User:Tls2018/sandbox

Signs and Symptoms:

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), Oppositional Defiant Disorder is a psychiatric condition seen in children and adolescents. The disorder is characterized by a pattern of angry/irritable mood, argumentative/defiant behavior, and/or vindictiveness directed toward others.

A. In order for a child to be diagnosed with Oppositional Defiant Disorder, he or she must show 4 symptoms of angry or irritable mood, argumentative or defiant behavior, or vindictiveness that last up to six months. Furthermore, these symptoms must be shown toward at least one individual who is not a sibling (e.g., parent, teacher, classmate). The frequency of the behaviors can be used to decipher between a mild, moderate, or severe diagnoses. Angry/Irritable mood: • Frequently loses temper • Easily annoyed • Angry or resentful Argumentative or defiant behavior: • Frequently argues with authority figures or adults • Purposely defies or denies requests from authority figures or adults. • Purposely annoys others • Frequently blames others for their own faults Vindictiveness: • Has been vindictive twice in the last six months

B. The misbehavior must creates distress in the individual or in others around them. Furthermore, it must impact the functionality of the individual.

C. The misbehavior must occur independently from other diagnosed disorders (ie. pediatric bipolar disorder).^[1]

Treatment:

Psychosocial treatment is often used to treat children and adolescents with Oppositional Defiant Disorder. Interventions usually involve parents or other caregivers and are directed at improving the quality of the parent-child relationship, providing more consistent discipline, and avoiding hostile/coercive parent-child interactions. Three common interventions are (1) parent management training, (2) parent-child interaction therapy, and (3) videotaped modeling.

Parent Management Training: In parent management training (PMT), the clinician assesses the parent-child interactions and takes note of the parent’s behavior that may be unintentionally modeling or reinforcing oppositional, defiant, or aggressive behavior. After assessment, the clinician teaches the parents more adaptive ways of parenting a child with Oppositional Defiant Disorder and how to avoid further opposition. Although all programs are different, most PMT programs begin with parent meetings with the clinician without the child and learn one management skill per week to practice at home. Each skill is followed up with positive reinforcement to maintain the good behavior. The steps are usually categorized into four phases of management. Phase 1: Parents learn about the cause of the child's behavior problems from the clinician. This phase is important for parents because they learn that their parenting is not the only factor in the oppositional attitude of their child (e.g., environmental factors). Phase 2: Parents learn the importance of positive reinforcement. Instead of only focusing on the child's bad behavior, the clinician encourages the parent's to also emphasize good behavior and through positive reinforcement, increase the frequency of the good behavior. Next, through selective ignoring, the parent's learn to decrease the frequency of bad behavior. Ignoring the behavior gives the child no satisfaction. Lastly, the parents create a system of reward such that for every good behavior the child performs, they receive a tangible reinforcement. Phase 3: Parents learn how to effectively reduce the bad behavior of their child through structure. First, the parents learn negative punishment such as time out. Next, the parents learn to generalize this structure to misbehaviors in other environments. This generalization may include bringing snacks or toys that will prevent misbehaviors from happening. Phase 4: Finally, the child must generalize their appropriate behavior to settings such as school. In order to monitor this, the teacher keeps a daily report of the child. Lastly, the clinician warns the parents about future behaviors that may arise and suggest a follow up session to make sure things are going as planned.

Parent-Child Interaction Therapy: Parent-child interaction therapy is derived from Parent Management Training. The major difference between the two is that Parent-Child Interaction Therapy requires that the parent and child are in the sessions with the clinician together. During these sessions, the clinician records the relationship between parent and child and through observation, they come up with effective techniques for decreasing the child's bad behavior. In each session, the clinician models the skills to the parents in order to make sure the parents are executing them correctly. Furthermore, the clinician gives examples of future problems that may arise in order to prepare them. Unlike Parent Management Training, Parent-Child Interaction Therapy is split into two phases. Phase 1- child-directed interaction: This phase highlights the importance of a strong parent-child relationship through teaching sensitivity and responsiveness to the child. The parents learn the acronym PRIDE (praising, reflecting, limiting, and describing their child's good behavior in an enthusiastic way). Through this process, the parent shows acceptance to their child's actions instead of controlling them. Phase 2- parent-directed interaction: This phase encourages parents to have expectations for their child that correspond with their developmental stage, reduce hostility in their relationship, and to promote a consistent system of discipline.

Videotaped Modeling and the Incredible Years Program: Videotaped modeling and the Incredible Years Program were designed specifically for low-income families or families under high stress who are statistically more likely to drop out of Parent Management Training or Parent-Child Interaction Therapy before completion. The Incredible Years Program is split into four different programs each with an intended purpose (BASIC, ADVANCED, SCHOOL/TEACHER, Child Training Program). Each of the four programs was created for a different audience in order to target oppositional behaviors at home and at school.^[2]