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

Oppositional Defiant Disorder Epidemiology Oppositional Defiant Disorder Epidemiology Oppositional Defiant Disorder Comorbidity Oppositional Defiant Disorder

Aetiology & Risk Factors

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

Phobias Other anxiety disorders Obsessive Compulsive Disorder ADHD Autism Depression Oppositional Defiant Disorder Treatment

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

Individual therapy (anger management) Medication Oppositional Defiant Disorder Treatment Goals Parents: Improve positive parenting skills Enhance problem solving, conflict resolution, communication skills Child: Develop effective communication, problem-solving and anger management skills Family:

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

Thank You!

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