EXTERNALISING DISORDERS Chapter D.2 OPPOSITIONAL DEFIANT DISORDER Katie Quy & Argyris Stringaris DEPRESSION IN CHILDREN AND ADOLESCENTS Companion PowerPoint
Presentation Adapted by Julie Chilton The IACAPAP Textbook of Child and Adolescent Mental Health is available at the IACAPAP website http://iacapap.org/iacapap-textbook-of-child-and-adolescentmental-health Please note that this book and its companion powerpoint are: Free and no registration is required to read or download it This is an open-access publication under the Creative Commons Attribution Noncommercial License. According to this, use, distribution and reproduction in any medium are allowed without prior permission provided the original work is properly cited and the use is non-commercial.
Oppositional Defiant Disorder Outline The Basics Diagnosis
Epidemiology Aetiology & risk factors Assessment Treatment Oppositional Defiant Disorder The Basics A persistent pattern of defiant, disobedient, and antagonistic behavior toward adults No antisocial or aggressive acts like the ones found in conduct disorder Common
Substantial impairment Poorer adjustment outcomes Increased cost to society Oppositional Defiant Disorder Diagnosis DSM-5: 4 or more of the following, not just with siblings, lasting greater than 6 months Often loses temper Often touchy or easily annoyed Often angry and resentful Often argumentative with adults/authority figures
Often defies or doesnt follow rules Often deliberately annoys others Often blames others Spiteful or vindictive 2 x in 6 months ICD-10: persistent pattern of provocative, hostile and noncompliant behavior, with low temper threshold Oppositional Defiant Disorder Epidemiology
Prevalence: 2-10% Boys>girls Symptoms decline after age 10 Rarely diagnosed in older children Estimates vary across countries Majority do not develop conduct disorder High rates of comorbidities
Genetics Gene-environment interplay Earlier age of onset of antisocial symptoms Different temperamental routes Rejection by non-deviant peers Callous and unemotional traits Social and economic disadvantage Neighborhood violence Negative parenting Coercive family processes Oppositional Defiant Disorder
Parental Influence: coercive family processes Parents of children with disruptive behavior problems are more likely to be inconsistent in how they apply rules, and give commands that are either unclear or the result of their own current emotional state rather than contingent upon the childs behavior
Gerald R Patterson Founder of the Oregon Social Learning Centre Oppositional Defiant Disorder Assessment
Gather information from multiple sources Assess comorbidities Consider family, school and neighborhood Watch for bullying or peer deviance Assess for learning difficulties Oppositional Defiant Disorder Differential Diagnosis
Identify and treat comorbidities Address modifiable risks Parent management training (see Chapter A.12) The Incredible Years Triple P (Positive Parenting Program) Alternative approaches School-based interventions
Family counseling and support Classroom: Social skills sessions from teacher or counselor Oppositional Defiant Disorder Treatment: The Incredible Years For parents, teachers, and children 3 programs: basic, advanced, partners Basic: 13-16 2 hour weekly sessions Videos of right vs wrong child management Topics: play, praise, rewards, limit-setting, handling misbehavior
Discussions after with rehearsal Homework Telephone support Multi-center controlled trial in 141 children age 3-8 with antisocial behavior utilizing Basic programme Decrease in antisocial behavior, hyperactivity, total number of problems per day, conduct problems, total deviance (SDQ), externalizing and total problem scores (CBCL), parent defined problems, and ICD 10 diagnoses of ODD Decrease in parents inappropriate commands Oppositional Defiant Disorder
Treatment: Triple PPositive Parenting Program Multiple levels: Information on parenting issues for interested parents Advice for specific problem behaviors Brief programs for advice/training with minor behavioral problems More intensive programs for persistent and pervasive behavioral problems mood management strategies Coping skills Partner support skills
Oppositional Defiant Disorder Treatment: School-Based Interventions Tools for teachers in 4 Primary Domains: Promoting compliance and adherence to classroom rules and acceptable behaviors Developing problem solving skills Preventing problem behavior Avoiding escalation of oppositional behavior Oppositional Defiant Disorder
Treatment: Individual therapyAnger Management CBT-based Coping skills approach with stress inoculation 3 elements: Cognitive preparation Skill acquisition Application training Role play Oppositional Defiant Disorder
Treatment: Medication No evidence for medication in ODD alone Stimulants improve conduct and oppositional symptoms in ADHD Sodium valproate may help with aggression in hospitalized children with ADHD if stimulants failed No effects on severe irritability with Lithium Evidence lacking for use of SSRIs for anger in children Anti-manic agents should not be given for ODD only Dopamine antagonists: use short-term on a case by case basis Oppositional Defiant Disorder
/ 1 Quality of answers Total: /25 = pts We have chosen the following stresses: Yelling Shaking Elevated CO2 Fungal stress N and S deprivation High Temp Predation Flooding Each of you will make presentations and write a 5 page...
05 Feb 01 Integration of Systems and Software Engineering within the APS-137 Radar Branch of Surveillance Systems Integrating Systems and Software Engineering - A Call to Action As processing power increases, more functionality is migrating from Hardware to Software implementations...
One patient with preintervention blood cyanide concentration of 170 lmol/L, a value substantially exceeding the typically lethal threshold, survived when treated with hydroxocobalamin 4 hours after cyanide ingestion. This patient ingested acetonitrile, which causes delayed onset of cyanide poisoning.
Regional Perspective on Global Disarmament Treaties ... (consistent with operative paragraph (1) of the Security Council resolution 1540). 1. Egyptian Implementation of 1540 (Regional Workshop 7-10 December 2009) Take effective measures to tighten controls on the movement and handling of...
Matt 6:34 Take therefore no thought for the morrow: for the morrow shall take thought for the things of itself. Sufficient unto the day is the evil thereof. ... AND DAUGHTERS HAYLEY, 17, AND MICHAELA, 11. He was also found...