Oppositional

Defiance Disorder



What Is ODD? A Definition
Oppositional defiant disorder (ODD) is a childhood behavioural problem in which a child's hostility, disobedience and negative attitude are out of proportion to what would be expected for his or her age group (Heflinger, 2008). It is one of a group of behavioural disorders known collectively as disruptive behaviour disorders, which include conduct disorder (CD) and attention deficit hyperactivity disorder (ADHD) (Watson, 2009). To fit the diagnosis, the behavior must persist for at least six months and occur more often than might be expected for the child's age and developmental stage, as some oppositional behavior is to be expected as a child grows (Watson, 2009). ODD is more prevalent in boys than girls (2:1) (Ballarat Health, 2009). 1 in 5 primary age students display ODD characteristics (this can be influenced by economical, racial and cultural factors) and 1 in 10 are though to actually have ODD.


Possible Causes
The cause of Oppositional Defiant Disorder is unknown at this time. It is thought that ODD may arise
from a number of different factors, rather than one specific cause. The following are some of the theories being investigated:
  • It may be related to the child’s temperament and the family’s response to that temperament (Ballarat Health, 2009)
  • A predisposition to ODD is inherited in some families (especially a lack of clear and consistent rules, lack of boundaries and lack of day to day structure and predictability) (Ballarat Health, 2009)
  • There may be problems in the brain that cause ODD
  • It may be cause by a chemical imbalance in the brain


Some studies have found that certain environmental factors in the family increase the risk of disruptive behaviour disorders. These include:
  • Poor parenting skills
  • Domestic violence
  • Physical abuse
  • Sexual abuse
  • Neglect
  • Poverty
  • Substance misuse by parents or carers (Ballarat Health, 2009)



Without intervention and treatment, some children with ODD progress to develop conduct disorder (CD) (Ballarat Health, 2009), which is characterised by aggressive and delinquent behaviours including:
  • Lying
  • Being sadistic or cruel to animals and people
  • Physically or sexually abusing others
  • Law-breaking behaviours like deliberately lighting fires, vandalism or stealing. (Duff, 2005)


external image tantrum.jpg



Characteristics
  • Is easily angered, annoyed or irritated
  • Frequent anger and resentment
  • Mean and hateful when talking especially when upset
  • Spiteful or vindictive
  • Swearing or using obscene language
  • Low opinion of themselves
  • May abuse drugs (probably not in primary school)
  • Angry and resentful of others
  • Frequent temper tantrums
  • Excessive arguing with adults
  • Actively defiant and refusal to comply with adult requests and rules
  • Deliberate attempts to annoy or upset people
  • Blaming others for his or her mistakes or misbehaviour's
  • Loss of friendship or trouble in school
  • Refuses to obey rules/ questions rules

(Dengate, 2004; Duff, 2005; Oatis, 2009; Watson, 2009; Ballarat Health, 2009)



Note: This video does not show a child with ODD. It is an advertisement. However, it was the best example of a tantrum we found.

Implications
Early intervention and treatment is important, since children with untreated ODD may continue to be difficult and antisocial into their adult years. This can impact on their relationships, career prospects and quality of life.

For the Individual
  • Social isolation
  • Feeling of constant criticism
  • Takes things personally
  • Low self esteem
  • Difficulty in social interaction
  • Impairment in academic performance (Ballarat Health, 2009)


For Family and Acquaintances
  • Emotional stress (Watson, 2009)
  • Rifts between parents
  • Withdrawal from social functions
  • Feelings of inadequacy
  • Parents becoming strict and hostile
  • Siblings feeling ignored or overlooked
  • Family life becoming dysfunctional (the ‘war zone’) (Drugli et. al., 2007)

For Teachers
  • Emotional stress (Watson, 2009)
  • Class disruption
  • Need to make 'reasonable adjustments' to the curriculum and class
  • See Management Strategies for some 'reasonable adjustments'

Management Strategies
Parents and Caregivers
  • Parental training - To help parents better manage and interact with their child,
  • Includes behavioural techniques that reinforce good behaviour and discourage bad.
  • This is the primary form of treatment and most effective. (Ballarat Health, 2009)
  • Functional family therapy - o teach all family members to communicate and problem solve more effectively external image article-tantrums-photo.jpg
  • Consistency of care – all carers of the child need to be consistent in the way they behave towards and manage the child.
  • Educators - Communicate with parents so that strategies are consistent. Remember a child may behave differently at home and at school, parents may not be aware of their child's school-specific symptoms (Cancio, 2010)

Time-out
  • Take a time-out break yourself if you feel you may make the conflict worse. This is good modelling for the child (Oatis, 2009)
  • Support the child if they decide to take time-out to prevent overreacting.
  • Provide an appropriate space for timeout (e.g. a quiet corner) (Watson, 2009)

Focus on Prevention
  • Pick your battles - since the child may have trouble avoiding a power struggle, priorities the things you want the student to do (Oatis, 2009)
  • Aim to avoid conflict in the first place
  • Dr. Ross Greene suggests teachers work to identifying the types of activities that are likely to cause frustration
  • Develop specific coping mechanisms
  • Promote self-esteem and confidence (Watson, 2009)

Set Expectations
  • Most students respond well when teachers clearly state their behavioral expectations (Drugli et. al., 2007)
  • Teachers may start by stating two or three behavioral goals for the student. These goals may include expectations such as “I will accept the word ‘No’ “ or “I will follow directions.”
  • If possible, include these expectations on a behavioral chart to refer to and monitor progress throughout the day.
  • Be fair but be firm, give respect to get respect (Watson, 2009)

Praise/Rewards
  • Build on the positives – offer praise and positive reinforcement for flexibility or cooperation (Oatis, 2009)
  • Using praise whenever appropriate can make teaching these students much more effective. If you use a behavioral chart be sure to reward good behavior as well
  • A smile or word of praise from a teacher can mean a great deal
  • Providing an incentive or reward for appropriate behaviors that occur over a defined period of time can be a great motivator. Also, allowing the child to pick the reward can help (Oatis, 2009)
  • E.g. If you do this work, you will have time to play on the computer

Consequences
  • Consequences are very different to threats. Children with ODD do not respond well to the threat of punishment (Cancio, 2010)
  • Their interest in winning the battle is stronger than their fear of its consequences
  • Set up reasonable, age appropriate limits with consequences that can be enforced consistently (Oatis, 2009)
  • Students need to know that their behavior will have consequences and what these will be (Drugli et. al., 2007)
  • Consequences should be appropriate and meaningful, but they MUST be something the child wishes to avoid (chores are not appropriate for a child who loves them)

Routines
  • Improve classroom management with effective classroom routines (Watson, 2009)
  • Involve the child when you are establishing rules and routines. Ask for his/her assistance. Make sure they repeat them - this will help them remember
  • Visual timetables are used for children with a variety of disabilities and may also help here
  • Minimise downtime and plan transitions carefully. Students with ODD do best when kept busy (Heflinger, 2008)

Self Regulation
  • Systematically teach social skills, including anger management, conflict resolution and how to be assertive in an appropriate manner (Watson, 2009)
  • Discuss specific strategies that the student may use to themselves in future situations
  • Select materials that encourage student interaction. Students with ODD need to learn to talk to their peers and to adults in an appropriate manner. All cooperative learning activities must be carefully structured
  • Cognitive Behaviour Modification (CBM) involves teaching student to use self talk to control their own reactions and responses (Crowe, 2010)
  • Discussion and role-play activities that give all student experience in conflict resolution is also suggested
  • Conferencing is a form of restorative justice that asks questions like (Oatis, 2009)
  • What happened?
  • How each person has been affected?
  • What might be done to improve the situation?


external image tantrum-20225343.jpg




Click the link below to see how to write up these strategies as a Behaviour Management Plan
Behaviour Management Plan

Behaviour Management Plans are usually developed in conjunction with the student and family as well as any other stakeholders.


This is the web-site from the tutorial.
ODD Management Digest


Tutorial Resources
Case Study Document

Behaviour Management - Blank




References
Ballarat Health Services VIC, Initials. (2009). Oppositonal defiance disorder. Retrieved fromhttp://www.bhs.org.au/files/fmanager/mental_health/camhs/OppositionalDefiance.pdf

Cancio, C. (2010). How oppositional defiant disorder works. Retrieved from http://health.howstuffworks.com/pregnancy-and-parenting/childhood-conditions/oppositional-defiant-disorder4.htm

Crowe, C. (2010). Teaching children with challenging behaviour. Educational Leadership, 67(5), 65-67.

Dengate, S. (2004) Oppositional Defiant Disorder, Food Intolerance Network Factsheet. [Electronic Version]. Retrieved from http://www.fedupwithfoodadditives.info/factsheets/FactODD.htm

Duff, J. (2005). Disruptive Behaviour Disorders. Retrieved from http://www.adhd.com.au/conduct.html

Drugli, M., Larsson, B., Clifford, G., Fossum, S., (2007) Pervasive and Non-Pervasive Conduct Problems in a Clinic Sample Aged 4-8 years: Child, Family and Day-Care/School Factors. Journal of Educational Research. Vol 51(5) pp. 547-559.

Heflinger, C., Humphreys, K. (2008) Identification and Treatment of Children with Oppositional Defiant Disorder: A Case Study. Psychological Services, Vol 5(2) pp. 139-152

Oatis, M. (2009). Children with oppositional defiant disorder. Facts for Families, 72. Retrieved from http://aacap.org/page.ww?name=Children+with+Oppositional+Defiant+Disorder&section=Facts+for+Families

Trix, V. (2009). Strategies for teaching children with oppositional defiant disorder. Retrieved fromhttp://www.brighthub.com/education/special/articles/26631.aspx

Walker, L. (2002). What is oppositional defiant disorder?. Retrieved from http://www.essortment.com/all/whatisoppositi_rlnc.htm

Watson, S. (2009). Oppositonal Defiance Disorder. Retrieved from http://specialed.about.com/od/behavioremotional/a/odd.htm


Image Credits
http://americanmoms.com/issue-tantrums.html

http://alternativeremediesonline.storeblogs.com/files/2009/06/tantrum.jpg

http://ucgmikebennett.files.wordpress.com/2009/12/tantrum-20225343.jpg