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=What is Oppositional Defiant Disorder? =

The American Psychiatric Association //Diagnostic and Statistical// Manual of Mental Disorders, Fourth Edition, (DSM-IV) defines oppositional defiant disorder (ODD) as a recurrent pattern of negativistic, defiant, disobedient, and hostile behavior toward authority figures that persists for at least six months. Behaviors included in the definition are losing one’s temper; arguing with adults; actively defying requests;refusing to follow rules; deliberately annoying other people; blaming others for one’s own mistakes or misbehavior; being touchy, easily annoyed or angered, resentful, spiteful, or vindictive. ODD is usually diagnosed when a child has a persistent or consistent pattern of disobedience and hostility toward parents, teachers, or other adults. The criteria for ODD are met only when the problem behaviors occur more frequently in the child than in other children of the same age and developmental level. These behaviors cause significant difficulties with family and friends,and the oppositional behaviors are the same both at home and in school. Sometimes, ODD may be a precursor of a conduct disorder. Comorbidity of ODD with ADHD has been reported to occur in 50%–65% of affected children. ODD is not diagnosed if the problematic behaviors occur exclusively with a mood or psychotic disorder. Before puberty, the condition is more prevalent in boys; after puberty, rates are nearly equal in boys and girls. ODD and other conduct problems are the most common reasons for referrals to outpatient and inpatient mental health settings for children, accounting for half or more of all referrals.

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=What Causes Oppositional Defiant Disorders? =

This behavior typically starts by age 8, but it may start as early as the preschool years. This disorder is thought to be caused by a combination of biological, psychological, and social factors.

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 * **Biological**: Some studies suggest that defects in or injuries to certain areas of the brain can lead to serious behavioral problems in children. In addition, ODD has been linked to abnormal amounts of special chemicals in the brain called neurotransmitters. Neurotransmitters help nerve cells in the brain communicate with each other. If these chemicals are out of balance or not working properly, messages may not make it through the brain correctly, leading to symptoms of ODD, and other mental illnesses. Further, many children and teens with ODD also have other mental illnesses, such as [|ADHD], learning disorders, depression, or an anxiety disorder, which may contribute to their behavior problems.


 * **Genetics**: Many children and teens with ODD have close family members with mental illnesses, including mood disorders, anxiety disorders, and personality disorders. This suggests that a vulnerability to develop ODD may be inherited.

= = = = =Symptoms =
 * **Environmental**: Factors such as a dysfunctional family life, a family history of mental illnesses and/or [|substance abuse], and inconsistent discipline by parents may contribute to the development of behavior disorders.
 * Actively does not comply with adults' requests
 * Angry and resentful of others
 * Argues with adults
 * Blames others for own mistakes
 * Has poor relationships
 * Is in constant trouble in school
 * Loses temper
 * Spiteful or seeks revenge
 * <span style="font-family: 'Arial Black',Gadget,sans-serif;">Irritable

<span style="font-family: 'Arial Black',Gadget,sans-serif;">The pattern of behaviors must be different from those of other children around the same age and developmental level. The behavior must lead to significant problems in school, or social activities

=<span style="font-family: 'Arial Black',Gadget,sans-serif;">**Treatments for Children with Oppositional Defiant Disorder** = <span style="font-family: 'Arial Black',Gadget,sans-serif;">**There are many optional treatments for children with oppositional defiant disorder from prescription drugs to intervention therapies. The most effective treatments are those that involve the child's peer groups, family and school.**

<span style="font-family: 'Arial Black',Gadget,sans-serif;">There are no specific medications intended to help children with ODD, although there are medications to treat ADHD and aggression, which are <span style="font-family: 'Arial Black',Gadget,sans-serif;">frequently diagnosed as co-disorders. <span style="font-family: 'Arial Black',Gadget,sans-serif;">Less commonly, antidepressant medication may be used if there are indicators that a serious depressive disorder is also present.
 * ==<span style="font-family: 'Arial Black',Gadget,sans-serif;">**Medication** ==

<span style="font-family: 'Arial Black',Gadget,sans-serif;">Examples of commonly prescribed medication include:

 * <span style="font-family: 'Arial Black',Gadget,sans-serif;">**Psychostimulants** ( Ritalin, Metadate, Concerta, Cylert) These may reduce aggression and increase compliance.


 * <span style="font-family: 'Arial Black',Gadget,sans-serif;">**Mood stabilizers** ( Tegretol, Depakote) These have been used to reduce aggression and uncontrollable angry outbursts.


 * <span style="font-family: 'Arial Black',Gadget,sans-serif;">**Antidepressants** (Prozac) These may improve a child’s mood and attitude

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 * = <span style="font-family: 'Arial Black',Gadget,sans-serif;">Therapy Options =


 * <span style="font-family: 'Arial Black',Gadget,sans-serif;">**Parent Management Training-** PMT is the most studied treatment for ODD and CD and provies clinincal evidence that family interaction processes positively changes child behaviors . PMT is a cognitive behavioral approach that teaches to monitor child behaviors, maintain discipline and provide rewards.


 * <span style="font-family: 'Arial Black',Gadget,sans-serif;">**Multi-systematic Therapy-** MST is a family and community based therapy for adolescents who present serious clinical problems as substance misuse, chronic antisocial behavior, serious mental health issues, and family dysfunction. MST addresses the multiple layers in which ODD is manifested.


 * <span style="font-family: 'Arial Black',Gadget,sans-serif;">**Problem Solving Skills Training-** PSST teachers children to define a problem, identify a goal, generate options, choose the best option and evlaute the outcomes. This training uses social learning theory techniques that involve modeling, role playing, reinforcement and shaping of behaviors, and enhancing the clients ability to make decisions. PSST leads to significant reductions in parents' and teachers' rating on aggression, both immediately after treatment and one year later ( Kazdin, 2003),

=<span style="font-family: 'Arial Black',Gadget,sans-serif;">Strategies for Oppositional Defiant Disorder in the Classroom Setting = = = =media type="youtube" key="EkJtcO8t_3E" width="425" height="350"=
 * =<span style="font-family: 'Arial Black',Gadget,sans-serif;">Establish Expectations =

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<span style="font-family: 'Arial Black',Gadget,sans-serif;">Most students respond well when teachers clearly state their behavioral expectations. This is especially important for students with Oppositional Defiance Disorder. Teachers may start by stating two or three behavioral goals for the student. These goals may include expectations such as “I will accept the word ‘No’ “ or “I will follow directions.” If possible, include these expectations on a behavioral chart and monitor progress throughout the day. Have the student state the expectations at the beginning of the day, and restate it as needed. ====== <span style="font-family: 'Arial Black',Gadget,sans-serif;">Students with Oppositional Defiant Disorder often act as though they don’t care about others. However, using praise whenever appropriate can make teaching these students much more effective. Teachers who use a behavioral chart to monitor expectations should be sure to reward good behavior, too. A smile or word of praise from a teacher can mean a great deal. <span style="font-family: 'Arial Black',Gadget,sans-serif;">While students with Oppositional Defiant Disorder do respond to praise and should be given some flexibility, they also need to know that their behavior will have consequences. The consequences should be appropriate and meaningful, but they MUST be something the child wishes to avoid. Some children, for example, love doing chores in the classroom, so this would not be an effective consequence for inappropriate behavior. Teachers who know their students can choose consequences that will help their students with Oppositional Defiance Disorder consider the risks very carefully before engaging in disruptive behavior.
 * =<span style="font-family: 'Arial Black',Gadget,sans-serif;">Praise =
 * =<span style="font-family: 'Arial Black',Gadget,sans-serif;">Consequences =

<span style="font-family: 'Arial Black',Gadget,sans-serif;">Though working with students who have Oppositional Defiant Disorder can involve extra work, it can also be rewarding and enlightening for teachers who take the time to understand the student’s condition and establish clear expectations with predictable positive and negative consequences for their actions.

<span style="font-family: 'Arial Black',Gadget,sans-serif;">In Creative Strategies for Working with ODD Children and Adolescents, Frank, Paget, and Bowm suggest several "Houdini techniques" to escape from situations teachers may encounter with students with ODD. Some teacher behaviors that may add to power struggles in the classroom are:


 * <span style="font-family: 'Arial Black',Gadget,sans-serif;">Threatening the student.
 * <span style="font-family: 'Arial Black',Gadget,sans-serif;">Responding emotionally (i.e. getting angry or sarcastic).
 * <span style="font-family: 'Arial Black',Gadget,sans-serif;">Confronting the student near their peers.
 * <span style="font-family: 'Arial Black',Gadget,sans-serif;">Responding quickly.
 * <span style="font-family: 'Arial Black',Gadget,sans-serif;">Remaining in the interaction too long.
 * <span style="font-family: 'Arial Black',Gadget,sans-serif;">Bribes.
 * <span style="font-family: 'Arial Black',Gadget,sans-serif;">Trying to "convince."
 * <span style="font-family: 'Arial Black',Gadget,sans-serif;">"Putting down" the student.

<span style="font-family: 'Arial Black',Gadget,sans-serif;">**Diminish Power Struggles**

<span style="font-family: 'Arial Black',Gadget,sans-serif;">Other strategies that may diminish power struggles include:


 * <span style="font-family: 'Arial Black',Gadget,sans-serif;">Providing the student with simple directives and choices.
 * <span style="font-family: 'Arial Black',Gadget,sans-serif;">State pre-determined consequences clearly before problems occur.
 * <span style="font-family: 'Arial Black',Gadget,sans-serif;">Listen to the student before reacting.
 * <span style="font-family: 'Arial Black',Gadget,sans-serif;">Give brief and direct instructions in a calm tone.
 * <span style="font-family: 'Arial Black',Gadget,sans-serif;">Discuss the problem privately with the student.
 * <span style="font-family: 'Arial Black',Gadget,sans-serif;">Walk away before the situation gets too "hot."

<span style="font-family: 'Arial Black',Gadget,sans-serif;">**The Power Struggle Reduction Plan**

<span style="font-family: 'Arial Black',Gadget,sans-serif;">The authors also propose a Power Struggle Reduction Plan to prevent confrontations with students with ODD. These strategies include:


 * <span style="font-family: 'Arial Black',Gadget,sans-serif;">Talk and work with another teacher. Agree to take over for each other.
 * <span style="font-family: 'Arial Black',Gadget,sans-serif;">Pre-determine your consequences and then follow through.
 * <span style="font-family: 'Arial Black',Gadget,sans-serif;">Decide which rules are negotiable and which are non-negotiable.
 * <span style="font-family: 'Arial Black',Gadget,sans-serif;">When away from an incident, list all the things that hooked you into the power struggle.
 * <span style="font-family: 'Arial Black',Gadget,sans-serif;">"Walk-by" reinforcements should be brief, even non-verbal, and minimal attention should be drawn.
 * <span style="font-family: 'Arial Black',Gadget,sans-serif;">Whisper praises without bringing attention to the student.
 * <span style="font-family: 'Arial Black',Gadget,sans-serif;">Leave a positive note for the student to discover.

<span style="font-family: 'Arial Black',Gadget,sans-serif;">It is critical that the team approach be used in developing an intervention plan to be implemented in the school, home, and community. The team should be composed of not only teachers and other school professionals but also psychologists, psychiatrists, and other medical professionals who work together to insure the success of the student in a variety of settings. Listed below are strategies that have worked for us as parents, teachers, and team members. These strategies, when implemented in a consistent manner, have proven effective in teaching and parenting roles.


 * <span style="font-family: 'Arial Black',Gadget,sans-serif;">Don't threaten unless you are willing to carry the threats out. Threatening students with ODD allows them to test your ability to follow through.
 * <span style="font-family: 'Arial Black',Gadget,sans-serif;">Clearly define the behaviors you expect. Students with ODD search for the "gray area" to justify their actions.

<span style="font-family: 'Arial Black',Gadget,sans-serif;">References

<span style="font-family: 'Arial Black',Gadget,sans-serif;">Articles & Books: <span style="font-family: Arial,Helvetica,sans-serif;">Reichenberg W.L, Seligman L. (2007). //Selecting Effective Treatments.// 3rd Edition. San Francisco, CA: Jossey-Bass Press

<span style="font-family: Arial,Helvetica,sans-serif;">Steiner H, Remsing L, Work Group on Quality Issues. Practice parameter for the assessment and treatment of children and adolescents with oppositional defiant disorder. //J Am Acad Child Adolesc Psychiatry.// 2007;46:126-141.

<span style="font-family: 'Arial Black',Gadget,sans-serif;">Websites: BrightHub-[] WebMD-[] Council of Exceptional Children-[] Childswork- []