Oppositional+Defiant+Disorder+and+Conduct+Disorder+in+Adolescence

Created by Lindsey Joliff, Lisa McKee, and Shelby Dow

__Oppositional Defiant Disorder (ODD):__ __ Helpful Information and Resources for Parents and Teachers __ According to the Mayo Clinic, ODD is, "A persistent pattern of tantrums, arguing, and angry or disruptive behavior toward you and other authority figures." Conduct Disorder, a more severe form of ODD, can be difficult for families and teachers to cope with. This Wiki will provide peace of mind, knowledge, and information on how to handle this diagnosis of a child.

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__**Background:**__ ODD usually develops before age 8 and gradually gets worse through adolescence. ODD is identified when negativity, defiance, disobedience, and hostility last continuously for three months or longer. It has been related to Attention Deficit Hyperactivity Disorder (ADHD), Anxiety, and Depression (Mayo Clinic, 2012). [|Instant Help for Children with Oppositional Defiant Disorder]



The following are Evidence-Based Questions for Assessing Likelihood of Meeting DSM-IV Criteria for Oppositional Defiant Disorder (American Family Physician, 2008). These questions are designed to help parents, physicians, and psychologists with determining if further inquiry should take place.

**Evidence-Based Questions for Assessing Likelihood of Meeting DSM-IV Criteria for Oppositional Defiant Disorder **
 * **1. Has your child in the past three months been spiteful or vindictive, or blamed others for his or her own mistakes? //(Any “yes” is a positive response.)// ** ||
 * **2. How often is your child touchy or easily annoyed, and how often has your child lost his or her temper, argued with adults, or defied or refused adults' requests? //(Two or more times weekly is a positive response.)// ** ||
 * **3. How often has your child been angry and resentful or deliberately annoying to others? //(Four or more times weekly is a positive response.)// ** ||

note: //A positive response for all three is 91 percent specific for meeting DSM-IV criteria on full interview. Any negative response is 94 percent sensitive for ruling out oppositional defiant disorder //. //DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th ed., rev //.

__**Causes:**__ According to the Mayo Clinic (2012), there is no distinct cause of ODD and Conduct Disorder. There are however, some contributing factors such as:
 * natural disposition
 * specific skill limitations or delays
 * lack of supervision
 * inconsistent or harsh discipline
 * abuse or neglect
 * imbalance of chemicals in the brain

Challenging behavior is likely to occur when a child reaches his capacity to respond to situations adaptively. Many children and adults respond to stressful situations in a variety of ways: some cry, sulk, pout, whine, or withdraw. Children with ODD often respond in a more expressive manner, including screaming, swearing, spiting, hitting, kicking, destroying property, lying, and truancy (Greene, 2008).

It is caused by students lacking specific skills, particularly in executive functioning. These executive functioning skills include "shifting cognitive set (the ability to shift efficiently from one mind set to another), organization and planning (organizing a coherent plan of action to deal with a problem or frustration), and separation of affect (the ability to separate your emotional response to a problem from the thinking you need to perform to solve the problem)" (Greene, 2005, p. 25).

Outbursts are usually caused by specific "triggers". A trigger is " a situation or event that routinely precipitates an explosive outburst" (Greene, 2005). Triggers are different for each individual student. Some examples of triggers include, homework, sensory hypersensitivies, tics, sibling interactions, bedtime, wake up time, boredom, riding in the car, teasing, recess, reading, writing, tiredness, hunger, and temperature changes (Greene, 2005).

__**Prevalence:**__
 * || == Prevalence Estimates of Mental, Emotional and Behavioral Disorders In Young People ==



//CD = Conduct Disorder; ODD = Oppositional Defiant Disorder; ADHD = Attention Deficit Hyperactivity Disorder Source: Preventing Mental, Emotional and Behavioral Disorders Among Young People, 2009. National Research Council and Institute of Medicine, of the National Academies.// //Retrieved from The National Council for Community Behavioral Healthcare Website, 2012// [|Click Here for More Information] ||  || media type="youtube" key="A3EbngOEWCs" width="425" height="350" align="center"

The estimation of the prevalence rate of oppositional defiant disorder is 2-16% in the general population. Prior to the onset of puberty, it is more common in boys. After puberty, ODD is an equal opportunity offender and is generally found equally among boys and girls. ODD typically presents itself before the age of 8 years old and about half usually have a second diagnosis of ADHD (Johnson, 2011).

Students diagnosed with ADHD are at a higher risk of a second diagnosis of ODD (Greene, 2008, p. 38).

__**Treatment:**__ There are many forms of treatment that are used for ODD. Typically, some sort of psycho therapy is recommended (Mayo Clinic, 2012). Psycho therapy may involve individual therapy, family therapy, parent-child interaction therapy, and/or any combination of these therapies. As part of treatment, training is recommended is cognitive problem solving, social skills, and parenting. The key to helping children with a diagnosis of ODD is to teach them the skills that they are lacking. These training sessions help to teach children specific skills to reduce frustration and learn how to appropriately handle the stresses of life. Here are some tips and strategies that may be helpful in developing skills for children with ODD. (Green, 2005).

__<span style="font-family: Arial,sans-serif; font-size: 10pt;">Problem Solving __ __<span style="font-family: Arial,sans-serif; font-size: 10pt;">Impulsive Behavior __ || **<span style="font-family: Arial,sans-serif; font-size: 10pt;">Disorganized thoughts and impulsive behavior lead to frustration in problem solving ** __<span style="font-family: Arial,sans-serif; font-size: 10pt;">Chronic Irritability or Anxiety __ || * <span style="font-family: Arial,sans-serif; font-size: 10pt;">Teach children how to “put their emotions on the shelf” __<span style="font-family: Arial,sans-serif; font-size: 10pt;">Difficulty Changing Routines/Unpredictability __ __<span style="font-family: Arial,sans-serif; font-size: 10pt;">Inflexibility __ || * <span style="font-family: Arial,sans-serif; font-size: 10pt;">Follow routines.
 * <span style="font-family: Arial,sans-serif; font-size: 22pt;">Skill Set || <span style="font-family: Arial,sans-serif; font-size: 22pt;">Strategy ||
 * __<span style="font-family: Arial,sans-serif; font-size: 10pt;">Difficulty with Transition __<span style="font-family: Arial,sans-serif; font-size: 10pt;"> //(Shifting from one task or mind set to another)// || * <span style="font-family: Arial,sans-serif; font-size: 10pt;">Give notice of transition before it’s time to transition (“In three minutes we will go brush our teeth” “When you are done with math, we are moving on to reading”)
 * <span style="font-family: Arial,sans-serif; font-size: 10pt;">Explicitly teach how to shift gears in each environment
 * <span style="font-family: Arial,sans-serif; font-size: 10pt;">Teach and practice expectations of each environment ||
 * __<span style="font-family: Arial,sans-serif; font-size: 10pt;">Disorganization __
 * <span style="font-family: Arial,sans-serif; font-size: 10pt;">Work with children to learn how to solve problems and organize their thoughts.
 * 1) <span style="font-family: Arial,sans-serif; font-size: 10pt;">STOP – take a breath and count to ten
 * 2) <span style="font-family: Arial,sans-serif; font-size: 10pt;">ASK – What am I trying to do?
 * 3) <span style="font-family: Arial,sans-serif; font-size: 10pt;">THINK – How can I do this?
 * 4) <span style="font-family: Arial,sans-serif; font-size: 10pt;">EVALUATE – Is there another way I could do this?
 * 5) <span style="font-family: Arial,sans-serif; font-size: 10pt;">DECIDE – Which way will be the best?
 * <span style="font-family: Arial,sans-serif; font-size: 10pt;">Set expectations with appropriate consequences
 * <span style="font-family: Arial,sans-serif; font-size: 10pt;">Reflect on previous decisions ||
 * __<span style="font-family: Arial,sans-serif; font-size: 10pt;">Difficulty Expressing Self __ || * <span style="font-family: Arial,sans-serif; font-size: 10pt;">Help children identify their emotions
 * <span style="font-family: Arial,sans-serif; font-size: 10pt;">Develop a signal for the child to indicate when they are starting to get frustrated. Allow the child to leave the situation.
 * <span style="font-family: Arial,sans-serif; font-size: 10pt;">Practice expressing emotions and communicating what they want with others (“I don’t feel like talking right now.”) ||
 * __<span style="font-family: Arial,sans-serif; font-size: 10pt;">Difficulty Separating Emotions from an issue __
 * <span style="font-family: Arial,sans-serif; font-size: 10pt;">Work with the child to identify the stem of the anxiety
 * <span style="font-family: Arial,sans-serif; font-size: 10pt;">Once the cause of the anxiety is determined, help the student to solve the problem. ||
 * __<span style="font-family: Arial,sans-serif; font-size: 10pt;">Difficulty Seeing the “Grays” __
 * <span style="font-family: Arial,sans-serif; font-size: 10pt;">Teach flexibility by preparing children for changes in routine
 * <span style="font-family: Arial,sans-serif; font-size: 10pt;">Give options for children instead of “doing whatever you want” ||
 * __<span style="font-family: Arial,sans-serif; font-size: 10pt;">Difficulty Understanding How Their Behavior Affects Others __ || * <span style="font-family: Arial,sans-serif; font-size: 10pt;">Help children understand how their behavior affects others by having them think about how they feel when others do the same thing.
 * <span style="font-family: Arial,sans-serif; font-size: 10pt;">Analyze how others might see the child’s behavior ||

<span style="font-family: Arial,sans-serif; font-size: 110%;">In order to identify specificskills Ross Greene (2008) recommends completing an Analysis of Lagging Skills and Unsolved Problems (ALSUP) and/or a Situational Analysis of the problem behavior. Both of these forms can be found online at [|www.lostatschool.org].

<span style="font-family: Arial,sans-serif; font-size: 110%;">Greene (2008) also suggests the use of what he refers to as "PLAN B" or the "Collaborative Problem Solving" Approach to address issues with children do not meet expectations. "PLAN B" can be used in just about any setting. Greene (2008) explains it like this: When issues are not being met, you need to have a plan in place for handling the unmet expectations. There are three options for handling this situation: PLAN A, PLAN B, and PLAN C. PLAN A is when adults //impose their will// and force children to met an expectation. PLAN C is when "giving in" occurs and the expectation is dropped. PLAN B, however, is a win-win for both the child and the adult because they create a mutually satisfying plan for resolving the problem or unmet expectation. PLAN B helps adults clarify and understand the child's point of view. Meanwhile, it also helps the child clarify and understand the view of the adult. Both parties concerns are address, the problem gets solved, and the appropriate skills get taught. Learn more about PLAN B at <span style="font-family: Arial,sans-serif; font-size: 110%;"> [].

<span style="color: #000080; font-family: 'Arial Black',Gadget,sans-serif; font-size: 120%;">**__School:__** <span style="font-family: Arial,sans-serif; font-size: 110%;">Schools already have many ways to help identify problem behaviors and create plans to help address individual student needs. This flow chart identifies the steps a school might follow to better support a child with excessive problem or explosive behavior such as students with ODD.



<span style="font-family: Arial,sans-serif; font-size: 10pt;">When students demonstrate excessive problem behavior in the school setting the school will usually start by completing a Fuctional Behavior Assessment (FBA). Here is a sample FBA from Elkhart Community Schools in Elkhart, IN:

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__<span style="color: #000080; font-family: 'Arial Black',Gadget,sans-serif; font-size: 17px;">**Local Agencies:** __ <span style="color: #0088ff; font-family: 'Arial Black',Gadget,sans-serif; font-size: 120%;">__**Resources for Parents & Teachers:**__ media type="youtube" key="cHPGoqDmlRQ" width="358" height="295" align="center"
 * Dr. Lisa Sexton MS/LMHC - Therapy & Family Mediation Offices
 * (574) 607-4362
 * 205 W. Jefferson Blvd. Suite 504, South Bend, IN 46601
 * Family & Children's Center Counseling and Development Services
 * (574) 968-9660
 * 315 W. Jefferson Blvd. South Bend, IN 46601
 * Dr. Gregory Hinkle - The Samaritan Center
 * (574) 262-3597
 * 221 E. Crawford Street, Elkhart, IN 46514

Do you suspect that your child has ODD? [|Click here for a full sample questionnaire.]

<span style="color: #000080; font-family: 'Arial Black',Gadget,sans-serif; font-size: 120%;">__**Progress Monitoring and Behavior Charts:**__ Establishing routines and expectations are very important when dealing with children with behavioral disorders. The following links are charts intended to monitor behaviors. There are four charts, two for teachers and two for parents. We have offered charts for small children as well as adolescents. The charts were designed so that the students could self-monitor behaviors. Smaller children can color in the correct smiley faces. Stickers can obviously be substituted and are popular with small children. Older children can circle a number rating 1-5 and total up their points for the day. You can personalize what points goals students should make each day. All are Microsoft Word documents, and include blanks for personalized goals. Feel free to change them, print them, share them, steal them, and don't forget...USE THEM!!!

<span style="color: #000080; font-family: 'Arial Black',Gadget,sans-serif; font-size: 120%;">__**Tradebooks:**__ The following tradebook is an excellent resource for parents. This book offers parents step by step directions on taking back control of your home. It is an easy read and will be a valuable tool when making decisions regarding behavior plans and incentives. This tradebook has even been recommended to my own sister who struggles with a child that has many behavior issues. //Redicrecting the Out of Control Child: Eliminating Defiance & Talking Back Without Using Punishments, Time-outs, Behavioral Plans, or Rewards// - By Jason K. Johnson (2011) [|Interested in buying this book?]

In his book //Lost at School,// Dr. Ross Greene, professor at Harvard Medical School and founder of the Collaborative Problem Solving Institute, offers insight into students with behavior challenges in schools. He gives realistic views, case studies, and plans regarding how to ensure students with ODD and other behavior disorders do not "fall through the cracks." This book is a MUST READ for parents and teachers. This book is an eye-opener, giving the reader hope that there actually is a variety of strategies that can help these troubled students. //Lost at School -// By Ross W. Greene, Ph.D. (2008) [|Interested in buying this book?] [|Visit this site for a series of videos by Dr. Greene]

<span style="color: #000080; font-family: 'Arial Black',Gadget,sans-serif; font-size: 120%;">__**Helpful Websites:**__
 * Mayo Clinic - ODD []
 * The Mayo Clinic, an esteemed branch of hospitals located in Arizona, Florida, and Minnesota offers description of the disorder, symptoms, treatment, and plenty more information for anyone looking to discover more about ODD. Parents considering meeting with their child's physician will appreciate the "Preparing for your appointment" link which gives helpful hints on what to do to prepare, and questions to ask at the appointment.
 * American Academy of Family Physicians - ODD []
 * This website, while very academically written, provides an abundant amount of information regarding ODD. A link towards the top of the article near "Patient Information" will take you to a more user friendly page, with additional resources and information.
 * American Academy of Child and Adolescent Psychiatry - A Guide for Families []
 * ***This is a must-read article!!! While this article is lengthy (18 pages), it tells anything and everything someone needs to know about ODD. Writen directly for parents and families affected by this disorder, it is extremely user friendly and offers information about social factors, effective therapy, and what to expect for your child in the future.
 * PBS: Building Inner Controls []
 * When viewing this page, you will find strategies and information how to help your child build inner controls. While it seems geared towards small children, the content is still valuable and relevant to families with adolescents with ODD.

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<span style="color: #000080; font-family: 'Arial Black',Gadget,sans-serif; font-size: 120%;">__**Scholarly Articles Worth Reading:**__
 * "Time to redefine the diagnosis of oppositional defiant disorder" - Alison S. Poulton, //Journal of Paediatrics// //and Child Health//(2010)
 * This article features information on how children are diagnosed with ODD. It calls for adding ODD under the ADHD umbrella and gives research why this change should take place. It also tracks the behavior disorders from childhood to adulthood. [|Read the Full Article]
 * "Impact of oppositional defiant disorder dimensions on the temporal ordering of conduct problems and depression across childhood and adolescence in girls" - Alison E. Hipwell et al., //The Journal of Child Psychology and Psychiatry//(2011)
 * This article is a research project regarding the relationship between depression and the onset of ODD in girls. There is little research about these disorders in girls so this article is definitely worth reading. The researchers discovered that ODD often leads to depression as an adult, and brings attention that necessary action needs to be taken once females are diagnosed with ODD/CD. [|Read the Full Article]
 * "Investigation of cool and hot executive function in ODD/CD independently of ADHD" - Hobson, Scott, and Rubia, //The Journal of Child Psychology and Psychiatry//(2011)
 * This research looks at how the different symptoms and problems associated with ODD compare with those of ADHD. The study specifically looked at the executive functioning of the adolescents with ODD and basic ADHD. The results showed that those with ODD were more likely to have "hot" executive functioning and make risks in decision making. [|Read the Full Article]
 * "Directed Teaching" - Drew Laurence, //Learning & Leading with Technology//(2004)
 * Featured in //Learning & Leading with Technology,// teacher Drew Laurence demonstrates how using technology engaged students in learning, therefore eliminating behavioral and emotional problems. //[|Read the Full Article]//
 * "Calling All Frequent Flyers" - Ross W. Greene//,// //Educational Leadership,//(2010)
 * From the author of //Lost at School,// this article contains much of the same topics, techniques, and plans featured in his book in a more condensed format. This article uses more reader-friendly language, but still offers plenty of research based insight into how educators should rethink their behavior/discipline programs in schools. [|Read the Full Article]
 * "Developmental Pathways in Oppositional Defiant Disorder and Conduct Disorder" - Richard Row, Jane E. Costello, Adrian Angold, William E. Copeland, Barbara Maughan, //Journal of Abnormal Psychology//(2010)
 * __Developmental pathways in Oppositional Defiant Disorder and Conduct Disorder__ discusses the difference between Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD) and the probability of ODD developing into CD. [|Read the Full Article]
 * " Does the prevalence of CD and ODD vary across cultures? " - Glorisa Canino, Guilherme Polanczyk, Jose J. Bauermeister, Luis A. Rohde, Paul J. Frick,//Social Psychiatry & Psychiatric Epidemiology//(2010)
 * __Does the prevalence of CD and ODD vary across cultures?__ examines the connections between Conduct Disorder, Oppositional Defiant Disorder, and Cultures. This study finds that culture and location do not significantly affect the prevalence of ODD/CD. In the areas studied the results showed consistent growth of ODD/CD in the teenage years. [|Read the Full Article]

<span style="color: #0088ff; font-family: 'Arial Black',Gadget,sans-serif; font-size: 170%;">__**References:**__ Greene, R. (2008). //Lost at school: Why our kids with behavioral challenges are falling through the cracks and how we can help them//. New York, NY: Scribner.
 * Trade-books:**

Johnson, J.K. (2011). //Redirecting the out of control child: Eliminating defiance & talking back without using punishments, time-outs,// //behavioral plans, or rewards//. The In-Home Parent Coach, L.L.C.

Canino, G., Polanczyk, G., Bauermeister, J.J., Rohde, L.A., & Frick, P.J. (2010) Does the prevalence of CD and ODD vary across cultures? //Social Psychiatry and Psychiatric Epidemiology, 45,// 695-704.
 * Scholarly Articles:**

Greene, R.W. (2010). Calling all frequent flyers. //Educational Leadership, 68(//2), 28-34.

Hipwell, A.E., Stepp, S., Feng, X., Burke, J., Battista, D.R., Loeber, R., & Keenan, K. (2011). Impact of oppositional defiant disorder dimensions on the temporal ordering of conduct problems and depression across childhood and adolescence in girls. //Journal of// //Child Psychology and Psychiatry, 52//(10), 1099-1108.

Hobson, C.W., Scott, S., & Rubia, K. (2011). Investigation of cool and hot executive function in ODD/CD independently of ADHD. //Journal of Child Psychology and Psychiatry, 52//(10), 1035-1043.

Laurence, D. (2004). Directed teaching. //Learning & Leading with Technology, 31//(7), 46-47.

Poulton, A.S. (2010). Time to redefine the diagnosis of oppositional defiant disorder. //Journal of Paediatrics and Child Health, 47//(6), 332-334.

Rowe, R., Costello, J. Angold, A., Copeland, W.E., & Maughan, B. (2010). Developmental pathways in oppositional defiant disorder and conduct disorder. //Journal of Abnormal Psychology 119//(4), 726-738.


 * Websites:**
 * Mayo Clinic - ODD []
 * American Academy of Family Physicians - ODD []
 * American Academy of Child and Adolescent Psychiatry - A Guide for Families []
 * PBS: Building Inner Controls []