Outline the onset of ODD
- typically before the child turns 8
- rarely diagnosed in older children/adults
- more common in males
- symptoms stable between 5 and 10 years, then slowly decline
ODD symptoms are often identified around…. and often precede….
preschool age
symptoms of conduct disorder
Broadly speaking, ODD includes…
a persistent pattern of angry/irritable mood, defiant behavior and vindictiveness
Risk-based links between ODD and CD
ODD is a strong risk factor for development of CD in boys
ODD is not a risk factor for CD in girls
MAJORITY of kids with ODD do not go on to develop CD, despite the high rates of other comorbidities
ODD and comorbidities?
92.4% of those with ODD had at least 1 other mental disorder
Impulse control disorders
Anxiety disorders
Mood disorders
Subs Use disorders
What is the global prevalence of ODD?
10.2% average
(11.2 and 9.2 in boys and girls)
Although there is big research gap on ODD is SA,
local rates may exceed international ones due to South Africa’s low SES, family dynamics etc
While ODD diagnoses may help children get treatment, it can also…
Have harmful social consequences
- stigmatization and being outcasts (parents and children)
- harsher punishments
- assumed future criminality
- biases from teachers
- low expectations -> confirmation bias
*youths of color also tend to be diagnosed more easily with ODD than white youths
Diagnoses of ODD and CD may perpetuate:
- structural racism
- poor academic achievement
- increased risk of juvenile and justice involvement
- disciplinary disparities
Outline 3 biological etiological factors for ODD?
Genetics (50-62% variance)
Temperament (high persistence, low harm avoidance, negative affect)
Prenatal factors (mother smoking and mood disturbances)
Outline the 3 environmental etiological factors for ODD?
- maladaptive parental behavior (long term negative emotion and environment
- adverse childhood exps (abuse, divorce etc)
- SES (lower ed, disordered family, harsher parenting)
Outline the social etiological factors for ODD
- family dysfunction (low levels of cohesion, rigid structures, low adaptability)
- inconsistent parenting (low parental warmth, minimal involvement, negative reinforcement)
Outline the psychological etiological factors for ODD
- Callous-unemotional behavior (lack of guilt/empathy, blunted effect)
LEADS TO:
- Emotional dysregulation, and future externalizing behavior
What is another risk factors for ODD?
Having and ADHD diagnosis (affects social functioning and behavior, could predispose one to ODD)
What are the diagnostic criteria for ODD?
Three main categories:
1. Angry/irritable mood
2. Argumentative/defiant behavior
3. Vindictiveness
- A pattern of one of the three lasting at least 6 months (evidenced by symptoms) exhibited in interactions with individuals OTHER than their sibling
*symptoms should not be explained by other disorder, substance use, culture or circumstance. And should cause distress to the individual or others in context
What are the differences in diagnostic criteria or older and younger kids?
Younger than 5:
- behavior should occur on most days for at least 6 months
Older than 5:
- behavior should occur at least once per week for at least 6 months
There are 3 severity levels of ODD. What are they?
Mild: symptoms confined to one setting
Moderate: symptoms present in at least 2 settings
Severe: symptoms are present in 3 or more setting
Give two examples of ODD screening tools
- The Child Behavior Checklist
- The Behavior Assessment for Children (BASC-2)
What are some considerations surrounding ODD treatment
(4 points)
- ought to be multimodal (multiple role players)
- varies depending on child’s age, heath, severity
- treatment is influenced by parent-treatment compatibility
- early intervention is NB (prevents future problems; CD and antisocial behaviors etc
What are the 6 types of treatment for ODD?
- Psychosocial interventions
- Individual and family therapy
- School-based interventions
- Pharmacology (reserved for comorbidities an severe behavioral issues)
- Lifestyle and home remedies
- Problem-solving and coping skills
Outline psychosocial interventions for ODD
Family intervention
- primary treatment, parents trained in child management, interventions for behavioral change
Behavioral Parent training -
- parents taught contingency plans
CBT (parents) and C-CBT
- Children taught impulse and anger control.
- Enhance communication and coping skills
Regulation-Focused Psychotherapy for Children (RFP-C)
- focuses on emotional regulation rather then externalized behaviors (like most other treatments)
- targets defense mechanisms against unpleasant feeling states
What are some of the factors that complicate ODD diagnosis?
- a child’s developmental period
- a child’s environmental factors
Three of the controversies surrounding ODD are….
- racial bias in diagnosis
- is ODD real? Or simply a combination of comorbidities and behavioral problems
- difference between ODD and CD/ ODD as a precursor to CD? Not clear
What are 4 South African factors that contribute to the development of ODD?
- harsh discipline/abuse
- family disruptions
- poverty
- delinquent peer groups
