The Clinician's Guide to Oppositional Defiant Disorder

Symptoms, Assessment, and Treatment

Michelle M. Martel

• Publisher: Academic Press
• Year: 2019
• Print ISBN: 9780128156827
• eBook ISBN: 9780128156834
• Topic: Psychology
• Subtopic: Clinical Psychology
• Index: Psychology

The Clinician's Guide to Oppositional Defiant Disorder: Symptoms, Assessment, and Treatment uniquely focuses on practical strategies for assessing and treating Oppositional Defiant Disorder (ODD) in youth. After briefly reviewing clinical characteristics of ODD and known causal factors, the book reviews brief and easily administered assessment measures of ODD. It further describes efficacious treatment elements across different treatment protocols that can be personalized for young children, older children, and/or adolescents that are based on unique clinical and family characteristics. Assessment and treatment tips for addressing commonly co-occurring problems, such as difficulties with toilet training, lying, problems with peers, and aggression are included.Finally, the book includes practical tools, such as therapeutic handouts, sample rating forms, and psychoeducational materials for parents and clinicians, along with links to online materials for ease of use in applied clinical settings.- Provides cutting-edge clinical insights on the etiology, assessment and treatment of ODD- Outlines the symptoms of ODD and their links to the development of other disorders- Reviews heritable and environmental causes of ODD- Describes efficacious treatment elements, such as differential attention and time out- Provides guidelines for associated problems, such as bedwetting and lying- Includes in-text and online materials for applied use in assessment and treatment

Chapter 1

Oppositional defiant disorder dimensions and prediction of later problems

Abstract

Oppositional defiant disorder (ODD) is a common and impairing disorder characterized by angry/irritable mood, argumentative/defiant behavior, and vindictiveness. These symptom domains are related to and predict attention-deficit/hyperactivity disorder, conduct disorder, and mood and anxiety problems. ODD often begins early during preschool, is relatively stable, and exhibits irritability as a core feature. ODD is also associated with other disruptive behavior disorders and other problems such as problems with peers, toilet training problems, and problems with independent sleep. There is substantial heterogeneity in ODD, including a callous/unemotional pathway and a reactive mood/aggression pathway. Yet, accurate characterization of the disorder is important for early assessment and treatment.

Keywords

ODD; ADHD; CD; DBD; irritability

Luis is a 4-year-old Latino male. He was referred by his pediatrician for an evaluation after his parents presented complaining about Luis’ aggression. Luis only uses one- to two-word phrases to communicate and is difficult to understand. His parents speak Spanish at home and both work long hours at minimum wage jobs. They have five kids total, ages 1, 4, 8, 10, and 12. Luis’ parents report that he was born 1 month premature, weighing 4 lb and 3 oz. Luis’ mother had severe hypertension toward the end of her pregnancy. Although his motor milestones were reported to be on time, Luis did not say his first words until age 3. He is still not potty trained and sleeps in bed with his parents. Luis’ parents complain that he becomes angry and aggressive with minimal provocation. Luis will hit, kick, bite, and throw a tantrum if he does not get his way. He frequently does things that he knows his parents find annoying (such as yelling and running away at the supermarket). He does not comply with adult commands, yelling no and running away. He once ran away in a store parking lot and was almost hit by a car. His parents were worried social services would be called. Luis’ parents are concerned about him starting school next year, given they cannot currently leave him at home with even a babysitter due to his severe misbehavior.

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Frederick is a 10-year-old African American male. His mother presents with him to the emergency room after his school called her to come and pick him up during the middle of the day after he threatened to “gut” another 10-year-old boy in his class. The school reported that the provocation for this incident was that Frederick became angry when the other boy asked him to share his colored pencil. More concerning, Frederick was found to have had a knife hidden in his schoolbag and indicated that he planned to use it on the other boy so the other boy would “get what was coming to him.” The school has suspended Frederick until his mother obtains treatment for him. Frederick has a history of problems with peers. He has few friends and his peers report being scared of him. Frederick frequently graphically threatens his peers following minor disagreements, telling them he will “cut them open,” he “wants to explore their insides,” and he will “show them their hearts.” He is known to hold a grudge and will wait for a peer following a disagreement after school, threatening them and saying he will hurt them. Frederick lives with his mother, who is single. His biological father has been in jail for armed robbery since he was born. His mother is a mortician with little family in the area. Frederick often spends his afternoons largely unsupervised at the morgue. Frederick’s mother acknowledges that she is sometimes scared of him. He reportedly does not listen to her, often argues with her, and she is at a loss as to how to discipline him. Frederick’s mother indicated that he has always been difficult to parent. She is worried because his school is insisting she seek some kind of treatment for Frederick; otherwise, they have said they will expel him.

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Anna is a 15-year-old Caucasian female whose parents present with concerns about possible drug use, sexting, and promiscuous sex. Anna has been diagnosed with depression and has been taking antidepressants since age 13. She was described as irritable and easily annoyed most of the time. She acknowledges frequent marijuana use with friends and being sexually active with several males. She has been grounded for the last 2 weeks after she sent a naked picture to one of these males, and her parents were informed by a friend’s mother, who saw the picture on her daughter’s Snapchat. Anna acknowledges that her current friend group has not been the best influence. She complains that the girls are all catty and talk about her behind her back. She reports engaging in sexting or sex, as well as impulsivity, without a lot of forethought about the consequences, or while under the influence of alcohol. She indicated that she has no desire to listen to her parents and often argues with them about curfews and rules. She justified her behavior by reporting that she was bullied extensively in grade school and feels the need to fit in with her peers whatever the cost.

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What is oppositional defiant disorder?

All of these cases are examples of oppositional defiant disorder (ODD). But what exactly is ODD? ODD “ain’t [just] misbehaving” (Wakschlag, Tolan, & Leventhal, 2010), although some parents will certainly present with concerns that include that. According to American Psychiatric Association’s (APA) (2013) Diagnostic and statistical Manual of Mental Disorders, 5th edition (DSM-5), ODD is a disruptive, impulse-control, and conduct disorder (CD) characterized by frequent and persistent angry/irritable mood, argumentative/defiant behavior, and/or vindictiveness. As shown in Table 1.1, DSM-5 lists the symptoms of ODD under three symptom domains: angry/irritable mood (i.e., loses temper, touchy or easily annoyed, and angry and resentful), argumentative/defiant behavior (argues, actively defies or refuses to comply with requests or with rules, deliberately annoys others, and blames others for mistakes or misbehavior), and vindictiveness (spiteful; APA, 2013). Importantly, an individual has to exhibit four or more symptoms in the last 6 months to meet diagnostic criteria. Further, the persistence and frequency of symptoms should exceed age, gender, and cultural expectations, and symptoms do not need to be present in more than one setting. The American Medical Association’s International Classification of Diseases, 10th edition (World Health Organization, 1992), describes ODD similarly as a pattern of negative, defiant, disobedient, and hostile behavior toward authority figures.

Table 1.1

ODD symptoms.

Angry/irritable mood

• Often loses temper

• Is often touchy or easily annoyed

• Is often angry and resentful

Argumentative/defiant behavior

• Often argues with authority figures or, for children and adolescents, with adults

• Often actively defies or refuses to comply with requests from authority figures or with rules

• Often deliberately annoys others

• Often blames others for his or her mistakes or misbehavior

Vindictiveness

• Has been spiteful or vindictive at least twice within the past 6 months

ODD, Oppositional defiant disorder.

ODD typically begins early, during preschool. The disorder is fairly stable and leads to numerous problems, notably problems in family relationships and later problems with peers (Foster, Jones, & Conduct Problems Prevention Research Group, 2005; Nock, Kazdin, Hiripi, & Kessler, 2007). If left untreated, it dramatically increases risk for school failure and later delinquency and problems with the legal system (Foster et al., 2005). Therefore it is associated with high societal cost in the amount of over $70,000 per child over a 7-year period in the United States alone (Foster et al., 2005).

ODD is also quite common, occurring in about 3%–10% of the population. It affects slightly more boys than girls at a ratio of about 1.5:1 during childhood (APA, 2013; Frick & Nigg, 2012; Kessler et al., 2005a; Kessler, Chiu, Demler, & Walters, 2005b; Nock et al., 2007). Importantly, ODD predisposes to many other types of problems. ODD turns into conduct disorder (CD) in a subset of individuals. Further, it cooccurs with attention-deficit/hyperactivity disorder (ADHD) in approximately 50% of cases (Lavigne et al., 2001). Lastly, it increases risk for anxiety and mood problems, perhaps particularly in females.

ODD is associated with substantial later impairment, including family problems, academic problems, peer problems, self-esteem problems, and even legal problems (Campbe...

Table of contents

• Cover image
• Title page
• Table of Contents
• Copyright
• Dedication
• Preface
• Chapter 1. Oppositional defiant disorder dimensions and prediction of later problems
• Chapter 2. Causal factors of oppositional defiant disorder
• Chapter 3. Theories of oppositional defiant disorder
• Chapter 4. The importance and ease of assessment of oppositional-defiant disorder
• Chapter 5. Overview of evidence-based treatments of oppositional defiant disorder
• Chapter 6. Overview of evidence-based treatment components for oppositional defiant disorder
• Chapter 7. Treatment component #1: Differential attention
• Chapter 8. Treatment component #2: Effective commands and consistent consequences including rewards
• Chapter 9. Treatment component #3: Time-out
• Chapter 10. Treatment component #4: Cognitive skills
• Chapter 11. Treatment component #5: Problem-solving
• Chapter 12. Related treatment issues: how to address sleep, toilet training, social skills, and learning problems and when to consider medication for comorbid disorders
• Index