Jacqueline Corcoran, Ph.D.From: Corcoran, J., & Walsh, J. (2012 2nd ed.). Mental Health in Social Work: A Casebook on Diagnosis and Strengths-Based Assessment. Boston: Allyn & Bacon.

Oppositional Defiant Disorder (ODD) and

Conduct Disorder (CD)

Classified as Disruptive, Impulse-Control, and Conduct Disorders

Rationale for discussing together: both feature anger, defiance,

rebellion, lying, and school problems

ODD is often a developmental antecedent to CD (40% of those with ODD go on to CD)

Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD)

• ODD characterized by a pattern of angry/irritable mood, argumentative/defiant behavior and/or vindictiveness for at least 6 mos but don’t seriously violate basic rights of others

• CD includes aggression toward people or animals, destruction of property, or a pattern of theft or deceit over 1 year

Differences between

ODD: lifetime prevalence rate of 10.2%CD: 1-10%More common in boys Comorbodity

HighSubstance use disorders,ADHD, mood disorders

Prevalence and Co-Morbidity

Because transient oppositional behavior is common in preschool children and adolescents, caution should be exercised in diagnosing ODD during these developmental periods.

Oppositional behaviors in children and adolescents should be distinguished from the disruptive behavior resulting from inattention and impulsivity that is associated with attention-deficit/hyperactivity disorder

should not be made when the symptomatic behavior is protective for a child living in an impoverished, high-crime community or war zone

ODD should be distinguished from a failure to follow directions that is the result of impaired language comprehension due to hearing loss or a learning disability.

In cases in which both CD and ODD are present, only CD should be diagnosed.

When ODD or CD is diagnosed, a child and family relational problem should not be included because the ODD or CD diagnosis includes conflict.

A less severe diagnosis should be considered initially—either an adjustment disorder with disturbance of conduct in response to an identifiable stressor or the V-code for “child or adolescent antisocial behavior.”

Conduct disorder should be diagnosed in adults older than 18 only if the criteria for antisocial personality disorder are not met.

Assessment Guidelines

Genetics may account for 50% or more of the variance in conduct disorder

Interaction of genes and environment (child maltreatment, living in urban area)

Risk and Protective Factors for Onset

2% of youth with no childhood risk showed persistencein adolescence vs. 71% of youth who had risk influences in 5 different areas

Childhood onset – more severe

Male – ODD to CD

Risk and Protective Factors for Course

Specifying goals for behavioral change

Tracking target behaviors Positively reinforcing pro-

social conduct through the use of attention, praise, and point systems

Employing alternative discipline methods, such as withdrawal of attention, time out from reinforcement, imposition of costs on inappropriate behavior, and removal of privileges

TREATMENT – PARENT TRAINING

The Parent Management Training Oregon Model (ages 3–12) (Patterson & Gullion, 1968)

Helping the Noncompliant Child (ages 3–8) (Forehand & McMahon, 1981)

Parent-Child Interaction Therapy (ages 2-7) (Brinkmeyer & Eyberg, 2003)

The Incredible Years (ages 2–8) (Webster-Stratton, 2001)the Positive Parenting Program (called Triple P) (preschool

through adolescence)

Parent Training Programs

Multi-Systemic TherapyFunctional family therapy integrates systems, cognitive, and

behavioral theories Treatment foster care

ADOLESCENTS – MULTI-DIMENSIONAL MODELS

anger management, assertiveness training, cognitive restructuring, relaxation, social problem solving or social skills development

Cognitive-Behavioral

the stimulants, selective norepinephrine reuptake inhibitors, antipsychotics, mood stabilizers

Medication