Oppositional Defiant Disorder / Conduct Disorder

I attend a luncheon this week at Valle Vista in Greenwood Indiana. The speaker was Angela Madison, MSW, LSW. It was very informative. Below is the information on this disorder.

Oppositional Defiance Disorder
Recurrent pattern of negativistic, disobedient, and hostile behaviour toward authority figures that persists for at least six months (APA, 2000).

Oppositional Defiance Disorder Behaviour

• Behaviour is hostile and uncooperative
• Behaviour is frequent and consistent
• Behaviour disrupts normal daily activity
• Family
• School
• Social Life

Oppositional Defiance Disorder Symptoms

• Frequent temper tantrums
• Deliberate attempts to annoy and upset others
• Excessive arguing with adults
• Often questioning rules
• Regularly blames others
• Refusal to comply with rules
• Easily annoyed by others
• Spiteful attitude and revenge seeking
• Angry and resentful
• Mean and hateful taking

Oppositional Defiance Disorder Characteristics

• Strong need for control
• Deny responsibility
• Thrive on negativity
• Socially explosive

Oppositional Defiance Disorder Comorbidity
Other illnesses often contribute to behavioural problems

• Attention deficit hyperactivity disorder (ADHD)
• Learning disorders
• Mood disorders

Oppositional Defiance Disorder Prevalence

• Approximately 2% - 16% of children and teens
• In younger children - more common in boys
• In older children - condition occurs equally

Oppositional Defiance Disorder Course

• Symptoms appear by early adolescence
• Symptoms often resolve within 3 years
• 30% develop conduct disorder

Oppositional Defiance Causes

• The exact cause of Oppositional Defiance Disorder is unknown
• A combination of factors contribute to condition
• Biological
• Psychological
• Social

Oppositional Defiance Disorder Biological Causes
Brain injuries/defects can lead to behavioral problems

• Brain imaging shows differences
• Chemical imbalances in the brain
• Abnormal amounts of neurotransmitters
• Defects lead to other mental conditions

Oppositional Defiance Disorder Psychological Causes
Studies show different responses from kids with Oppositional Defiance Disorder

• Difficulty interpreting social cues (see aggression where there is none)
• Limited solutions to resolving problems
• Anticipated rewards from aggressive responses

Oppositional Defiance Disorder Genetic Causes
Research indicates there is a genetic vulnerability

• Tends to occur in families with mental illness
• ADHD
• Mood disorders
• Personality disorders

Oppositional Defiance Disorder Environmental Causes
Dysfunctional families contribute to Oppositional Defiance Disorder development

• Harsh or inconsistent discipline
• Low nurturing
• Substance abuse
• Lack of structure
• Exposure to abuse

Assessment
Assessment requires the collection of data from a number of individuals in multiple settings

Interventions

Do Not...

• Defend yourself
• Try to convince the child you are right
• Scream
• Become irrational
• Take behaviour personally

Do....

• Remain calm
• De-escalate
• Give choices
• Use key words

Conduct Disorder
Repetitive and persistent pattern of behaviour in which the basic rights of others or major age-appropriate societal norms or rules are violated (APA, 2000).

Differentiation

• Oppositional Defiance Disorder and Conduct Disorder behaviour overlap
• Conduct Disorder is more extreme, includes physical aggression

Examples

• Aggression to people or animals
• Legal problems
• Stealing
• Setting fires

Clinical Features of Conduct Disorder
Four types of symptoms are recognized

• Aggressive conduct that causes physical harm to other people or animals
• Non aggressive behaviour which causes property damage
• Deceitfulness or theft
• Serious violation of the rules

Conduct Disorder Behaviour

• Defiant behaviour
• Impulsive behaviour
• Drug use
• Criminal activity
• Breaking rules without an obvious reason

Conduct Disorder and Gender

• Males tend to be more confrontational / aggressive
• Females tend to display nonconfrontational behaviour

Conduct Disorder Symptoms

• Females
• Lying
• Truancy
• Running away
• Prostitution
• Males
• Fighting
• Stealing
• Vandalism
• School disciplinary problems

Conduct Disorder Comorbidity
It is estimated that over 50% of those with Conduct Disorder have a co-occurring condition 

• Attention deficit hyperactivity disorder (ADHD)
• Learning disorders
• Mood disorders

 Conduct Disorder  Prevalence

• Approximately 1% - 10% of the population has Conduct Disorder
• Prevalence is higher for boys

Conduct Disorder Subtypes

• Childhood Onset
• Worse prognosis
• 40% develop antisocial personality disorder
• Adolescent Onset
• Social context must be considered
• Behaviour remits with support/structure

Conduct Disorder Course

• Disorder usually remits by adulthood
• Oppositional Defiance Disorder is generally a precursor to Conduct Disorder
• Significant symptoms often occur between middle childhood through middle adolescence
• Onset is rare after age 13

Conduct Disorder Course

• Early onset predicts a worse prognosis
• Some develop antisocial personality disorder
• At risk for substance related disorders
• Some develop mood or anxiety disorders

Conduct Disorder Causes

• Substance abuse in parents
• Family conflicts
• Genetic defects
• Substance abuse

Parenting Aspects

• Poor supervision
• Harsh discipline
• Parental disharmony
• Rejection of the child
• Low parental involvement

Conduct Disorder Interventions
Multi systemic Treatment

• Behavioral Parent Management Training
• Social Skills Training
• Individual Therapy
• Pharmacological Treatment
• Academic Support

Social Learning Theory
Social learning theories indicate that parenting effectiveness can improve social competence and reduce conduct problems

Parent Management Training

• Reinforce positive behaviour
• Be more positive and less harsh
• Utilize clear reasonable consequences
• Improve emotional climate
• use consequences that parents control
• Communicate clear specific requests
• Remain calm
• Model self control

Individual Therapy
Individual Therapy can help a child to understand why he does what he does

• Helps with building insight
• Supports comprehensive program
• Strategies for managing emotions

Social Skills Training
Children with conduct problems show cognitive and social skill deficits with peers

• Peer coping skills
• Problem solving skills
• Anger coping skills
• Group social skills

Pharmacotherapy

• Part of comprehensive program
• Comorbid conditions treated
• May help manage aggression
• Reduces likelihood of "self medication"

Behaviour Modification Programs
Research does not support "Attack Therapy"

• Behaviour Modification Schools
• Wilderness Programs
• Boot Camps

Angela Madison, MSW, LSW went on to explain that the above listed programs work while the child is at camp. Upon return the behaviours return and sometimes worsen.