional Defiant Disorder ANGIE LABAY July 31, 2010 Wiki Project MICHIGAN STATE UNIVERSITY

2. Why ODD? The number of children with Special needs is on the rise. Information is power! I have always wanted to be able to understand this disorder. I want to help the children afflicted with ODD and want to give my classmates the information to help their peers. Teaching is our profession and we need to power ourselves with knowledge to best suite the needs of our students. We need to help the students that nobody else is willing to help. I ask for all the “bad” kids to be placed in my room every year. It is my job to educate and make the kids a productive part of society.

3. This needs to stop! “When a child starts school, a pattern of passive-aggressive, oppositional behavior tends to provoke teachers and other children as well. At school the child is met wit anger, punitive reactions and criticism. The child then argues back, blames others and gets angry. By the time a youngster with ODD reaches adolescence, she may have had years of difficulty at school. Her behavior and attitude regularly cause disruption in the classroom and interfere with social and academic functioning.” (Pruitt)

4. Ask yourself these questions • Do you want to help all the children in your classroom? • Do you believe that all children are entitled to education? • Do you believe children should be able to succeed and be productive in society? • Do you believe that information is power? • If you answered yes to these questions then, continue to empower yourself with the knowledge to help children!

5. ODD Defined • According to the Journal of Emotional and Behavior Disorders, “Individuals with ODD display a recurrent patterns of behavior that is disobedient, negativistic, defiant and hostile toward authority figures that impairs the individual’s ability to function personally, socially, or academically over a period of at least 6 months.”(Journal of Emotional and behavior disorders – June 22, 06) • According to www.conductdisorders.com, “Oppositional Defiance Disorder is a supposed and largely disputed ‘mental illness’ characterized by an ongoing pattern of disobedient, hostile and defiant behavior toward authority figures that goes beyond the bounds of normal childhood behavior. When a child cannot seem to control his anger or frustration, even or what seems to be trivial or simple to others, the child will often react in violence or negative ways to his own feelings.”(“Oppositional Defiance Disorder”)

6. Who? 1.More boys are diagnosed with ODD that girls, especially before puberty. Kids begin to exhibit the signs of ODD before the age of 8 and no later than 13-15. The professionals are cautious diagnosing ODD before a child reaches school age, many kids with ODD were fussy, argued and were likely to throw temper tantrums as very young kids.(Evans Feb. 27, 2007) 2.ODD is characteristically seen in children below the age of 9 or 10 years. (Oppositional Defiant Disorder 1992) 3.After puberty the male: female ratio is about 1:1. (Tynan June 2004)

7. Statistics 1.Estimated that 2%-16% or kids and teens have ODD (www.jas.familyfun.go.com 2008) 2.According to the Journal of Abnormal Child Psychology, “Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) DSM-IV gives the rate as between 2-16% while the American Academy of Child and Adolescent Psychiatry (AACAP) gives a figure of 5%-15%, and a researcher at a children's hospital gives a rate of 6-10%.” (Tynan, June 2004)

8. Statistics “16%-22% of normal school –age children engage in oppositional behavior. Thus, oppositional behavior may be developmentally normal in early children. It is when the oppositional behavior is significantly greater than what would normally be expected in other children of the same age that a diagnosis of Oppositional Defiant Disorder is appropriate.”(MedFriendly.com: Oppositional Defiant Disorder)

9. Symptoms of ODD Four of more of these symptoms need to have occurred in the last 6 months • Frequent Temper Tantrums • Argumentative with adults • Refusal to comply with adult rules or requests • Deliberate annoyance of other people • Blaming others form mistakes or misbehavior • Acting touchy or easily annoyed • Anger and resentment • Spiteful and vindictive behavior • Aggressiveness toward peers • Difficulty maintaining friendships • Academic Problems (Oppositional defiant disorder (ODD) Dec. 19, 2007)

10. Symptom Variables • According to the American Academy of Child & Adolescent Psychiatry, “When a child is presenting the symptoms of ODD it is extremely important to look for other disorders; such as ADHD (attention deficit hyperactive disorder), learning disabilities, mood disorders (depression, bipolar disorder) and anxiety disorders. It is hard to improve on ODD symptoms without treating the coexisting disorder. Some children with ODD may go on to develop conduct disorder (CD). (AACAP 1999)

11. Symptoms According to the Journal of Abnormal Child Psychology, “Symptoms of ODD are common in young children, but normally decline in prevalence with age. They are considered pathologic only when they are severe or when they persist until ages when most other children have outgrown them (i.e., middle to late childhood)” (Loeber August 1993)

12. Causes of ODD • The child’s inherent temperament • Family response to child’s style • Genetic that when coupled with certain environmental conditions – such as lack of supervision, poor quality child care or family instability – increases the risk of ODD • A biochemical or neurological factor • Child’s perception that he or she isn’t getting enough of parent’s time and attention (Oppositional defiant disorder (ODD) Dec. 19, 2007)

13. Risk Factors • Having a parent with a mood or substance abuse disorder • Being abused or neglected • Harsh or inconsistent discipline • Lack of Supervision • Poor relationship with one or both parents • Family instability such as occurs with divorce, multiple moves, or changing schools or child care providers frequently • Parents with a history of ADHD, ODD or conduct problems • Financial problems in family • Exposure to violence • Substance abuse in the child or adolescent(Oppositional defiant disorder (ODD) Dec. 19, 2007)

14. Treatment According to WebMD, “Treatment is determined based on risk factors, including the child’s age, the severity of symptoms, and child’s ability to participate in and tolerate specific therapies Treatment usually consists of a combination of psychotherapy and medication: Psychotherapy: Is aimed at helping the child develop more effective ways to manage and control anger. Medication: The same medications that are used to treat ADHD, depression or other mental illnesses.” (Mental Health: Oppositional Defiant Disorder 2005-2007)

15. Treatment • Parent Training Programs • Parents are taught negotiation skills, and positive reinforcement skills • Individual Psychotherapy • Allows the child to explore feelings and behaviors which may decrease defiant behavior • Family Therapy • Family dynamics and strategies for handling difficulties are modified through therapy • Cognitive Behavioral Therapy • This type of therapy helps kids control their aggression and modulate their social behavior • Social Skills Training • Social skill training incorporates reinforcement strategies and rewards for an appropriate behavior to help generalize appropriate behavior. Which means applying one set of rules to many social situations. (Pruitt)

16. Treatment continued • Children with symptoms should see a doctor. The doctor will want to know the child’s behavior history and possibly testing will be done. • Therapy (individual, group or family) • Anger management skills • Family is educated on how to support and help child • Hospitalization – only if child is dangerous to him/herself or others • Medication – sometimes (Nopoulos 2002)

17. Medication continued • Three basic principles when using psychiatric drugs in children: • Start Low • Go Slow • Monitor Carefully • Types of medication: • Atypical Antipsychotics – first used for schizophrenia • Risperidone (Risperidal) – Used for Tourettes, psychosis, aggression and conduct disorders. Usually given twice daily. • Olanzapine (Zyprexa) – Used for mania in adults and given once daily • Quetiapine (Seroquel) – No studies done on using for ODD, given twice daily. (Chandler 2008 )

18. Medication Side Effects • Weight Gain • Stiffness, restlessness and tremors • Elevated Cholesterol and Triglycerides • Diabetes • TardiveDyskinsea • Sexual Side Effects • Gynecomastia about 5% of boys and/or girls develop this • Menstruation in girls • Galactorrhea • Neuroleptic malignant Syndrome • Psychiatric Symptoms(Chandler 2008)

19. What can I do at Home? • Talk about new problems or ways to help • Keeping daily schedule the same will help control behavior • Be consistent with rules and discipline • Set limits for him/her • Have a plan in place on what to do when child misbehaves. Stay calm and follow through • Use time-out when child misbehaves. Separate child from activity or group until child calms down • Praise and reward child (Nopoulos 2002)

20. The Context • One student at a local Area High School (he is a Sophomore) – he is described in detail on the following slide • The staff it is affecting is: • 5 teachers (Each subject teacher – a combined experience of 75+ years collectively) • Special Education Director – 30 years experience • Special Education Secretary – 20 years experience • Principals (There is a Principal and Asst. Principal – combined there is 35 years experience) • Guardians • Law Enforcement (the student is currently on juvenile probation)

21. The Student • How do I as an educator teach a child who does not want to be taught? • The Scenario: (We will call him Devin) • 17 year old white male • Sophomore in High School • Failing every class • Mother died 6 years ago the day before Easter • Father signed off custody • Lives with Aunt and Uncle (The Aunt is his Mother’s sister) • Feels passed around and unwanted by everyone • No consequences for his action • Recently busted with marijuana, and for smoking cigarette’s on school property • Convict felon for selling his Ritalin while in Middle School • On Probation, very close to being placed in a juvenile detention home • Adopted at Birth

22. The Problem • Devin believes and trusts nobody. He has an I don’t care attitude. He has an explosive temper, has ODD and ADHD. He currently takes medication and visit a child psychiatrist 4 times a year or as needed. Focusing on school work is very hard, but the hardest part is he just doesn’t care. He makes bad choices to see how mad he has to make his Aunt and Uncle before they will kick him out of the house. When he turns 18 he will be a junior in High School and will no longer have a legal guardian. I find this very disturbing. He says he is going to drop out of high school when he turns 18 which will be in March. The problem is getting him to focus and care about his work, grades and future.

23. The Classroom • The classroom needs to be arranged to set the child up for success • Planning for the child and his/her environment before meeting the child. (“Environmental Engineering”) • Avoid verbal directives because this usually results in non-compliance and defiance from the children • The intention of engineering the classroom is to teach the child the skills to participate in a relationship (Hall 2003)

24. The Action Plan • To improve Devin’s grades to passing with a C. • To improve Devin’s attitude, trust and self worth through positive reinforcement. • To improve Devin’s explosive temper. • To keep Devin in High School until Graduation.

25. Action Plan step 1: How to improve Devin’s grades to passing with a C or better. • Students with ODD like to create power struggles. State position clearly. • Choose battles wisely • Give 2 choices when a decision needs to be made. State the choices briefly and clearly. • Establish classroom rules • Praise Devin positively • Academic work at the appropriate level • Teach Devin social skills (conflict resolution and anger management) • Provide consistency and structure • Allow Devin to re-do assignments • Structure activities so the student with ODD (Devin) is not always left out or is the last one picked (Minnesota Association for Children’s Mental Health – MACMH) • Weekly progress meeting with Teacher, Aunt, Uncle and Devin

26. Action Plan Step 2: Improve attitude and self worth • Consistency of rules and consequences between home and school • Sit with Aunt, Uncle and Patrick to establish a rules and consequence list. EX: An unfinished homework assign results in a loss of a privilege • Positive reinforcement at home and school. EX: When assignment is turned in on time and done with 75% accuracy then an added privilege is granted. • There is never too much positive reinforcement. Praise all baby steps made. EX: If he arrives to school or home in a good mood = reward

27. Action Plan Step 3: The Explosive Temper • Continue to see Psychiatrist • Allow Devin a place at school and home to express his anger. A let it all out room. Some place where he will not disturb other kids • Allow Devin to talk to school psychologist whenever necessary an open door policy. • He needs to build a trusting relationship with someone with whom he can share anything and everything that is bothering him • Teach him different deep breathing techniques • Explain to him that it is OK to get angry and everyone does, it is how we express our anger that is different. Reinforce in him that anger is a normal emotion and what is OK and what is not OK to do when he is angry

28. Action Plan Step 4:The Aunt and Uncle • They in themselves are a risk factor of ODD because they have inconsistent rules and consequences. Also, they are the third place Devin has lived in 17 years. • Have the Aunt and Uncle go to therapy as singles and as group. • Make a poster of rules and consequences. EX of what not to do: Devin just got busted with Marijuana and he still gets to go on an Oregon snowboarding vacation during Spring Break. EX of what to do: Busted with Marijuana = no spring break vacation • Both Aunt and Uncle need to be on same page. They need to unite. • Need to make Devin feel loved, nurtured, wanted and appreciated. • Need to watch tone of voice and words chosen when talking to Devin. • Positive reinforcement for every baby step made in the right direction toward recovery.

29. Action Plan Step 5: Keeping Devin in High School until Graduation • Make and stick to a plan (Devin, Aunt, Uncle and school) • Positive Reinforcement (a tremendous amount) • Let Devin pick the reward if he follows through with graduation plan • Realize there will be bumps along the way, but get right back on that plan.

30. Important Message about Children’s Mental Health • Every child’s mental health is important. • Many children have mental problems. • These problems are real, painful and can be severe. • Mental health problems can be recognized and treated. • Caring families and communities working together can help. (Substance Abuse and Mental Health Service Administration – SAMHSA)

31. Something to think about According to EAP partners website written by Ablon and Greene, “Recent research into the childhood diagnosis “Oppositional Defiant Disorder” (ODD) found the presence of cognitive deficits amongst these children who are behaviorally challenging. Such deficits were found most notably in areas of executive functioning skills, emotion regulation skills, language processing skills, and social information processing skills. For example, approximately 55% of children with language processing difficulties also the diagnostic criteria for ODD, suggesting that, if a child does not possess the linguistic skills necessary to label and categorize emotions or communicate needs to others, the stage may be set for concurrent difficulties with frustration tolerance and problem solving. These cognitive skill deficits suggest that it may be productive to understand explosive/noncompliant behavior as the byproduct of a developmental delay or learning disability. Unlike other well-recognized learning disabilities that manifest themselves purely in the academic domain (i.e., dyslexia), the learning disability of a child diagnosed with ODD appears in specific arenas in which frustration tolerant and flexibility are required.” (Ablon 2008)

32. Conclusion According to EAP partners website written by Ablon and Greene, “The analogy of ODD as a learning disability points us in the right direction as it relates to our understanding and treatment of children with ODD. Sending a dyslexic child out of the class or giving him/her a detention because he/she was not reading? Unimaginable. Putting that same child in time-out when he/she was not able to read a bedtime story at home? Unfathomable. Hopefully the same reactions will be applicable to ODD in the coming years.” (Ablon 2008)

33. Conclusion Continued In the case of Devin a close monitoring will be necessary along with many collaborative meetings with family and school participants. Positive reinforcement will be key to success along with minimal extra stimulus. Baby steps to better grades will be taken one assignment at a time. With careful monitoring and strong support system, Devin can be successful and overcome. The day he graduates I will have the biggest smile on my face of anyone in attendance.

34. Resources • American Academy of Child & Adolescent Psychiatry(AACAP) Children with Oppositional Defiant Disorder No. 72, (Dec. 1999) 1-800-333-7636 ext. 140 P.O. Box 96106, Washington, D.C. 20090. from www.aacap.org/cs/roots/facts_for_families/children_with_oppositional_defiant_disorder. • Chandler, James M.D. FRCPC, Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD) in Children and Adolescents: Diagnosis and Treatment. Retrieved April 3, 2009 http://jamesdauntchandler.tripod.com/ODD_CD/oddcdpamphlet.htm. • Children and Adolescents with Conduct Disorder, Substance Abuse and Mental Health Service Administration (SAMHSA), 1-800-789-2647 Retrieved April 4, 2009 http://www.education.com/print/Ref_Children_Conduct/. • Ablon, Stuart J Ph.D. & Ross W. Greene, Department of Psychiatry, Massachusetts General Hospital, Employee Assistance Program. The Learning disability of Oppositional Defiant Disorder. 1-866-724-4EAP Retrieved April 4, 2009, from www.eap.partners.org/WorkLife/Parenting/Special_Needs_Children/Oppositional_Defiant_Disorder . Content Provided with Permission from Ross W. Green. • Evans, Garrett D Psy.D., Oppositional Defiant Disorder (ODD)(February 27, 2007). Retrieved April 3, 2009, from http://edis.ifas.ufl.edu/FY002 . (University of Florida IFAS Extension) • Hall, Philip S. and Nancy D. Hall, Educating Oppositional and Defiant Children Association for Supervision and Curriculum Development, (2003). • Loeber, Rolf. Evidence for developmentally based diagnoses of oppositional defiant disorder and conduct disorder. Journal of Abnormal Child Psychology, (August 1993). Retrieved April 4, 2009, http://findarticles.com/p/articles/mi_m0902/is_n4_v21/ai_13240555/print .

35. Resources • Minnesota Association for Children’s Mental Health. 1-800-528-4511 (MN only) 165 Western Avenue North, Suite 2, St. Paul, MN 55102 Retrieved July 14, 2008www.macmh.org. • MedFriendly: Oppositional Defiant Disorder Retrieved June 4, 2008 http://www.medfriendly.com/oppositionaldefiantdisorder.html. • Mental Health: Oppositional Defiant Disorder, (2005-2007) Retrieved June 3, 2008 www.webmd.com/mental-health/oppositional-defiant-disorder?page=3&print=true. • Napoulos, Peggy M.D., Donna D’Alessandro M.D. and Lindsay Huth, B.A., Oppositional Defiant disorder. (April 2002). Retrieved June 3, 2008 http://www.virtualpediatrichospital.org/patients/cqqa/odd.shtml • Oppositional Defiance Disorder, Wikipedia Contributors. Retrieved June 3, 2008 http://www.conductdisorders.com/ourarticles/oppositional_defiance.shtml • Oppositional defiant disorder (ODD) (Dec., 19, 2007) Retrieved June 3, 2008 www.mayoclinic.com/print/oppositional-defiant-disorder/DS00630/METHOD=print. • Oppositional Defiant Disorder, (1995). Retrieved June 4, 2008 http://jas.familyfun.go.com/sendpage?page=sendpage&dest=print.

36. Resources • Oppositional Defiant Disorder, (1992).Retrieved April 3, 2009 http://www.mental-health-matters.com/disorders/print.php?disID=67. • Oppositional defiant disorder rating scale: preliminary evidence of reliability and validity.(psychological research)(includes statistical tables) (22-Jun-06). Journal of Emotional and Behavioral Disorder. Retrieved April 4, 2008, http://www.accessmylibrary.com/comsite5/bin/aml_landing_tt.pl?purchasetype=ITM&ite. • Pruitt, David M.D. and AACAP, Your Child: Emotional, Behavioral & Cognitive Development from through Preadolescence. Retrieved April 14, 2009 http://www.aacap.org/cs/root/publication_store/your_child_oppositional_defiant_disorder. • Pruitt, David M.D. and AACAP Your Child: Emotional, Behavioral & Cognitive Development from Early Adolescence through the teen years. Retrieved April 14, 2009 http://www.aacap.org/cs/root/publication_store/your_adolescent_oppositional_defiant_disorder. • Tynan, W. Douglas, PhD Journal of Abnormal Child Psychology 32 (June 2004): 263-271."Oppositional Defiant Disorder." eMedicine November 2, 2003. ... Retrieved April 15, 2009 www.healthatoz.com/healthatoz/Atoz/common/standard...

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