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  1. 1. Oppositional Defiant/Conduct Disorders Presented By: Ashley, Shealin, and Courtney
  2. 2. Outline of Presentation <ul><li>Oppositional Defiant Disorder in detail </li></ul><ul><li>Conduct Disorder in detail </li></ul><ul><li>Developmental Considerations </li></ul><ul><li>Diagnosis </li></ul><ul><li>Treatment </li></ul><ul><li>References </li></ul>
  3. 3. Defining ODD <ul><li>ODD (Oppositional Defiant Disorder): </li></ul><ul><li>The least severe form of disruptive behavior disorder, in which children show an age-inappropriate and persistent pattern of irritable, hostile, oppositional and defiant behavior(text) </li></ul><ul><li>Defined by two separate sets of problems, aggressiveness and the tendency to bother and irritate others (Chandler) </li></ul>
  4. 4. Description of ODD <ul><li>Children and teens who are appositionally </li></ul><ul><li>defiant show consistent patterns of: </li></ul><ul><li>Refusing to follow directions by adults </li></ul><ul><li>Repeatedly lose their temper </li></ul><ul><li>Testing authority figures </li></ul><ul><li>Do not take responsibility for their actions </li></ul><ul><li>Easily annoyed </li></ul><ul><li>Stubborn </li></ul>
  5. 5. Theories of ODD <ul><li>Developmental Theory </li></ul><ul><li>ODD is the result of incomplete development </li></ul><ul><li>Children are stuck in the 2-3 year old stage of deviance </li></ul><ul><li>Learning Theory </li></ul><ul><li>ODD is the result of negative interactions </li></ul><ul><li>Parenting Techniques may bring about disobedient behavior </li></ul><ul><li>Multifinality </li></ul>
  6. 6. Diagnostic Criteria-DSM IV <ul><li>ODD is a pattern of negativistic , hostile, and defiant behavior lasting at least six months during at which at least 4 of the following criteria are present: </li></ul><ul><li>Often loses temper </li></ul><ul><li>Often argues with adults </li></ul><ul><li>Often actively defies or refuses to comply with adults’ requests or rules </li></ul><ul><li>Often deliberately annoys people </li></ul><ul><li>Often blames others for his or her mistakes or misbehavior </li></ul><ul><li>Its often touchy or easily annoyed by others </li></ul><ul><li>Is often angry and resentful </li></ul><ul><li>Is often spiteful or vindictive </li></ul>
  7. 7. Causes of ODD <ul><li>No one knows for certain </li></ul><ul><li>Problems usually begin between ages 1-3 </li></ul><ul><li>Many behaviors are usually normal at age 2 but in in ODD these behaviors never go away </li></ul><ul><li>Chemical imbalance in brain: lack of Serotonin </li></ul><ul><li>Family Problems </li></ul><ul><ul><li>If parents are alcoholic or have been in trouble with the law children are almost 3 times more likely to have ODD </li></ul></ul><ul><ul><li>18% of children will have ODD if the parents are alcoholic and have been in trouble with the law </li></ul></ul>
  8. 8. Who Gets ODD? <ul><li>Most common psychiatric problem found in over 5% of children </li></ul><ul><li>In younger children it is mostly found in boys </li></ul><ul><li>Older children: the rate is equal among the sexes </li></ul>
  9. 9. ODD and Comorbidity <ul><li>ODD is rarely seen as a single occurring disorder </li></ul><ul><li>50-65% of these children also have ADD/ADHD </li></ul><ul><li>35% of these children develop some form of Affective Disorder </li></ul><ul><li>20% have some form of Mood Disorder such as Bipolar Disorder or Anxiety </li></ul><ul><li>15% develop some form of Personality Disorder </li></ul><ul><li>Many of these children have Learning Disorders </li></ul><ul><li>Any child with ODD must be evaluated for other disorders associated with the symptoms of ODD </li></ul>
  10. 10. Comorbidity continued <ul><li>Other Common Combinations </li></ul><ul><ul><li>ODD + ADHD </li></ul></ul><ul><ul><ul><li>ODD is purposeful, whereas ADHD is not. </li></ul></ul></ul><ul><ul><ul><li>E.g. Pushing a child. </li></ul></ul></ul><ul><ul><ul><li>Low IQ </li></ul></ul></ul><ul><ul><li>ODD + Depression/Anxiety </li></ul></ul><ul><ul><ul><li>Children with ODD experience strong emotions, therefore Depression and Anxiety are more common. </li></ul></ul></ul>
  11. 11. Prognosis of ODD <ul><li>There are four possible paths for children with ODD </li></ul><ul><ul><li>Some will grow out of it </li></ul></ul><ul><ul><ul><li>Preschoolers by the age of 8 will grow out of it </li></ul></ul></ul><ul><ul><ul><li>75% of older children will still fulfill the diagnostic criteria later in life </li></ul></ul></ul><ul><ul><li>It may turn into something else </li></ul></ul><ul><ul><ul><li>5-10% of preschoolers will have their diagnosis of ODD changed to ADHD </li></ul></ul></ul><ul><ul><ul><li>In 25% of children with ODD the defiant behaviour gets worse and these children are eventually diagnosed with CD. </li></ul></ul></ul><ul><ul><li>The child may continue to have ODD without anything else </li></ul></ul><ul><ul><ul><li>This is unusual </li></ul></ul></ul><ul><ul><ul><li>by the time preschoolers are 8 yrs old, only 5% have just ODD and nothing else. </li></ul></ul></ul><ul><ul><li>The child develops other disorders </li></ul></ul><ul><ul><ul><li>This is very common </li></ul></ul></ul>
  12. 12. Defining CD <ul><li>CD(Conduct Disorder): Conduct Disorder is one of the most common psychiatric disorders in children and adolescents between the ages of four and sixteen. It is distinguished by a persistent pattern of behaviour in which the basic rights of others and major age-appropriate societal norms are violated. Children with this disorder have great difficulty following rules and behaving in a socially acceptable way. They are often viewed by other children, teachers, and parents as &quot;bad&quot; or delinquent, rather than mentally ill. They are &quot;troublesome&quot; children, more often than &quot;troubled&quot; children (The Association of Chief Psychologists with Ontario School Boards). </li></ul>
  13. 13. Description of CD <ul><li>Children and teens who have conduct </li></ul><ul><li>disorder behaviors show consistent </li></ul><ul><li>patterns of: </li></ul><ul><li>Expression of anger </li></ul><ul><li>Verbal and physical aggression with other children as well as with adults and animals </li></ul><ul><li>Destruction of property </li></ul><ul><li>Lying or stealing </li></ul><ul><li>Serious violation of rules </li></ul>
  14. 14. Diagnostic Criteria-DSM IV <ul><li>CD is a repetitive and persistent pattern of behavior violating the basic rights of others or major rules and values of society. It is shown by 3 or more of the following behavior patterns in the past 12 months with at least one behavior pattern in the past 6 months: </li></ul><ul><li>Aggression to people and animals </li></ul><ul><li>Often bullies, threatens, or intimidates others </li></ul><ul><li>Often initiates physical fights </li></ul><ul><li>Has used a weapon that can cause serious physical harm to others (i.e. knife, gun, bottle) </li></ul><ul><li>Has been physically cruel to people </li></ul><ul><li>Has been physically cruel to animals </li></ul><ul><li>Has stolen while confronting a victim (i.e. mugging, purse snatching, armed robbery) </li></ul><ul><li>Has forced someone into sexual activity </li></ul>
  15. 15. CD-Diagnostic Criteria-DSM IV <ul><li>Destruction of Property </li></ul><ul><li>Has deliberately engaged in fire setting with the intention of causing serious damage </li></ul><ul><li>Has deliberately destroyed others property (other than fire setting) </li></ul><ul><li>Deceitfulness or Threat </li></ul><ul><li>Has broken into someone else's house, building or car </li></ul><ul><li>Often lies to obtain goods or favors or to avoid obligations (i.e. cons others) </li></ul><ul><li>Has stolen items of non trivial value without confronting the victim (ex. Shop lifting without breaking and entering:;forgery) </li></ul><ul><li>Serious Violations of Rules </li></ul><ul><li>Often stays out at night despite parental prohibitions, beginning before age 13 years </li></ul><ul><li>Has run away from home overnight at least twice while living in parental or parental surrogate home (or once without returning for a lengthy period) </li></ul><ul><li>Often truant from school, beginning before age 13 years </li></ul>
  16. 16. Causes of CD <ul><li>Cognitive Developmental Model </li></ul><ul><li>Inconsistent parenting: </li></ul><ul><ul><li>Failure to provide a consistently supportive and nurturing environment </li></ul></ul><ul><ul><li>Inconsistent use of discipline </li></ul></ul><ul><ul><li>Reliance on punishment to change behaviour </li></ul></ul><ul><li>Genetic and biological factors: </li></ul><ul><ul><li>Temperament, sociability, impulsivity </li></ul></ul><ul><li>Impairment in the Frontal Lobe of the Brain: interferes with ability to plan, avoid harm, and learn from negative experiences </li></ul><ul><li>Poor Social Skills – peer group rejection </li></ul><ul><li>Low Economic Status </li></ul><ul><li>Maladaptive Beliefs about ones personal worth </li></ul><ul><li>Overactive BAS and Underactive BIS </li></ul>
  17. 17. Who Gets CD? <ul><li>More common in boys than in girls </li></ul><ul><li>Prevalence has increased over recent decades </li></ul><ul><li>Siblings in similar environments tend to show similar conduct problems </li></ul>
  18. 18. CD and Comorbidity <ul><li>By carefully examining children with CD, we almost always find other serious neurological disorders </li></ul><ul><li>30-50% of children with CD will also have ADHD </li></ul><ul><ul><li>When ADHD is present with CD, the ADHD symptoms are much more severe. </li></ul></ul><ul><li>Other common combinations </li></ul><ul><ul><li>CD + Depression/Anxiety </li></ul></ul><ul><ul><ul><li>Because the child has CD, parents and physicians may relate their emotional imbalance to CD rather than depression/anxiety. </li></ul></ul></ul><ul><ul><ul><li>Suicide is worth worrying about in CD </li></ul></ul></ul><ul><ul><li>CD + Substance Abuse </li></ul></ul><ul><ul><ul><li>3 times more likely to smoke cigarettes </li></ul></ul></ul><ul><ul><ul><li>2.5 times more likely to drink </li></ul></ul></ul><ul><ul><ul><li>5 times more likely to smoke pot </li></ul></ul></ul><ul><ul><li>Also common are associations with learning disorders, bipolar disorder, and Tourettes syndrome </li></ul></ul>
  19. 19. Prognosis <ul><li>30% of CD children continue with similar problems in adulthood </li></ul><ul><li>More common for males to continue with CD into adulthood </li></ul><ul><li>Females are more likely to end up having mood and anxiety disorders as adults </li></ul><ul><li>50-70% of 10yr olds will be abusing substances 4 years later </li></ul><ul><li>Girls experience poor physical health because they are 6 times more likely to abuse drugs or alcohol, 8 times more likely to smoke cigarettes daily, almost twice as likely to have STD’s, had twice the number of sexual partners, and were 3 times more likely to become pregnant than girls without CD </li></ul><ul><li>If the CD is paired with another disorder, then CD will go away in adulthood, and the other disorder will remain or worsen </li></ul>
  20. 20. Developmental Considerations <ul><li>This is the typical progression seen as children develop </li></ul><ul><ul><li>0-4 yrs- irritable and difficult child </li></ul></ul><ul><ul><li>4-8 yrs – ADHD </li></ul></ul><ul><ul><li>8-12 yrs – Oppositional Defiant Disorder </li></ul></ul><ul><ul><li>12-16 yrs – Conduct Disorder </li></ul></ul><ul><ul><li>Adult – Antisocial Personality Disorder </li></ul></ul>
  21. 21. Diagnosing ODD and CD <ul><li>Who can diagnose? </li></ul><ul><li>Psychiatrist, psychologist, or some other </li></ul><ul><li>qualified mental health professional </li></ul><ul><ul><li>after a comprehensive diagnostic evaluation </li></ul></ul><ul><li>Why is it difficult to diagnose? </li></ul><ul><li>Defiance is typical in child development and </li></ul><ul><li>may be a product of hunger, tiredness, or </li></ul><ul><li>the child being upset </li></ul>
  22. 22. How Diagnosis is done. <ul><li>Interviews with parents and children both together and separately are done to go over the history and to check out all other possible comorbid conditions. </li></ul><ul><li>School and teacher reports are done </li></ul><ul><li>School work to rule out other disorders </li></ul><ul><li>Parts of physical exams to also rule out other disorders </li></ul><ul><li>Social histories will be examined </li></ul><ul><li>Behavioural, intellectual and emotional functioning skills are assessed </li></ul>
  23. 23. Diagnosis Cont. <ul><li>ODD is twice as prevalent as CD </li></ul><ul><li>There is a large overlap between conduct disorders and oppositional deficit disorders </li></ul><ul><li>How to differentiate between the two: </li></ul><ul><ul><li>Treatment of animals </li></ul></ul><ul><ul><ul><li>Is he or she mean/cruel or kind to the family pets. </li></ul></ul></ul><ul><ul><ul><ul><li>In CD they are cruel to the pets </li></ul></ul></ul></ul><ul><ul><li>Legal Problems </li></ul></ul><ul><ul><ul><li>What the legal problems are and whether or not they are recurring </li></ul></ul></ul><ul><ul><ul><ul><li>CD if there are serious legal problems </li></ul></ul></ul></ul><ul><ul><li>Safety Issues </li></ul></ul><ul><ul><ul><li>Setting fires, stealing, etc. </li></ul></ul></ul><ul><ul><ul><ul><li>Serious danger to themselves and others. </li></ul></ul></ul></ul>
  24. 24. Which is more Difficult to Treat? ODD or CD? <ul><li> </li></ul>
  25. 25. Treatment of ODD and CD <ul><li>Treatments are designed to decrease or eliminate as many identified problem behaviours as possible in the short term and also to work towards the long-term goal of preventing children’s behavioural problems from worsening over time. </li></ul><ul><li>A home rules contract between the parents and child about rules, consequences and privileges </li></ul><ul><li>In the event that problems have become severe enough to require more intensive behaviour modifications in a residential setting may be necessary. </li></ul>
  26. 26. Treatment cont. <ul><li>Treatment is likely to be most affective before the child is 8 years old </li></ul><ul><ul><li>Because anti-social habits will be less ingrained </li></ul></ul><ul><ul><li>They are less likely to have become part of a deviant peer group </li></ul></ul><ul><li>Treating comorbid disorder </li></ul><ul><ul><li>Trying to lesson symptoms of comorbid disorder, so that it is easier to treat ODD and CD </li></ul></ul><ul><ul><li>Treat the comorbid disorder first, before the ODD or OC </li></ul></ul>
  27. 27. Treatment cont. <ul><li>Types of non-medicinal treatment </li></ul><ul><ul><li>Cognitive Behavioural Approaches </li></ul></ul><ul><ul><li>Peer Group Therapy </li></ul></ul><ul><ul><li>Improving parental skills </li></ul></ul><ul><ul><li>Medication </li></ul></ul><ul><ul><li>Individual and family counseling </li></ul></ul><ul><ul><ul><li>Help to manage anger </li></ul></ul></ul><ul><ul><li>Multi-system therapy – best one! </li></ul></ul><ul><ul><ul><li>Balance of many approaches </li></ul></ul></ul>
  28. 28. Treatment cont. <ul><li>3 reasons to use medical interventions </li></ul><ul><ul><li>1. if medically treatable comorbid conditions are present </li></ul></ul><ul><ul><li>2. if non medical interventions are not successful </li></ul></ul><ul><ul><li>3. when symptoms are very severe </li></ul></ul><ul><ul><li>-Medical treatment varies </li></ul></ul><ul><ul><li>- Ritalin is the most commonly used to reduce impulsivity and aggressiveness. </li></ul></ul><ul><ul><li>- Lithium reduces mood fluctuations, irritability, restlessness, hostility and explosiveness. </li></ul></ul>
  29. 29. References <ul><li>Barkoukis, A., Reiss, N. S., & Dombeck, M. (1995-2008). Childhood Mental Disorders and Illnesses. In Mental Help.Net . Retrieved October 30, 2008, from view_doc.php?type=doc&id=14503&cn=37 </li></ul><ul><li>Chandler, J. (1998-2008). Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD) in children and adolescents: diagnosis and treatment. In Attention Deficit Disorder Resources . Retrieved October 30, 2008, from </li></ul><ul><li>Chandler, J. (n.d.). Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD) in Children and Adolescents: Diagnosis and Treatment . Retrieved October 30, 2008, from chandler/pamphlet/oddcd/oddcdpamphlet.htm#_Toc121406182 </li></ul><ul><li>Conduct Disorder. (n.d.). The Association of Chief Psychologists with Ontario School Boards . Retrieved October 30, 2008, from </li></ul><ul><li>Doermann, D. J. (2002, December). Oppositional defiant disorder. In Health AtoZ A world of health at your fingertips . Retrieved October 30, 2008, from common/standard/transform.jsp?requestURI=/healthatoz/Atoz/ency/oppositional_defiant_disorder.jsp </li></ul><ul><li>John, K. (n.d.). Opposition Defiant and Conduct Disorders. In CAMHS Training Strategy . Retrieved October 30, 2008, from oppositional-defiant-and-conduct-disorders </li></ul><ul><li>Kane, A. (n.d.). Oppositional Defiant Disorder Treatment. In add adhd advances . Retrieved October 30, 2008, from </li></ul><ul><li>Mash, E. J., & Wolfe, D. A. (2007). Conduct Problems. In Abnormal Child Psychology Third Edition (pp. 142-179). Toronto ON: Thomson Wadsworth. </li></ul><ul><li>Mental Health Disorders. (2008). University of Virginia Health System [Conduct Disorder]. Retrieved October 30, 2008, from condis.cfm </li></ul><ul><li>Oppositional Defiant Disorder (ODD). (1998-2008). Tools for Healthier Lives . Retrieved October 30, 2008, from DS00630/DSECTION=treatments-and-drugs  </li></ul><ul><li>Oppositional Defiant Disorder (ODD) verses Conduct Disorder. (n.d.). Teens With Problems . Retrieved October 30, 2008, from http://www.teenswithproblems/conduct_disorder.html </li></ul><ul><li>Oppositional Defiant Disorder vs. Conduct Disorder, You Tube Video </li></ul>