Understanding Students with Oppositional Defiant and Disruptive Disorders

Understanding Students with Oppositional Defiant and Disruptive Disorders Presented by Janet Simmons Star Summit 2016 Based on the seminar Oppositional, Defiant and Disruptive Children and Adolescents- Non-medication approaches to the Most Challenging Behaviors, by Robert Hull, MA, EDS, MHS

Purpose This presentation will introduce various behaviors disorders including ADHD and educate on ways to approach, manage and morally engage difficult students.

Oppositional Defiant Disorder (ODD) and Co-Occurring Disorders DSM-V (published May 2013) created new, co-occurring and revised criteria disorders. We are now seeing them in medical, psychiatric and psychological reports. Here a few changes: Disruptive mood dysregulation disorder (age of onset between 6 and 10 years of age) Persistent depressive disorder (combines dysthymia and major depressive disorder, chronic) Hoarding disorder Excoriation disorder (skin picking) Disinhibited social engagement disorder (differentiated from reactive attachment disorder) Gambling disorder (previously listed as a condition for further study)

Oppositional Defiant Disorder (ODD) and Co-Occurring Disorders Oppositional Defiant Disorder will have a co-occurring disorders: Conduct Disorder Attention Deficit Hyperactivity Disorder (ADHD) Disruptive Mood Dysregulation Disorder Trauma and Stressor Disorder The causes are often very recognizably different; however, the resulting behaviors are often similar.

ODD and DSM-V : How is it described? New descriptors: ODD has three symptom clusters (subgroups): Angry/Irritable (Internalized Anger)- feelings of cognitive arousal (awareness of sadness, frustration, anger), rejection, anger-in, bitterness, resentment, suspicion Argumentative/Defiant (Externalized Anger)- feelings of overt (obvious) aggression, physical aggression, verbal aggression, covert (not obvious) aggression, bullying, impulsivity, passive aggression Vindictiveness (Externalized Anger)- Same as Argumentative/Defiant For each severity and frequency is measured. An Anger Regulation and Expression Scale is a self-reported assessment of one’s expression and regulation of anger in youth.

Oppositional Defiant Disorder (ODD) and Co-Occurring Disorders Treatment and Interventions can be very different in each case. There are 4 major categories of evidenced based interventions. Functional Behavior Assessment and Behavior Intervention Plans Cognitive Behavior Therapy Anger Management Relationship Coaching Accomplished through Individual Interventions Parent Training Community Collaboration- (parent training in conjunction with juvenile system and school system)

If ODD is not treated it usually leads to a Conduct Disorder

Conduct Disorder Meets the criteria for ODD but Conduct Disorder has limited pro-social emotions. Pro-social emotions are shame, guilt, empathy, remorse which causes negative feelings at doing something that appears wrong according to one's own values and/or those whose opinions one values. An emotion is prosocial if it increases the chance of better results/payoff to members of the group.

Conduct Disorder: Promoting Pro-Social Emotions Those with limited pro-social emotions do not know or believe in reciprocity. Reciprocity is an exchange for mutual benefit. Where punishment in most people causes shame a person with a conduct disorder experiences spite and the desire to hurt, annoy, offend. Intervention: On Big Bang Theory, Sheldon explains Reciprocity. https: //www. youtube. com/watch? v=ofxxvc 1 KPa 8 Explain that it is hard to trust others and open up; however it is an important part of building healthy relationships. Have them complete the following tasks on Random Acts of Pro-Social Behaviors over a week’s time and then review it.

Random Acts of Pro-Social Behaviors Task Introduce yourself to someone new Be kind to someone you do not know Give a compliment to someone Include other in an activity Eat lunch with someone new Return a shopping cart Help you parent do something that you would typically not help them do. Thank an adult in your life Find a volunteer activity that interests you and call them. What did you do specifically? What thought feeling and relationship of necessary? How did you feel an hour after completing the task?

Conduct Disorder: What is Moral Disengagement? It is the belief that ethical standards do not apply to oneself in particular situations. It can be due feelings of: Betrayal Honor and Reputation challenged Albert Bandura stated 4 ways to become Morally Disengaged Moral Justification Minimize consequences Dehumanize victims Displace responsibility Sanctioned by authority figure Victim is legitimate target Identified as “other” Everyone displays moral disengagement to different degrees at times in their lives.

Promoting Moral Engagement Create an Alliance “We are going to ______ together. ” Define and Confront the Concept of Betrayal Build Self Worth which lead to Honor and desire for a Positive Reputation Put their good deeds into focus

Intermittent Explosive Disorder, IED is Impulsive aggressiveness, grossly out of proportion for the situation Cognitive Behavioral Therapy (CBT) has been a successful treatment. Cognitive Restructuring, Relaxation and Coping Skills Training has also been successful. Teaching Relaxation skills and Rational thinking are important. Woody Schuldt, MA, a licensed Mental Health Counselor Explains CBT. https: //www. youtube. com/watch? v=b. UOa. Hsxe 8 OQ

Other Treatments Other Evidenced- Based Treatments for Disruptive Behavior include: Parent Training Social Skills Training Assertiveness Training Communication Skills Anger Management Relaxation Training

Attention Deficit Hyperactivity Disorder- ADHD Categorized as a neurodevelopmental disorder with brain based interventions. Brain Based interventions… View the brain as being use dependent Use computer assisted techniques Use executive functioning skills Turn the brain “on” (Brain Gym) Use modeling, training and examples Used physical and language processing

Brain Based Interventions Classroom track Have students complete track every morning so it is learned and then when students are frustrated they can go over track to calm and self regulate. Fidgets have also been effective as a calming device.

Disruptive Mood Dysregulation Disorder (Categorized as a Depressive Disorder) They may have been diagnosed as bipolar in the past; however, there are no manic periods. Severe and recurrent temper outbursts that our grossly out of proportion in intensity or duration to the situation. Usually occurring three or more times per week for one year or more. Similar to ODD but the person has a persistent irritable or angry mood https: //www. youtube. com/watch? v=UPzd. Ah. Tx. GIc

Intervention: Reducing Emotional /Intellectual Noise Brautigan’s Karma Repair Kit- Richard Brautigan was American novelist, poet, and short story writer. His Karma Repair kit promote reducing intellectual and emotional noise. Karma Repair Kit Eat Enough Sleep Enough Reduce Mental Noise https: //www. youtube. com/watch? v=We 7 Q 1 p 4 ns. Eg

Interventions: DMDD Teaching and encourage the reduction of intellectual and emotional noise. Teach Emotional Vocabulary Teach Emotional Intelligence ** Very Important Factor** Be ready to do a lot of Practice! Emotional Intelligence: https: //www. youtube. com/watch? v=dmz 9 Yb 9 d. Wck

Interventions: DMDD and Video Gaming Emotional Regulation Games http: //harvardmagazine. com/2011/01/gaming-the-emotions Subjects wore sensors on their finger that monitored their emotional level through blood pressure and pulse and when levels grew too high the firing mechanism was locked until levels decreased. Subjects had to self regulate and calm themselves. In this video, subjects are monitored with a headset and the screen is distorted when their emotional levels become too high. To regain a clear screen, subjects had calm themselves. https: //www. youtube. com/watch? v=TNd. Dhg 7 OE 5 o

Trauma and Stressor Related Disorders New category in the DSM-V. Trauma and Stressor Related Disorders involve exposure to a traumatic or stressful event. Disorders include acute stress disorder (ASD) and posttraumatic stress disorder (PTSD). There are four symptoms: 1. Intrusion 2. Avoidance 3. Persistent negative alterations in cognition and mood 4. Alterations in arousal and reactivity.

Treatment: Trauma and Stressor Related Disorders There has been good results using TF-CBT as a model for treatment Trauma Focused- Cognitive Based Therapy Dr. Joan Kaufman explains TF-CBT. https: //www. youtube. com/watch? v=h. KAzsf-Vqd. Q

It is important to remember that these interventions are intended to mitigate the behaviors, and do not guarantee ending the behaviors or providing a cure.