Oppositional Defiant Disorder (ODD) According

Oppositional Defiant Disorder (ODD)

According to the American Academy of Child & Adolescent Psychiatry (AACAP), normal children are expected to whine, talk back, argue, disobey and occasionally defy their parents. That's just part of the "normal development" for young people, especially two and three-year-olds and those young people who are moving into early adolescence. Opposing authority is nothing new, and any parent who has raised children understands that kids will test the will and patience of their parents. But a child that displays "openly uncooperative and hostile behavior" on a frequent, consistent basis is showing clear signs of Oppositional Defiant Disorder (ODD) (www.aacap.org).

The pattern of uncooperative behavior associated with ODD, the American Academy of Child & Adolescent Psychiatry reports, includes: frequent temper tantrums; arguing excessively with adults; resistance to abide by rules; attempts to annoy adults and parents that are deliberate and pre-meditated; blaming others for mistakes or bad behavior ("he made me do it"); easily set off and easily annoyed; resentment and anger spilling over into hateful, mean-spirited language; and seeking revenge. The AACAP explains that "five to fifteen percent" of all school-age children have ODD, and that a foolproof, reliable treatment for this problem has not been established.

Four Interventions for Treatment of ODD

Dr. DuBose Ravenel writes in the journal, Ethical Human Psychology and Psychiatry, that "prevailing medical model" for managing the child with ODD (and ADD) assumes that there is a "neurological or biological cause, with strong genetic influence" (Ravenel, 2008, p. 71). Practitioners of that school of thought also believe, according to Ravenel, that treatment for patients with ODD "...relies completely on psychotropic medications" (Ravenel, p. 71). The idea of using drugs without initially trying other remedies for children with ODD was repugnant for Ravenel, so he began to research the possibility of "alternative approaches" - including the Caregivers Skills Program described by Dr. David B. Stein in his book, Unraveling the ADD/ADHD Fiasco: Successful Parenting Without Drugs. Ravenel found parents who were raising children with ODD and who did not want their children drugged and worked with them. The assumption using Stein's model is that "inattentive and impulsive behaviors" by children reflects a "lack of training and motivation for appropriate behaviors" rather than a neurological or biological cause (Ravenel, p. 72).

Ravenel also employed techniques and models by John Rosemond ("Traditional Parenting"), Howie Glasser's Natural Heart approach, and the "self-efficacy" method of Albert Bandura. Ravenel offers that parents of ODD children "...intuitively understand and embrace" non-drug approaches "with a high degree of acceptance" (Ravenel, p. 73). And moreover, he goes on, his work has brought success in many instances, and deserves further research.

Meanwhile an article published in the Journal of Applied School Psychology (Mottram, et al., 2002) discusses a study conducted in a classroom that was designed to reduce "disruptive...behavior" among three males in the second grade. The study was effective, the authors report, in that it resulted in a "pronounced decrease in disruptive behavior" (Mottram, pp. 55-6). Moreover, the authors report that the teacher in this classroom claims the model used in intervention "...was relatively easy to implement" and that the decrease in behavioral inappropriateness continued during a follow-up study conducted by the researchers.

How was this intervention approached? Three-seven-year-old students of average intelligent were participants in this study. One child was African-American, another Filipino and the third of Chinese ancestry; all were from middle class families and were performing at average or above grade levels. Going into the study, these three were identified as "noncompliant, inattentive, and aggressive" (Mottram, p. 68). Over a three and a half month period of time, the three were observed for 20 minutes three days per week and a "time-sampling method" was utilized with 15-second intervals. The observers were two clinical psychology doctoral students, who were trained in a protocol (a checklist) that called for adherence to "all aspects of classroom rules, token economy, response cost, and mystery motivators" (Mottram, p. 69).

Following these observations, a "treatment phase" was implemented, with the teacher fully appraised and trained in all of the aspects of this remedy. The treatment phase lasted 8 weeks, 6 weeks, and 4 weeks for the three (respectively, based on the degree of their non-compliance with classroom deportment). Index cards were used in this treatment phase as each of the five pivotal classroom rules were written on cards and attached to the inside of the students' desks.

Those five rules were: follow the teacher's instructions; don't leave your seat without permission; keep your eyes on the teacher when she is talking; do not touch objects "other than materials for instruction" or as designated by the teacher; and five, raise your hand if you wish to make a verbal contribution. The three students were told that they would get a "token" (reward) for every ten minutes that they followed the rules. When they failed to follow the rules, one token was taken away. If any of the three earned at least 5 tokens in one school day, that student was given a "mystery motivator prize" in an envelope at the end of the day. The specific math that reflects results shown in the article are too detailed to present here, but the bottom line was a 4.5 on a scale of 5 in terms of "treatment acceptability." The teacher lauded the results indicated she would use it again because it brought "positive change" to her classroom.

Another article - published in the journal Aggressive Behavior - reports on an intervention that approached problem solving strategies from three "broad dimensions" (a, aggressive antisocial solutions; b, nonverbal-non-aggressive solutions; and c, verbal-non-aggressive solutions). In this study, 30 boys with "conduct disorder" (CD) and 25 boys with ODD were part of the research (Dunn, et al., 1997).

Author Dunn and colleagues explain on page 458 that "more severe" antisocial behavior has been linked to CD than to ODD, which indicates that boys with CD may well be more "deficient in problem-solving skills" that boys with ODD. This study took place over a seven-year period and the boys ranged in age from 6 to 15; eighty percent of them were African-American and 17% were Caucasian. The diagnoses of these boys were gleaned from the 3rd edition of the Diagnostic and Statistical Manual of Mental Disorders and the 3rd Revised edition of the Diagnostic and Statistical Manual of Mental Disorders (both manuals provided by the American Psychiatric Association). The reports on the boys were obtained via a "structured interview" with each child and a "clinical review" by an adult caregiver.

The boys were given the PSM-C to assess their social problem-solving skills (and given six means-ends stories, each one describing a "conflictual situation and a conclusion in which the conflict is not long occurring" (Dunn, p. 459). The results require a reader to digest several pages of quasi-esoteric material and lengthy mathematical equations, but the conclusion on page 468 offers some down-to-earth summaries. To wit, when ODD boys "generate aggressive/antisocial solutions to peer conflicts, they also generate verbal-non-aggressive solutions" (Dunn, p. 468). In other words, ODD boys have "less severe problems" than CD boys; and hence, well-designed interventions that involve teachers and parents can improve problem-solving skills in ODD boys, if they are "tailored for the specific deficits of the target population" (Dunn, p. 468).