The document summarizes Oppositional Defiant Disorder (ODD), including its diagnostic criteria, prevalence rates, common behaviors, risk factors, treatment approaches, and prognosis. ODD is characterized by angry, irritable mood and argumentative/defiant behavior lasting at least 6 months. Parent-management training to improve positive parenting strategies and reduce negative ones is considered one of the most effective treatment approaches. Approximately two-thirds of children with ODD receiving treatment will be symptom-free after 3 years.

1. Reagon Heikes

2.  DSM 5:
Disruptive, Impulse-Control and Conduct Disorders.
 Pattern of angry/irritable mood, argumentative/defiant behavior,
and vindictiveness
• Is it persistent?
• Has it lasted for 6 months or more?
• Is it clearly disruptive to family/home/school?
 Has 4 symptoms, exhibited with at least one individual who is not a sibling:
• Often looses temper
• Is often touchy or easily annoyed
• Is often angry and resentful
• Often argues with authority figures
• Often actively defies or refuses to comply with requests or rules
• Often deliberately annoys others
• Often blames others for his or her mistakes or behaviors
• Has been spiteful or vindictive at least twice in the past 6 months

3.  Frequency:
• Important to distinguish from normal behavior.
• 2-5: occurs on most days for 6 + months
• 5+: occurs at least 1/wk for 6 + months
 Behaviors occur outside of psychotic,
substance use, depressive or bipolar
disorder.
 Severity: Mild, Moderate, Severe
 Video: 6 year old boy

4.  Frequent temper tantrums
 Argumentativeness with adults
 Refusal to comply to adults requests
 Deliberate annoyance of others
 Blaming other
 Aggressiveness towards peers
 Difficulty maintaining friendships
 Academic problems
 Bullying or bullied

5. Acceptable stress-related behaviors
Non-severe behavior
Conflicts with peers only
Case Example
Mirroring Activity

6.  Rating Scales and Questionnaires
 ARES: Anger Regulation & Expression Scale (Full 75 or Short 17)
• Internalized –v- externalized anger
• Anger as a predictor for conduct problems
 MASC: Multidimensional Anxiety Scale for Children
 Parenting Alliance Measure: significantly predicts child's behavior, self report
from parents
 CBCRS-SR: Conners Comprehensive Behaviors Rating Scale Self Report
Oppositional Defiant Disorder Scale
• 8 items correspond to DSM
• Measures emotional, behavioral, academic, social functioning
• Children and teenagers
• Can be read aloud
• Self-report
• Good internal consistency and test-reliability

7.  2-15% of children and adolescence
• Research inconsistent, nonrepresentational samples,
inconsistent diagnostic approaches
 3.3% Western Countries (Canino et al. 2010)
• 25 countries total
• 21 year review of worldwide prevalence
• Most reliable figure for Western Countries
 Gender:
• 1/10 Turkey. 1/4 U.S. Some places 1/1.

9. ADHD
Anxiety Disorder
Mood Disorders
Can become CD (30%)

10.  Heritability of ADHD 76% (Danforth et al. 2016) Parent-child bi-
directional influences
 On average 4 years between diagnosis of ADHD and ODD/CD
 Neurodevelopment impairment in executive function, specifically
verbal working memory
 Contingency (event/response/outcome) impaired
• Helps bridge the gap between current behavior and outcome
 ADHD increases the risk of coercive parenting style and reduces
constructive parenting interactions that would otherwise enhance the
development of the verbal working memory
• Lax or over-reactive parenting styles
 Share symptoms of disruptive behavior

11.  “Not a lot works”
 Combination of therapies, parent training,
family therapy, social skills, school based,
medications
 Tailor Tx Plan to each child, careful
consideration of individual behaviors
 Requires commitment and follow through
from parents

12.  Anger Management
• Relaxation, goal setting, problem solving, trigger identification, recognition of
consequences
 Individual therapy
• Behavior modification, rewards & consequences
• Play therapy
 Family therapy
• Parenting skills, PCIT, alteration of family environment if chaotic
 ABA/PBS: Behavior is learned & serves a specific purpose.
• For each year takes 1 month to see significant changes
• Children comply 80% of the time, recognized 2%
• Teach behavior, model behavior, practice behavior, praise attempts
 Rx: antidepressants, stimulants if other Dx are present

13.  One of the most effective ways to reduce behavior
symptoms is to address the parenting
 Tx: Parent-Management Training
• Increased positive parenting practices: supportive,
consistent supervision and discipline.
• Decreased negative parenting practices:
harsh punishment, focus on inappropriate behavior
• Predictable, immediate parental response.
 PCIT Therapy Video (Parent-Child Interaction)

14. 67% of ODD children receiving Tx will be
symptom free after 3 years (AACAP)
30% will go to develop CD
10% will go on to develop a personality
disorder such as Antisocial Personality
Disorder.
Increased risk for SA and delinquency

15.  Protective factors of a positive family
environment
 San Juan, Puerto Rico contrast with Bronx,
NY (Bird et al. 2006)
• Close family attachments, strict family monitoring &
supervision
 Turkey (Ercan et al. 2013) 3.8%
• 1/10 gender ratio ODD
 Debate about gender expression
• high rate of ADHD 13% in region
 may be due to DRD4 gene