Oppositional Defiant Disorder

1
Oppositional Defiant Disorder Conduct Disorder
2
Oppositional Defiant Disorder (313.81)

• Pattern of negativistic, hostile, and defiant
  behavior (p. 102)
• The disturbance in behavior causes clinically
  significant impairment in social, academic, or
  occupational functioning
• The behaviors do not occur only during the course
  of a psychotic or mood disorder
• Criteria are not met for either conduct disorder
  or antisocial personality disorder

3
ODD cont.

• 4 or more of the following need to be present
• often loses temper
• often argues with adults
• often actively defies or refuses to comply with
  adults
• often deliberately annoys people
• often blames others
• often easily annoyed by others
• often angry or resentful
• often spiteful or vindictive

4
ODD cont.

• Parents may present with complaints that client
  constantly misbehaves refuses to listen to them
  argues
• You may notice very poor parent-child
  interactions
• The client may deny all or some of the parents
  assertions, or blame others
• There may be swearing, temper tantrums, yelling,
  and fighting client may be easily frustrated
• There may be co-occurrence of substance or
  polysubstance use
• In school, there may be some of the same problems
  as at home

5
ODD cont.

• More boys than girls (before puberty)
• After puberty, genders relatively equal
• Boys behavior usually more confrontational
• Usually evident before 8 and no later than early
  adolescence
• Family history of similar dx., or symptomology
  (i.e., marital stress)

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Conduct Disorder 312.81 Childhood-Onset (lt 10
y/o)312.82 Adolescent-Onset (gt 10 y/o)312.89
Unspecified-Onset (if age is unknown)

• There are also severity specifiers
• Mild, Moderate, Severe
• This usually refers to the number of conduct
  problems type

7
Conduct Disorder, cont.

• 3 or more criteria within the following
  categories within the past 12 months with at
  least 1 criteria present in the past 6 months.
• Aggression to people and animals
• Destruction of property
• Deceitful or theft
• Serious violation of rules
• pp.98-99 lists the criteria

8
Conduct Disorder, cont.

• While this may be an appropriate diagnosis, it
  often carries long term implications
• Symptoms (behaviors) can vary with age
• The earlier the more destructive behaviors, the
  worse the prognosis
• Generally, the more destructive behaviors emerge
  last
• ODD is often a precursor to CD
• More common in boys, especially the childhood
  onset type
• CD often remits in adulthood, although many go on
  to develop Antisocial Personality Disorder

9
Caveats when considering either ODD or CD as a
provisional dx.

• Keep in mind who is providing the information
  (parents, school, physician, law
  enforcement/courts, the client)
• They may have biases
• They may be poor historians
• They may have an agenda
• Many of these behaviors may be transient
  (especially during developmental periods)
• Keep in mind the context
• Gather as much information, and from a variety of
  sources

10
Lets try a few!

• A 9 y/o boy is brought in by his mother. She
  relates that he has become more and more sullen.
  He yells at his older sister he refuses to clean
  up his room. Mom says he has always been
  difficult to control. A lot of time outs, and I
  have taken away his Nintendo.
• At school, he has gotten two referrals to the
  office One was for calling the teacher stupid
  when he got an answer wrong. The other was for
  pushing another student because he didnt throw
  me the ball. He has been in ISS several times,
  since the beginning of the school year.
• The boy tells you that people get make me mad.
  He also states that nobody likes him.

11
What do you think.?

• You are asked to interview and assess a 13 y/o
  girl.
• She tells you that she has been arrested twice in
  the past
• two months. The first time was for fighting
  another
• girl at the mall. She related that the girl
  asked for it.
• The second time was for stealing makeup from
• a car in her apartment complex She tells you that
  she
• knew the owner, and that it was okay to use her
• makeup.
• She also tells you that she ran away last month,
  and
• smokes a blunt every now and then.
• Last year, she would leave school sometimes to
  go see
• her boyfriend at his work.

12
Any thoughts on this client?

• You interview a 12 y/o boy and his mother. They
  are referred
• by the childs pediatrician. Mother and child
  appear to have
• very strong attachments. They both relate that
  the client has
• been angry lately. He was also kicked off the
  baseball team
• for repeatedly throwing his bat and storming off
  the baseball
• field. When asked, the client states that the
  umpires were
• out to get me. Mom tells you that when he gets
  in trouble,
• his father gets after him, and accuses her of
  babying him.
• The client says she will stay in her room all day
  and that my
• parents fight a lot. My dad says she takes
  happy pills.
• The client tells you other kids make fun of him
  for being
• a little chubby. He says that he really does not
  care.
• Mom stated that when he was a baby, he cried all
  the time.