Oppositional Defiant Disorder Empirically Supported Treatments Rachel J

Oppositional Defiant Disorder: Empirically Supported Treatments Rachel J. Valleley, Ph. D. Assistant Professor Munroe-Meyer Institute Nebraska Medical Center

Oppositional Defiant Disorder Ø Enduring pattern of uncooperative, defiant, and hostile behavior toward authority figures that does not involve major antisocial violations. Ø Frequently gets confused with ADHD. Can have both.

Oppositional Defiant Disorder: DSM-IV Criteria Ø Ø Ø Ø Loses temper Argues with adults Actively defiant or refuses to comply with adults’ requests or rules Deliberately annoys people Blames others for his or her mistakes or misbehavior Touchy or easily annoyed by others Angry and resentful Spiteful or vindictive

Oppositional Defiant Disorder Most common diagnosis given in our clinics in pediatric practices. Ø Often setting specific Ø Occurring more with parents or other caregiver Ø Difficulties with sleeping, eating, and toileting. Ø Increased risk for other problems Ø Coercive Family Process Ø

Oppositional Defiant Disorder Ø Misconception that “He’ll grow out of it”. Ø Often leads to Conduct Disorders or antisocial personality disorder. Ø Effective early intervention leads to longterm positive outcomes Ø No medication that will effectively work

Oppositional Defiant Disorder In Short: l Disruptive and defiant behaviors have paid off • Attention/Reaction • Removal of demand l l Often test limits Have not learned prerequisite skill of complying to authority

Oppositional Defiant Disorder Ø Treatment: l l Parent Training: Forehand & Mc. Mahon Parent-Child Interaction Therapy: Hembree. Kigin & Mc. Neil

Treatment for ODD: Parent Training 1. Encourage/increase appropriate behavior Ø Differential Attention Ø Child’s Game Ø Sticker Charts/Grab Bag Prizes

Treatment for ODD: Parent Training Ø Differential attention l l Attend to average behavior Praise exceptional behavior

Treatment for ODD: Parent Training Ø The Child’s Game: A relationship-building activity that makes children want to earn your POSITIVE attention.

Treatment for ODD: Parent Training Ø DO l l l Describe Reflect Imitate Praise Touch Ø DON’T l l l Command Reprimand Question

Treatment for ODD: Parent Training Ø Sticker Charts/Grab Bag Prizes: l l l Bedtime routine, morning routine Daily for overall behavior Magic circle chart Dot-to-dot’s Grab Bag Prizes

Treatment for ODD: Parent Training Ø Effective Commands: l l l Simple Direct One at a time Start small “Do” commands

Treatment for ODD: Parent Training Ø Bad Commands l l l “Don’t jump on the bed” “Bring your shoes to the bedroom, put your clothes in the hamper, make your bed, and take all the dishes to the sink. ” “Could you please turn off the T. V. ” “Watch out” “I need you to pick up the toys because grandma is coming over. ”

Treatment for ODD: Parent Training 2. Decrease inappropriate behavior Ø Time out Ø Job Card Grounding

Treatment for ODD: Parent Training Ø What is time out? l Time out is the removal of attention, tangibles, or anything interesting to the child for a brief amount of time.

Treatment for ODD: Parent Training Ø Misconceptions and mistakes with time out l l l Not the chair Have to sit quietly before time starts 1 minute per year Think about what did wrong and feel sorry Talking to child in time out Not expecting extinction burst

Treatment for ODD: Parent Training Ø How to do Time Out: l l l l Stop talking once told “Time Out” Get to chair/spot with minimal guidance Do not attend to anything in time out Stay close enough to monitor but be aloof Child serves 2 -3 minutes Let child out Follow up with expecting appropriate behavior

Treatment for ODD: Parent Training Ø Common problems with Time Out l l My child won’t go/stay in time out My child does not seem to care that they are in time out My child will not be quiet in time out My child won’t get out of time out

Treatment for ODD: Parent Training Ø Common uses for time-out l l Noncompliance Aggression Rule infractions Tantrums

Treatment for ODD: Parent Training Ø Compliance training Ø Give command, wait 5 -10 seconds. If comply, praise. If not comply, give time out warning. If comply, praise. If still does not comply, time out. After time out, go back to original command repeat until followed.

Treatment for ODD: Parent Training Ø Time out for aggression and rule infractions l l Do not use warning Look for positive behavior immediately following time out to praise. Create contrast!!

Treatment for ODD: Parent Training What is job card grounding? Ø Discipline program which requires children to earn their way off grounding, rather than simply waiting for time to pass.

Treatment for ODD: Parent Training Ø Common uses of job card grounding l l l Arguing Noncompliance Rule infractions

Treatment for ODD: Parent Training Ø Set up for Job Card Grounding l Develop house rules • Do what you are told • Be respectful l Develop list of jobs Develop list of rewards Set criteria for earning reward

Treatment for ODD: Parent Training Ø Rule infraction earns job card Ø Grounded from all privileges until job is complete Ø Once job is done, no more discussion of misbehavior Ø Reward for following rules

Treatment for ODD: Parent Training Trouble Shooting Job Card Grounding Ø l l l What if child argues when given job card? What if grounding seems to be lasting an excessively long time? What do you do regarding extracurricular activities?

Summary of Treatment for ODD Ø Just as important to increase appropriate behaviors as it is to decrease inappropriate behaviors