MS Pedia > ODD and CD > Flashcards

ODD and CD Flashcards

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1
Q

Persistent negativistic, disobedient, and hostile behavior toward authority, with refusal to take responsibility and tendency to blame others, but in the absence of serious violations of the rights of others

A

Oppositional Defiant Disorder

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2
Q

Often argues with adults, easily annoyed, frequently angry or resentful

A

Oppositional Defiant Disorder

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3
Q

May struggle in class and peer relationships but usually avoid physical aggression or major destructive acts

A

Oppositional Defiant Disorder

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4
Q

prevalence of ODD in age

A

can begin as early as 3 years, typically noted by 8 years, and usually not later than early adolescence

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5
Q

prevalence range of ODD

A

1% to 11%, averaging around 3.3%

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6
Q

prevalence of ODD in gender

A
  • Slightly more prevalent in males than females (1.4:1) before adolescence
    Prevalence in both sexes decreases after age 12
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7
Q

temperamental risk factor of ODD

A

Problems in emotional regulation (e.g., high emotional reactivity, poor frustration tolerance) predict the disorder

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8
Q

environmental risk factor of ODD

A

Harsh, inconsistent, or neglectful child-rearing is common and considered a key causal factor

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9
Q

genetic / physiological risk factors of ODD

A
  • lower heart rate and skin conductance
  • reduced basal cortisol
  • abnormalities in the prefrontal cortex and amygdala
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10
Q

pathology of ODD

A

Pathology begins when oppositional behavior persists abnormally, authority figures overreact, or behavior recurs more frequently than in most children of the same mental age

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11
Q

most predictive of later psychiatric disorders; other elements are components of temperament

A

irritability

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12
Q

peak of irritability in children with ODD

A

18 - 24 months

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13
Q

Often lose temper, easily annoyed, and irritable most of the time

A

angry / irritable

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14
Q

Argue with authority (parents, teachers, relatives), refuse requests, deliberately break rules, annoy others, avoid responsibility, and blame others

A

argumentative / defiant

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15
Q

Spiteful or vindictive actions at least twice in 6 months

A

vindictive

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16
Q

symptoms of ODD are most evident with

A

familiar adults or peers, often confined to one setting (usually home)

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17
Q

common clinical feature in children with ODD regarding their behavior

A

may know others disapprove but justify behavior as a response to unfair circumstances

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18
Q

interferes with relationships and school performance

A

Chronic ODD or irritability

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19
Q

children with ODD are often rejected by peers, leading to …

A

isolation and loneliness

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20
Q

IQ of children with ODD

A

normal intelligence but may fail in school due to poor cooperation, participation, and acceptance of help

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21
Q

children with ODD may develop

A
  • poor frustration tolerance
  • temper outbursts
  • self-esteem (low)
  • depressed mood
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22
Q

ostracized adults may turn to …

A

alcohol or illegal substances to fit in

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23
Q

Chronic irritability increases risk of mood disorders in

A

adolescence or adulthood

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24
Q

diagnostic criteria of ODD (A)

A

A. Pattern of angry/irritable mood, argumentative/ defiant behavior, or vindictiveness lasting at least six months, with at least four symptoms from any category, during interaction with at least one non-sibling:
- Angry/Irritable: Often loses temper, touchy or easily annoyed, angry or resentful
- Argumentative/Defiant: argues with authority figures or adults, defies rules or requests, Deliberately annoys others, Blames others for mistakes or misbehavior
- Vindictiveness: Spiteful or vindictive at least twice in past 6 months

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25
diagnostic criteria of ODD (B)
Behavior causes distress in individual or others (family, peers, teachers) or impacts social, educational, or occupational functioning
26
diagnostic criteria of ODD (C)
Behaviors not due to psychotic, substance use, depressive, or bipolar disorder; criteria not met for disruptive mood dysregulation disorder
27
frequency requirement for children younger than 5 years
Behaviors occur on most days for at least 6 months
28
frequency requirement for children 5 years and older
Occur at least once per week for at least 6 months (unless otherwise noted)
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general frequency requirement for ODD
Must be outside normal range for age, gender, culture
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symptoms confined to one setting
Mild ODD
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present in at least two settings
Moderate ODD
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present in three or more settings
Severe ODD
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DDx of ODD
- CD, ADHD, Mood Disorder, DMDD, IED, ID, Language Disorder, Social Anxiety Disorder
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Severe aggression or rule-breaking that violates others’ rights—more serious than ODD
Conduct Disorder
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Inattention and hyperactivity; oppositional acts stem from impulsivity, not hostility
ADHD
36
Comorbidity of ODD
ADHD, Mood Disorder, Anxiety Disorder
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Outcome of ODD depends on
symptom severity and ability to develop healthier responses to authority
38
percentage of ODD who may outgrow diagnosis over time
25%
39
Persistent symptoms of ODD raise risk for
anxiety, mood, conduct, and substance use disorders
40
Defiant / argumentative, vindictive traits predict
conduct disorder
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angry/irritable mood predicts
emotional disorders
42
primary treatment for clients with ODD
Family intervention
43
goals for treating ODD
- reinforce prosocial behaviors - reduce undesired behaviors - teach parents to ignore/avoid reinforcing defiance
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parents learn behavior-modification techniques; child practices adaptive responses through role-play
CBT
45
builds mastery, social skills, and self-esteem within a neutral, supportive relationship
Individual Therapy
46
parenting treatment for ODD
Replacing harsh or punitive parenting with positive parent–child interactions improve outcomes
47
Persistent pattern of aggressive behavior starting in early childhood that violate the basic rights of peers and family members
Conduct Disorder
48
Includes physical aggression or threats, destruction of property, theft/deceit, and frequent rule violations
Conduct Disorder
48
CD co-occurs with
ADHD, depression, and learning disorders
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one-year population prevalence of CD
2% - 10% (median: 4%)
50
male-to-female ratio of CD
4:1 to 12:1
51
CD is more frequent in children of parents with
antisocial personality disorder or alcohol dependence
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rates of CD are linked to
low socioeconomic status and parental psychopathology
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temperamental risk factor of CD
Difficult, under controlled temperament; low verbal IQ
54
environmental risk factors of CD
Parental rejection/neglect, inconsistent or harsh discipline, abuse, poor supervision, early institutional care, frequent caregiver changes, large family size, parental criminality/ psychopathology, delinquent peers, violent neighborhoods, and chronic exposure to violent media
55
genetic / physiological risk factors of CD
- Family history of conduct disorder, ADHD, alcohol use, mood disorders, or schizophrenia - slower resting heart rate, low skin conductance - abnormalities in ventral prefrontal cortex–amygdala connections
56
neurobiological risk factors of CD
- Decreased gray matter in limbic regions, bilateral anterior insula, and left amygdala - Low plasma dopamine-β-hydroxylase (↓ norepinephrine), high plasma serotonin, and low CSF 5-HIAA (linked to aggression/violence) - EEG: Greater right frontal activity at rest in aggressive children compared to nonaggressive peers
57
onset of CD
May begin in preschool, but key symptoms usually appear middle childhood to middle adolescence
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gender-based onset of CD
- Boys: onset around 10–12 years - Girls: onset around 14–16 years
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early signs of CD
bullying, physical aggression, cruel behavior, hostility, verbal abuse, and defiance toward adults
60
diagnostic criteria of CD (A)
A. Pattern of behavior violating others’ rights or age-appropriate societal rules, with at least 3 of the 15 criteria in the past 12 months and at least 1 in the past 6 months: - Aggression to People and Animals -- Bullies, threatens, or intimidates -- Initiates physical fights -- Uses a weapon (bat, brick, bottle, knife, gun) -- Physically cruel to people -- Physically cruel to animals -- Steals while confronting a victim (mugging, extortion) -- Forces sexual activity - Destruction of Property --Deliberately sets fires to cause damage -- Deliberately destroys others’ property (not by fire) - Deceitfulness or Theft -- Breaks into houses, buildings, or cars -- Lies to obtain goods/favors or avoid obligations -- Steals without confrontation (e.g., shoplifting, forgery) - Serious Rule Violations -- Stays out at night despite prohibitions (before age 13) -- Runs away overnight at least 2 times (or once for an extended period) -- Truancy from school (before age 13)
61
diagnostic criteria of CD (B)
Behavior causes clinically significant impairment in social, academic, or occupational functioning.
62
diagnostic criteria of CD (C)
If at least 18 years old, criteria not met for antisocial personality disorder.
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at least 1 symptom before age 10
Childhood-onset
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No symptom before age 10
adolescent-onset
65
Insufficient info to determine age of onset
Unspecified
66
Criteria if Specify if Limited With Prosocial Emotions
To use this specifier, at least 2 or more of the following must be present in multiple relationships and settings for 12 months or longer
67
Symptoms of Specify With Limited Prosocial Emotions
- Lack of guilt or remorse - Unconcerned about performance - Callous-lack of empathy - Shallow or deficient affect
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Shows little or no concern about having done something wrong or about the negative effects of actions on others
Lack of remorse or guilt
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Disregards the feelings and needs of others; appears cold or uncaring
Callous-lack of empathy
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Does not care about doing well at school, work, or other important activities, even when expectations are clear; typically blames others for poor performance
Unconcerned about Performance
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Emotions seem shallow, insincere, or superficial; can turn emotions “on” or “off” quickly, or express feelings only when used to manipulate or intimidate others
Shallow or deficient affect
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Few problems, minor harm (e.g., lying, truancy)
Mild Severity
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Intermediate number/effect of problems (e.g., stealing without confrontation)
Moderate Severity
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Many problems or major harm (e.g., forced sex, weapon use, breaking and entering)
Severe Severity
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More likely to show fighting, stealing, vandalism, and school discipline problems; display both physical and relational aggression
Males with CD
76
More likely to show lying, truancy, running away, substance use, and prostitution; display relatively more relational aggression (harming social relationships)
Females with CD
77
DDx of CD
- ADHD - Adjustment Disorder - Mood Disorder - Intermittent Explosive Disorder - ODD
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comorbid factors of CD
- ADHD & ODD - Antisocial Personality Traits - Co-occur with learning disorders, anxiety disorders, depressive or bipolar disorders, and substance-related disorders
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linked to early onset, numerous and severe symptoms, and frequent expression—raising risk for criminal behavior, persistent conduct problems, and substance-related disorders in adulthood
poor prognosis
80
best oucomes of CD occurs in
mild cases with no comorbid disorders and normal intellectual functioning
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Minimum age requirement to diagnose ASPD
18 years old
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Early history required for ASPD
Evidence of Conduct Disorder before age 15
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General pattern in ASPD
Pervasive disregard for and violation of others’ rights since age 15
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Core behavioral pattern for individuals with ASPD
- Failure to conform to lawful behavior (acts that are grounds for arrest) - Deceitfulness (repeated lying, use of aliases, conning for personal gain) - Impulsivity or failure to plan ahead - Irritability and aggressiveness (repeated fights or assaults) - Reckless disregard for safety of self or others - Consistent irresponsibility (failure to sustain work or honor financial obligations) - Lack of remorse or guilt
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Frequency requirement for ASPD
atleast 3 of criterion A
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criterion D for ASPD
Antisocial behavior is not exclusively during schizophrenia or bipolar disorder
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behavioral therapy to address CD
Cognitive Behavioral Therapy
88
Antipsychotics given for CD
risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), ziprasidone (Geodon), and aripiprazole (Abilify)
89
side effects of second generation antipsychotics
include sedation, increased prolactin levels, (with risperidone use) and extrapyramidal symptoms, including akathisia
90
decreases agression
Clonidine (Catapres)
91
used to target symptoms of impulsivity, irritability, and mood lability, which frequently accompany conduct disorder
SSRIs
92
examples of SSRIs
fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), and citalopram (Celexa)
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