The video below is the section for Oppositional Defiant Disorder from Part 4 of TSM’s lecture series on DSM-5 and the EPPP, followed by a transcript. This lecture series aims to equip those preparing for the EPPP with everything you need to know about the impact DSM-5 will be having on the EPPP. To watch all of Part 4, click HERE. To watch earlier lectures in this series, or register for our webinar series on DSM-5 and the EPPP, click HERE.
Transcript of DSM-5 EPPP Lecture Video: Oppositional Defiant Disorder
NARRATIVE DEFINITION: Oppositional Defiant Disorder (ODD) is a diagnosis in the chapter of Disruptive, Impulsive-Control, and Conduct Disorder. ODD is characterized by a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness that persists for at least six months. The criteria for Oppositional Defiant Disorder is more evenly distributed between emotions (anger) and behaviors (arguing) than other disruptive or impulsive-control disorders.
In order to be diagnosed with ODD, a child must meet at least four of the following criteria: frequently loses temper; often touchy or easily annoyed; often angry or resentful; frequently argues with adults; is actively defiant and refuses to comply with rules; often purposefully annoys others; or frequently blames his or her mistakes or inappropriate behavior on others; has reportedly been spiteful or vindictive at least twice in the past 6 months.
Oppositional Defiant Disorder often manifests itself through excessive stubbornness, revenge-seeking behavior, and an inability to compromise. Children with ODD may test limits by deliberately ignoring others, instigating arguments, and blaming others for their wrongdoing. These children rarely view themselves as being defiant. Any misdeeds are attributed or placed in an overly demanding or unreasonable situation — a pattern of externalization consistent with the placement of ODD as a Disruptive, Impulsive-Control, and Conduct Disorder.
Although verbal aggression and outbursts are common, but do not include aggression toward people or animals, or destruction of property. ODD often co-occurs with or is a developmental antecedent to Conduct Disorder.
First symptoms of ODD usually appear during preschool years and rarely later than early adolescence. Children are more likely to demonstrate defiant and hostile symptoms with their families or other familiar individuals than in other settings, although generalization to other settings may well occur. Because symptoms are not always evident in the presence of people the child does not know well, the disorder may not be apparent in the initial clinical examination.
The number of oppositional symptoms tends to increase as the child ages. Prevalence rates for ODD are estimated to be between 1 percent to 11 percent with an average prevelance of 3.3%. Prior to adolescence, males are more likely than females (4:1) to be diagnosed with the disorder. Upon reaching puberty, however, this gender difference diminishes.
Although the exact causes of ODD are unknown, the disorder is often linked with inconsistent, neglectful, or overly harsh parenting methods. ODD is also more likely to develop when a child’s life is disrupted by frequent changes in caregivers. Temperamental factors related to problems in emotional regulation have also been correlated. A number of neurobiological markers have been associated with ODD, but many of the research studies have not separated children with ODD and Conduct Disorder and therefore, exact markers for this disorder are not clear. Children with ODD often have a concurrent diagnosis of Attention-Deficit/Hyperactivity Disorder (ADHD). Individuals with ODD are also at an increased risk for anxiety, depressive, antisocial behavior, and substance use disorders.
Symptoms may be seen in various settings and therefore, the individual’s symptoms should be assessed across multiple settings and relationships. Psychologists are still determining the most effective treatment for ODD. There is little controlled research on treatment outcomes for the disorder. It appears that treating ODD should be a multifaceted process that involves treatment of comorbid disorders, especially ADHD; parent management training to help parents manage their children’s disruptive behavior; and/or structured individual psychotherapy (from a cognitive-behavioral perspective) to help the child with anger management; and social skills training to help the child learn how to interact appropriately with peers. Controversy exists over the use of group social skills treatments, as contagion (the spread of defiant and aggressive behavior) may be likely unless group leaders utilize strong behavioral controls. There is currently no primary medication treatment for ODD. Stimulant medications may be employed to combat comorbid ADHD, and such medications have been shown to reduce defiance and oppositionality and several forms of impulsive or retaliatory aggression.
FLASHCARD:
Oppositional Defiant Disorder
- A Disruptive, Impulsive-Control, and Conduct Disorder marked by a negativistic, hostile, and defiant behavior toward authority figures persisting for at least six months
- Developmental progression to Conduct Disorder; it often co-occurrs or precedes a diagnosis of Conduct Disorder, but many ODD never develop Conduct Disorder
- ODD often manifests through excessive stubbornness, revenge-seeking, oppositionality, and blaming of others for wrongdoing
- Verbal aggression and outbursts common, but do not include aggression toward people or animals, or destruction of property
- Symptoms begin round preschool years and most often present around family members
- Wide estimates of prevalence rates (1 to 11 percent). In childhood, boys more likely than girls to have ODD; gender disparity diminishes by adolescence
- Linked to inconsistent, neglectful, or overly harsh parenting, temperament. Possibly neurbiological markers.
- High comorbidity with Attention-Deficit/Hyperactivity Disorder
- increased risk for anxiety, depression, antisocial behavior, and substance use disorders.
Treatments
- Behavioral parent management training
- Cognitive-behavioral therapy related to anger management
- Social skills training (though contagion can occur in group treatments)
- No primary medication treatment; stimulant medications can reduce defiance and impulsive or retaliatory aggression
QUESTION
Ryan, a 9-year-old boy, is having difficulty at home and at school. His teacher reports that Ryan refuses to cooperate with his classmates, ignores classroom rules, and blames others when he is caught doing something wrong. Ryan appears to intentionally try to annoy his peers and is vindictive when he is annoyed with them. Ryan’s mother reports that she has difficulty controlling her son at home, as he refuses to comply with even the simplest requests. Ryan should most likely be diagnosed with:
ANSWERS:
A. Conduct Disorder.
B. Oppositional Defiant Disorder.
C. Disruptive Behavior Disorder.
D. Attention-Deficit/Hyperactivity Disorder.
RATIONALE: Rationale: B is correct, as this pattern of oppositionality, stubbornness, and defiance is most consistent with Oppositional Defiant Disorder. There is not the severe aggression and violation of the rights of others present in Conduct Disorder, so A is incorrect; C is incorrect: This category is given to those individuals who do not meet the specific criteria for ODD, CD, or Antisocial Personality Disorder according to the DSM-IV-TR. However Ryan’s behavior illustrates a typical instance of ODD.