Working with Oppositional and Defiant Children:

1. A School Counselor’s Guide to ODD Working with Oppositional and Defiant Children: Kathryn Casey The University of Arizona

2. A Case Example

3. Outline • What is ODD? • Identifying ODD children • Examples of ODD behaviors vs. age appropriate behaviors • Differential Diagnoses • Statistics • Prognosis • Correlates • Intervention Strategies • ASCA Standards • Ethical Considerations • Additional Information and Resources • Conclusion and Questions

4. What is ODD? • Definition • “A recurrent pattern of developmentally inappropriate levels of negativistic, defiant, disobedient, and hostile behavior toward authority figures” (Hamilton & Armando, 2008)

5. Diagnostic Criteria Refuses to comply Argues with adults Deliberately annoys others Four or more symptoms must be present for at least 6 months Blames others Easily annoyed or frustrated Often angry and resentful Spiteful and vindictive • (American Psychiatric Association, 2000)

6. Diagnostic Criteria • These behaviors must cause significant impairment in social, academic, or occupational functioning • The behaviors are not due to a psychotic or mood disorder • Criteria are not met for Conduct Disorder or Antisocial Personality Disorder (18+ only) (American Psychiatric Association, 2000)

7. At one time or another couldn’t every child be considered oppositional defiant?

8. ODD vs. Age Appropriate Behaviors • Infancy • More likely to have been fussy, colicky, or difficult to soothe when compared to other infants (American Academy of Child & Adolescent Psychiatry, 2010)

9. ODD vs. Age Appropriate Behaviors • Toddlers • More extreme temper tantrums surrounding major power issues such as toilet training, eating, and sleeping • Much worse than what one would expect in the Terrible Twos (American Academy of Child & Adolescent Psychiatry, 2010)

10. ODD vs. Age Appropriate Behaviors • School age • More likely to procrastinate, dawdle, or claim they did not hear the teacher • More likely to be set on winning at all costs • Even willing to lose privileges just to be “right” • Power struggles center on homework, cleaning up, and bathing/grooming • Has little insight or ability to admit their troubles, instead they blame others (American Academy of Child & Adolescent Psychiatry, 2010)

11. ODD vs. Age Appropriate Behavior • Teenagers • Power struggles center on curfew, obscene language, attending school, cleaning up • May get into trouble with the police • Question authority and break rules • Different from Conduct Disorder (CD) (American Academy of Child & Adolescent Psychiatry, 2010)

12. ODD vs. Conduct Disorder • Conduct disorder • More severe than ODD • Physical aggression toward people or animals • Examples: assault, bullying, muggings, forced sexual activity • Destruction of property • Examples : arson, vandalism • Deceitfulness or theft • Examples: shoplifting, forgery • Serious violation of rules • Examples: truancy, running away from home (American Psychiatric Association, 2000)

13. Differential Diagnoses • Conduct disorder • ADHD • Impaired Language Comprehension • Mental Retardation • Mood disorders and psychotic disorders • Normal individualization School Counselors do not diagnose! (Hamilton & Armando, 2008)

14. Statistics • ODD is one of the most diagnosed mental health disorders in childhood (Hamilton & Armando, 2008) • 2-16% of children meet criteria for ODD (Turgay, 2009; Sprague &Thyer, 2003) • Tends to be diagnosed more often in boys(Waschbusch & King, 2006) • Girls often display aggression more covertly (Hamilton & Armando, 2008) • Symptoms are often present for 2-3 years before diagnosis (Hamilton & Armando, 2008)

15. Statistics • Co-occurring disorders are common with ODD (Heflinger & Humphreys, 2008) • 50% diagnosed with another psychiatric disorder • ADHD and mood disorders are most common • Children with dual diagnosis of ADHD and ODD are more likely to develop CD and/or antisocial personality disorder later in life (Dickstein, 2010)

16. Prognosis • Academic Difficulties • Homework completion, classroom time • Social Difficulties • Poor social skills (i.e. aggression) • Career Difficulties • Following rules and authority • Emotional Problems • More likely to develop depression or bipolar disorder • Higher risk for suicidal ideation and attempts (Dickstein, 2010)

17. Correlates • Dysfunctional or maladaptive family dynamics (Cunningham, & Boyle 2002) • Trauma, abuse and/or domestic violence (Ford, Thomas, & Racusin, et al. 1999) • Low SES (Boden, Fergusson, & Horwood, 2010) • Lower cognitive ability (Boden, Fergusson, & Horwood, 2010) • Association with deviant peer groups (Boden, Fergusson, & Horwood, 2010)

18. Intervention Strategies Parents and Caregivers Teachers Interventions are most effective when Parents, Teachers, and Counselors work together! -Effective Discipline -Establish positive relationship -Establish clear expectations -Boundaries -Communication -Effective Discipline -Social Modeling -Behavior Plans -Classroom management support -Referrals, CST -Skills training -Family Therapy -Resources and Referrals School Counselor -Skills groups -Individual counseling -Establish positive relationship (Lanza, & Drabick 2011; Milne, Edwards, & Murchie, 2001;Sprague & Thyer 2003;Turgay, 2009 )

19. Applying the ASCA National Model (American School Counselor Association, 2012)

20. Ethical Considerations • School Counselors do not diagnose • Avoid over-identifying “problem” children • Symptoms can be ambiguous • Coordination of care • Confidentiality • Skills Competency • Making appropriate referrals when needed (Studer, 2005)

21. Case Study Follow Up

22. Additional Resources • The Oppositional Defiant Disorder Resource Center http://www.aacap.org/cs/ODD.ResourceCenter • The Total Transformation Program by James and Janet Lehman http://www.thetotaltransformation.com/ • Bright Hub Education: Strategies for Teaching Children with ODD http://www.brighthubeducation.com/special-ed-behavioral-disorders/26631-strategies-for-teaching-children-with-oppositional-defiant-disorder/ • The Defiant Child by Dr. Douglas A. Riley, Child and Adolescent Psychologist • Oppositional Defiant Disorder and Conduct Disorder in Children by Walter Matthys and John Lochman • Educating Oppositional and Defiant Children by Phillip Hall and Nancy Hall • Solutions to Oppositional Defiant Disorder by Marilyn Adams, LMFT http://www.guidancefacilitators.com/odd2.html

23. References American Academy of Child & Adolescent Psychiatry. (2010). Your Child- Oppositional Defiant Disorder. Retrieved from htt://www.aacap.org/cs/root/publications/store/your child oppositional defiant disorder American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders(4th ed., text rev.). Washington, DC: Author. American School Counselor Association. (2012). ASCA National Model: A Framework for School Counseling Programs, Third Edition. Alexandria, VA: Author. Boden, J., Fergusson, D., & Horwood, J. (2010). Risk Factors for Conduct Disorder and Oppositional/Defiant Disorder: Evidence from a New Zealand Birth Cohort. Journal of the American Academy of Child and Adolescent Psychiatry, 49(11), 1125-1133. Cunningham, C., & Boyle, M. (2002). Preschoolers at Risk for Attention-Deficit Hyperactivity Disorder and Oppositional Defiant Disorder: Family, Parenting, and Behavioral Correlates. Journal of Abnormal Child Psychology, 30(6), 555-569. Dickstein, D. (2010). Oppositional Defiant Disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 49(5), 435-436. Ford, J., Thomas, J., Racusin, R., Daviss, W., Ellis, C., Rogers, K., Reiser, J., Schiffman, J., Sengupta, A. (1999). Trauma Exposure Among Children With Oppositional Defiant Disorder and Attention Deficit-Hyperactivity Disorder. Journal of Consulting and Clinical Psychology, 67(5), 786-789.

24. References Continued Hamilton, S., & Armando, J. (2008) Oppositional Defiant Disorder. American Family Physician, 78(7), 861-866. Heflinger, C., & Humphreys, K. (2008). Identification and Treatment of Children with Oppositional Defiant Disorder: A Case Study of One State’s Public Service System. Psychological Services, 5(2), 139-152. Lanza, I., & Drabick, D. (2011). Family Routine Moderates the Relation Between Child Impulsivity and Oppositional Defiant Disorder Symptoms. Journal of Abnormal Child Psychology, 39, 83-94. Markward, M., & Bride, B. (2001). Oppositional Defiant Disorder and the Need for Family-Centered Practice in Schools. Children & Schools, 23(2),73-Milne, J., Edwards, J., & Murchie, J. (2001). Family Treatment of Oppositional Defiant Disorder: Changing Views and Strength-Based Approaches. The Family Journal: Counseling and Therapy for Couples and Families, 9(1), 17-28. Sprague, A. & Thyer, B. (2003). Psychosocial Treatment of Oppositional Defiant Disorder. Social Work in Mental Health, 1(1), 63-72. Studer, J. (2005). The Professional School Counselor: An Advocate for Students. Belmont, CA: Brooks/Cole. Turgay, A. (2009). Psychopharacological Treatment of Oppositional Defiant Disorder. CNS Drugs, 23(1), 1-17. Waschbusch, D., & King, S. (2006). Should Sex-Specific Norms Be Used to Assess Attention-Deficit/Hyperactivity Disorder or Oppositional Defiant Disorder? Journal of Consulting and Clinical Psychology, 74(1), 179- 185.

25. Questions?