Presentation on Oppositional Defiant Disorder and Conduct Disorder, VCU School of Social Work, Mental, Emotional, and Behavior Disorders

1. Jacqueline
Corcoran, Ph.D.
From: Corcoran, J., &
Walsh, J. (2012 2nd
ed.). Mental Health
in Social Work: A
Casebook on
Diagnosis and
Strengths-Based
Assessment.
Boston: Allyn &
Bacon.
Oppositional Defiant Disorder
(ODD) and Conduct Disorder
(CD)

2. Oppositional Defiant Disorder (ODD) and
Conduct Disorder (CD)
Classified as Disruptive, Impulse-
Control, and Conduct Disorders
Rationale for discussing together:
 both feature anger, defiance,
rebellion, lying, and school
problems
 ODD is often a developmental
antecedent to CD (40% of those
with ODD go on to CD)

3. Differences between
• ODD characterized by a pattern of
angry/irritable mood,
argumentative/defiant behavior and/or
vindictiveness for at least 6 mos but
don’t seriously violate basic rights of
others
• CD includes aggression toward
people or animals, destruction
of property, or a pattern of theft
or deceit over 1 year

4. Prevalence and Co-Morbidity
ODD: lifetime prevalence rate of 10.2%
CD: 1-10%
More common in boys
Comorbodity
High
Substance use disorders,
ADHD, mood disorders

5. Assessment Guidelines
 Because transient oppositional behavior is common in preschool
children and adolescents, caution should be exercised in diagnosing
ODD during these developmental periods.
 Oppositional behaviors in children and adolescents should be
distinguished from the disruptive behavior resulting from inattention
and impulsivity that is associated with attention-deficit/hyperactivity
disorder
 should not be made when the symptomatic behavior is protective for
a child living in an impoverished, high-crime community or war zone
 ODD should be distinguished from a failure to follow directions that is
the result of impaired language comprehension due to hearing loss or a
learning disability.
 In cases in which both CD and ODD are present, only CD should be
diagnosed.
 When ODD or CD is diagnosed, a child and family relational problem
should not be included because the ODD or CD diagnosis includes
conflict.
 A less severe diagnosis should be considered initially—either an
adjustment disorder with disturbance of conduct in response to an
identifiable stressor or the V-code for “child or adolescent antisocial
behavior.”
 Conduct disorder should be diagnosed in adults older than 18 only if
the criteria for antisocial personality disorder are not met.

6. Risk and Protective Factors for Onset
Genetics may account for 50% or more of the variance in conduct
disorder
Interaction of genes and environment (child maltreatment, living in urban
area)

7. Risk and Protective Factors for Course
2% of youth with no childhood
risk showed persistencein
adolescence vs. 71% of youth
who had risk influences in 5
different areas
Childhood onset – more severe
Male – ODD to CD

8. TREATMENT – PARENT TRAINING
Specifying goals for behavioral
change
Tracking target behaviors
Positively reinforcing pro-social
conduct through the use of
attention, praise, and point
systems
Employing alternative discipline
methods, such as withdrawal of
attention, time out from
reinforcement, imposition of costs
on inappropriate behavior, and
removal of privileges

9. Parent Training Programs
The Parent Management Training Oregon Model (ages 3–12) (Patterson
& Gullion, 1968)
Helping the Noncompliant Child (ages 3–8) (Forehand & McMahon, 1981)
Parent-Child Interaction Therapy (ages 2-7) (Brinkmeyer & Eyberg, 2003)
The Incredible Years (ages 2–8) (Webster-Stratton, 2001)
the Positive Parenting Program (called Triple P) (preschool through
adolescence)

10. ADOLESCENTS – MULTI-DIMENSIONAL
MODELS
Multi-Systemic Therapy
Functional family therapy integrates systems, cognitive, and behavioral
theories
Treatment foster care

11. Cognitive-Behavioral
anger management,
assertiveness training,
cognitive restructuring,
relaxation, social
problem solving or
social skills
development

12. Medication
the stimulants, selective
norepinephrine reuptake
inhibitors, antipsychotics,
mood stabilizers