OPPOSITIONAL DEFIANT

DISORDER
By: Amanda, Amy and Sarah

OVERVIEW

Pre-Test
Cases
Normal Behavior or ODD?
History
Diagnostic Criteria
Cause/Risk Factors
Prevalence
Prognosis
Co-morbidity
Treatment and Intervention
Strengths

TEST YOUR KNOWLEDGE

1. In order to diagnose ODD,

symptoms must occur in
multiple settings.
2. Diagnostic criteria for ODD
includes problems with
emotional regulation.
3. Diagnostic criteria for ODD
includes aggression toward
people and animals.
4. There is no clear cause of
ODD.
5. Parenting style can be a risk
factor for ODD.

6. Anxiety can be a
protective factor when comorbid with ODD.
7. All children with ODD
eventually receive a
diagnosis of CD.
8. ODD is easily treated with
medication.
9. Staying firm and saying
NO is an effective way to
curb defiance.
10. Steve Jobs was
diagnosed with ODD.

CASE

Jeremy is a 5 year old boy. His mother claims he has been a

handful since he was 2. She says when in daycare the workers
would be pulling their hair out. Her home life is stressful, and
Jeremy enjoys going against the grain. He is constantly talking and
is frequently annoyed by little things. Now in Kindergarten, he does
not make friends easily. His mother has received phone calls on a
weekly basis saying that he has disrupted the class or attacked
another child. Recently he has started to purposely annoy his
younger sister, resulting in yelling and hitting. He always says this
is her fault and will not apologize. If asked to stop playing
videogames before he is ready, this will often result in a full blown
tantrum with yelling, swearing, and throwing his toys.
Does Jeremy have ODD?

NORMAL BEHAVIOUR OR
ODD?

What is the difference between a strong

willed child and one with oppositional
defiant disorder?
Children experience pockets of
independence or defiant behaviours
throughout development.

(Oppositional Defiant Disorder Resource Centre, 2013)

HISTORY OF ODD

In 1980s, DSM-III included under Conduct

Disorder the term oppositional disorder
Included: irritable, stubborn, defiant
behaviour features, displayed at
developmentally deviant rates.
DSM-III-R changed to ODD and included 9
behavioural symptoms with 5 required for
diagnosis.
DSM-IV ODD with 4/8 symptoms
(Barkley & Mash, 2003).

DSM-V CRITERIA FOR ODD

A) A pattern of
angry/irritable mood,
argumentative/defiant
behavior or vindictiveness
at least 6 months
at least 4 of the 8 symptoms
from any categories
Seen during interaction
with at least one individual
who is not a sibling.

(American Psychiatric Association, 2013).

DSM CRITERIA FOR ODD

Angry/Irritable Mood

often looses temper

often touchy or easily annoyed

often angry and resentful

Argumentative/Defiant Behaviour

often argues with authority figures, or adults

often actively defies or refuses to comply with requests or

rules

often deliberately annoys others

often blames others for his or her mistakes or

misbehaviours.
(American Psychiatric Association, 2013).

DSM CRITERIA FOR ODD

B) The disturbance in behavior is associated with

distress in the individual or others in his or her
immediate social context, or it impacts negatively
on social, education, occupation, or other important
areas of functioning.

C) The behaviours do not occur exclusively during

the course of a psychotic, substance use,
depressive or bipolar disorder. Also the criteria are
not met for disruptive mood dysregulation disorder.
(American Psychiatric Association, 2013).

OTHER CONSIDERATIONS

Pay attention to the duration, severity and

frequency of these behaviours.
Consider if behaviours are outside a range
that is typical for the individuals
developmental level, gender and culture.
Children under 5 the behavior should
occur at least once per week for at least 6
months.
(Barkley & Mash, 2003).

CONTROVERSY
DSM-IV/V

VS.

ICD-10

DSM-IV: CD and ODD are ICD-10: ODD is a

separate disorders:
subtype:
four of eight symptoms for
a diagnosis of ODD
three of fifteen symptoms
for a diagnosis of CD.

fifteen more severe items

equivalent to the DSM-IV
CD symptoms.
eight less severe items,
equivalent to the DSM
symptoms of ODD.
All children who receive a
diagnosis by DSM-IV criteria
also receive an ICD-10
(Rowe,but
Maughan,
Costello, &
diagnosis,
a number
ofAngold, 2005)
children who meet ICD-10
criteria for CD (ODD sub-type)

CASE STUDY

Does Jeremy meet the criteria for ODD?

-

if you think Jeremy does meet criteria

if you think Jeremy does NOT meet criteria

if you are unsure or need more information to tell

CAUSE AND RISK FACTORS

No clear cause, contributing causes may be a

combination of inherited and environmental
and may result in the development of ODD
and effect on prognosis of ODD.
Contextual factors
Low Socioeconomic status
Stress and conflict in home
(Lavigne, Gouze, Hopkins, Bryant, & LeBailly, 2011).

CAUSES AND RISK FACTORS

Parental characteristics
Parent psychopathy
Insecure attachments associated with ODD
related symptoms
Parenting
Lack of supervision
Abuse or neglect
Harsh or inconsistent punishment
(Barkley & Mash, 2003; Lavigne, Gouze, Hopkins, Bryant, & LeBailly, 2011).

CAUSE AND RISK FACTORS

Child characteristics
natural disposition
Insecure attachments are associated with ODD
related symptoms
Limitations or developmental delays in a child's
ability to process thoughts and feelings
Imbalance of Brain chemicals (serotonin) or
subtle differences in brain chemistry
(Barkley & Mash, 2003; Lavigne, Gouze, Hopkins, Bryant, & LeBailly, 2011).

PREVALENCE

Ranges from 1% to 11%

with an average prevalence
estimate of around 3.3%

Prevalence is consistent
across race & ethnicity
(APA, 2013)

(APA, 2013; Dunsmore, Booker &

Ollendick, 2013)

More common in males

than females- ratio 1.4:1
prior to adolescence (APA,
2013)

More prevalent among

youth from low socioeconomic status (Loeber et al.,

2000)

Lifetime prevalence
estimated at 10.2% (males
11.2%. Females 9.2%) (Nock
et al., 2007)

PROGNOSIS

Less attention to outcomes

of ODD as much of the focus
of research has been on
developmental relationship
between CD & ODD (Burke &
Loeber, 2010)

Children diagnosed with

ODD have a greater risk of
adjustment problems as
adults (APA, 2013)

Anti-social behavior
Impulse-control problems
(68.2%)
Substance abuse (47.2 %)
Anxiety (62.3%)
Depression (Mood Disorders
45.8%)

Nock et al., 2007

COMORBIDITY

ODD is associated with high

rates of co-morbidity with
other disorders (Burke &
Loeber, 2010)

ADHD
ADHD

Substance
Substance
Abuse
Abuse

Learning
Learning
Disabilities
Disabilities

OD
D

Anxiety/Mo
Anxiety/Mo
od
od
Disorders
Disorders

CD
CD

COMORBIDITY
ADHD

40% of children with ADHD

meet criteria for ODD; these
children tend to be:

Rates of ODD higher in samples of

children and adults with ADHD
possibly the result of shared
tempermental risk factors (APA, 2013)

more aggressive

more persistent behavior

issues

more rejection from

peers

severely underachieve
Poor impulse control, attention
deficits and aggression predict
negative outcomes (Hinshaw & Lee, 2003)
(Hamilton & Armando, 2008)

COMORBIDITY
ANXIETY/MOOD DISORDERS

Children with ODD are at a higher risk for anxiety

disorders & major depressive disorder (APA, 2013)
*twice as likely to have severe major depressive disorder
or bipolar disorder compared to control group (Burke &
Loeber, 2010;

Hamilton & Armando, 2008)

When anxiety disorder & ODD co-occur, the clinical

presentation is more severe & includes additional academic,
social & familial complications (Drabick, Ollendick & Bubier, 2010)

COMORBIDITY
ANXIETY/MOOD DISORDERS

Can anxiety provide protective factors for

children with ODD?
The Buffer Hypothesis
vs
Multiple Problem Hypothesis

(Drabick et al., 2010)

COMORBIDITY
CONDUCT DISORDER

The majority of children diagnosed with ODD will not

progress to CD
ODD is presumed present when CD is diagnosed and can
be a precursor to CD, 1/3 of kids with ODD develop CD

(APA, 2013; Hinshaw & Lee, 2003)

(Burke & Loeber, 2010)

COMORBIDITY

Oppositional Defiant Disorder Dimensions (Burke & Loeber,

2010)
ODD
Behavior
_____________

CD

ODD
Negative
Affect
Depressio
n

COMORBIDITY
LEARNING DIFFICULTIES

When controlling for ADHD in the research, children with

ODD without ADHD do not have problems with attention,
executive functioning or learning. (Mayes & Calhoun,
2007).

WHAT TO DO?

GIVE ME THE SMILEY FACE

STICKER NOW!

CAN ODD BE PREVENTED?

Early Intervention may be helpful for

preschool children in high risk populations.
Social skills training for school aged
children.
For adolescents educational programs
help reduce disruptive behaviour.
(American Academy of Child and Adolescent Psychiatry)

HOW IS ODD TREATED?

One size
doesnt fit
all

INTERVENTION OPTIONS

Individual Therapy:

Problem-Solving Therapy
Cognitive Behavioural Therapy
Social Skills
Therapy

Family Therapy
Medication
Classroom intervention

INDIVIDUAL THERAPY

Problem-Solving Therapy
Cognitive Behavioural Therapy

Social Skills Therapy

(Johnson, 2012)

FAMILY THERAPY

Empowers families to effectively solve problems and

conflict
Individualized programs
Help deal with the familys immediate needs as well as
their long term goals
Be aware of how change affects every member of the
family

(Markward, 2001)

MEDICATION

Medications is not typically prescribed

CONSIDERATIONS:
Other treatment options are exhausted?
Extreme aggression?
Co-morbid disorders?

The research emphasize

the importance of a
MULTIDISIPLINARY
approach in the care
of these children and their
families.

THINK ABOUT YOUR

REACTION

POSSIBLE INITIAL
REACTIONS

Raise Voice
React
Frustration
Threat
Demand
Punishment

TRAIN YOURSELF TO
RESPOND DIFFERENTLY
Raise Voice Make sure we are calm
React Be Proactive not reactive
FrustrationUnderstand purpose of challenging behaviors and the
developmental level of students. Change your perspective.
Threat Avoid power struggles
Demand Instead of telling the child what NOT to do- tell them
what to do by labeling it when you see it.
Punishment Increase positive interactions between students and
adults and have students meet realistic expectations.

FUNCTIONS OF BEHAVIOUR

TO GET:

TO AVOID:

Attention from adults or peers

Work
Peers

Access to materials/ resources /

sensory

Adults
Demands
Sensory overload
Emotion or physical pain

(Riffel, 2009)

WHAT TARGET BEHAVIOUR DO

YOU WANT TO CHANGE

WHAT
SETTING
PRECEEDS
THIS
BEHAVIOUR
HOW
COULD YOU
BE
PROACTIVE
TO
CHANGE
THIS?

WHAT
BEHAVIOUR
CAN YOU USE
TO REPLACE
THIS
BEHAVIOUR?

WHAT IS
THE PAY
OFF FOR
THE
CHILD?
WHAT CAN
WE DO SO
THE CHILD
AVOIDS
THE PAY
OFF?
(Riffel, 2009)

ANNOYING OTHER CHILDREN ON

PURPOSE

DURING A
WORK JOB

PRE-TEACH
AND CHOOSE
APPORPRIATE
WORK FOR
THE CHILDS
LEVEL

CHOOSE A
DISTRACTION:
FIGET TOY,
SPECIAL
SUPPLIES,
HELP
ANOTHER
CHILD

WORK
AVOIDANCE

REWARD
WORK JOBS

THE GOOD NEWS!

Oppositional Defiant Disorder may improve

over time!

Studies have shown that symptoms of ODD

may resolve within 3 years in approximately
67% of children diagnosed with the disorder.

(American Academy of Child and Adolescent

Psychiatry)

STRENGTHS

They possess strengths like:

determination
strong will
courage to be different
strong need for control and
will do just about anything to
gain power

Discipline without a relationship leads to rebellion.

-Dr. Josh McDowell

HOW DID YOU DO?

1. In order to diagnose ODD,

symptoms must occur in multiple
settings.

2. Diagnostic criteria for ODD

T
includes problems with emotional
regulation.
3. Diagnostic criteria for ODD
includes aggression toward
people and animals.

4. There is no clear cause of

ODD.

5. Parenting style can be a risk

factor for ODD.

6. Anxiety can be a protective

HOW DID YOU DO?

8. ODD is easily treated with

medication.

9. Staying firm and saying NO is an

effective way to curb defiance.

10. Steve Jobs was diagnosed with

ODD.

REFERENCES
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders
(5thed.). Washington, DC: APA.

Axelrad, M. E., Garland, B. H., & Love, K. (2009). Brief Behavioral Intervention for Young
Children with Disruptive Behaviors. Journal Of Clinical Psychology In Medical
Settings, 16(3), 263-269.
Barkley, R. A. & Mash, E. J. (2003). Child psychopathology (2nd ed.). New York: Guilford Press.
Behaviour Doctor (2009). Retrieved from: http://www.behaviordoctor.org/
Burke, J. & Loeber, R. (2010). Oppositional Defiant Disorder & the Explanation of the
Comorbidity Between Behavior Disorder & Depression. Clinical Psychology: Science &
Practice, 17(4), 319-326.
Cunningham, N.R., & Ollendick, T.H. (2010). Comorbidity of Anxiety and Conduct Problems in
Children: Implications for Clinical Research & Practice. Clinical Child & Family
Psychology Review, 13: 333-347. doi: 10.1007/s10567-010-0077-9

REFERENCES

Drabick, D.A., Ollendick, T.H., & Bubier, J.L. (2010). Co-occurrence of

Oppositional Defiant & Anxiety Disorder: Shared Risk Processes &
Evidence for a Dual Pathway Model. Clinical Psychology: Science &
Practice, 17(4), 307-318.

Dunsmore, J.C., Booker, J.A., & Ollendick, T.H. (2013). Emotion

Regulation as Protective
Factors for Children with Oppostional
Defiant Disorder. Social Development, 22(3),
444-466.
Fulkerson, R. C., & Webb, A. R. (2005). What are effective treatments
for oppositional anddefiant behaviors in preadolescents?. Journal Of
Family Practice, 54(2), 162-165.
Hamilton, S.S., & Armando, J. (2008). Oppositional Defiant Disorder.
American Family Physician, Oct 1, 78(7), 861-866.
Hinshaw, S.P. & Lee, S.S. (2003). Conduct & Oppositional Defiant
Disorders. In Eric J. Mash & Russell A. Barkley. Child Psychopathology.
New York: The Guilford Press.

REFERENCES

Johnson, M., S., Fransson, G., Landgren, M., Nasic, S., Kadesj, B., & ...
Fernell, E. (2012). Attention-deficit/hyperactivity disorder with
oppositional defiant disorder in Swedish children - an open study of
collaborative problem solving. Acta Paediatrica,
101(6), 624-630.
Lavigne, J.V., Gouze, K.R., Hopkins, J., Bryant, F.B, & LeBailly, S.A. (2011). A
multi-domain model of
risk factors for ODD symptoms in a community
sample of 4-year-olds. Journal of Abnormal Child Psychology, 40, pp. 741757.
Oppositional Defiant Disorder Resource Centre (2013). American Academy of
Child and Adolescent Psychiatry. Retrieved from:
http://www.aacap.org/AACAP/Families_and_Youth/Resource_Centers/Opposi
tional_Defiant_Disorder_Resource_Center/Home.aspx
Rey, J. M., Walter, G., Plapp, J. M., & Denshire, E. (2000). Family environment
in attention deficit hyperactivity, oppositional defiant and conduct
disorders. Australian & New Zealand Journal Of Psychiatry, 34(3), 453-457.

QUESTIONS? COMMENTS?
EXPERIENCES?