The Challenge

If there ever was a condition, syndrome, or exceptionality that consistently

challenged even the most skilled of practitioners, it is ODD; striving to find
support, acceptance, and cooperation among administrators, teachers, and
parents of children with ODD marks lonely times for school psychologists.
This is the front line, a place that has eaten, chewed up, and spit out many a
practitioner of school psychology. p. 40
Exceptional Life Journeys Jac Andrews

OPPOSITIONAL DEFIANT
DISORDER (ODD) &
CONDUCT DISORDER (CD)
Presented by:
Katie Humilde, Jaime Kerr,
Melissa Martin, & Katerina Mrkva

Introduction

Youth and school violence a societal challenge:

Average of 16.5 student homicides each year
Juveniles 16% of all violent crime arrests and 26% of
all property crime arrests in 2007
In nationally-representative sample of youth grades 912:

35.5% reported being in physical fight in past 12 months.

18% reported carrying a weapon to school in past 30 days.

Complex issue with many interconnected factors

Normative range of aggression

tatistics from Centers for Disease Control and Prevention (2009)

Our Questions
Jaime

When does youth defiant behaviour and

aggression become a disorder?

Kat

What is the course of development and

comorbidities of each disorder?

Melissa

Katie

What are the causes of the disorder?

What can we do to help?

Prevalence

Highest rates of referral for mental health

services.

2 16% prevalence for ODD

1 - 10% prevalence for CD

Geography

Urban versus rural

Cultural - prevalence rates similar

Gender differences higher in males

Preschool population 1.8% ODD, 0.7% CD

Subtypes
Interpersonal aggression can be:
1. Verbal vs. Physical
2. Instrumental vs. Hostile
3. Proactive vs. Reactive
4. Direct vs. Indirect or Relational
5. Overt vs. Covert
6. Electronic Aggression

History

Early research - undersocialized and socialized

DSM-III (1980) CD first defined in DSM

Severe overt and covert manifestations with only one

action necessary for diagnosis

Included variant of CD called Oppositional Disorder

DSM-III-R (1987)

Increased number of symptoms to diagnose to 3/13

Oppositional Disorder changed to ODD - 5/9

behavioural symptoms for diagnosis

Oppositional Defiant Disorder

Negativistic and defiant behaviours

Hostility directed at adults/peers

Always present at home setting

Justification of behaviour

Males - problematic temperaments or high motor activity

in preschool

School years low self esteem or overly inflated, unstable

mood, low frustration tolerance, substance abuse

Usually evident before 8 years, not later than adolescence

Less severe than CD

ODD in DSM-IV-TR
A. A pattern of negativistic, hostile, and defiant behavior lasting at least 6 months, during
which four (or more) of the following are present:
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)

often loses temper

often argues with adults
often actively defies or refuses to comply with adults' requests or rules
often deliberately annoys people
often blames others for his or her mistakes or misbehavior
is often touchy or easily annoyed by others
is often angry and resentful
is often spiteful or vindictive

Note: Consider a criterion met only if the behavior occurs more frequently than is typically
observed in individuals of comparable age and developmental level.

B.
The disturbance in behavior causes clinically significant impairment in social, academic,
or occupational functioning.
C.
The behaviors do not occur exclusively during the course of a Psychotic or Mood
Disorder.
D. Criteria are not met for Conduct Disorder, and, if the individual
is age 18 years or older, criteria are not met for Antisocial
Personality Disorder.

ODD in DSM-5
Note that changes from DSM-IV-TR are indicated in blue text
A.

A persistent pattern of angry/irritable mood, argumentative/defiant behavior, or

vindictiveness lasting at least six months as evidenced by at least four symptoms
from any of the following categories, observed during interaction with at least one
individual that is not a sibling.

Angry/Irritable Mood
1. often loses temper
2. is often touchy or easily annoyed
3. is often angry and resentful

Argumentative/Defiant Behavior
4. often argues with authority figures or adults (for children and adolescents)
5. often actively defies or refuses to comply with requests from authority figures or
rules
6. often deliberately annoys others
7. often blames others for his or her mistakes or misbehavior

Vindictiveness
8. has been spiteful or vindictive at least twice within the past six months

10

ODD in DSM-5 cont.

Note. The persistence and frequency of these behaviors

should be used to distinguish a behavior that is within normal
limits from a behavior that is symptomatic. For children
under 5 years of age, the behavior should occur on most
days for a period of at least six months unless otherwise
noted (Criterion A8). For individuals 5 years or older, the
behavior should occur at least once per week for at least six
months, unless otherwise noted (Criterion A8). While these
frequency criteria provide guidance on a minimal level of
frequency to define symptoms, other factors should also be
considered such as whether the frequency and intensity of
the behaviors are non-normative given the individuals
developmental level, gender, and culture.
11

ODD in DSM-5 cont.

B.
The disturbance in behavior causes clinically significant impairment in
social, educational, or vocational activities

C.
The behaviors do not occur exclusively during the course of a Psychotic,
Substance Use, Depressive, or Bipolar Disorder. Also, the individual does not
meet criteria for Disruptive Mood Dysregulation Disorder. {note: that criteria
not met for CD or ASPD removed}

Q 00 Oppositional Defiant Disorder - Severity

0 - Absent:Shows fewer than two symptoms
1 - Subthreshold:Shows at least two but fewer than four symptoms or
symptoms do not cause significant impairment in any setting
2 - Mild:Shows at least four symptoms but symptoms are confined to only
one setting (e.g., at home, at school, at work, with peers)
3 - Moderate:Shows at least four symptoms and some symptoms are
present in at least two settings
4 - Severe:Shows at least four symptoms and some symptoms are present
in 3 or more settings
12

ODD in DSM-5: Research

Questions and Recommendations
Comprehensive literature review conducted for
DSM-5 to evaluate utility of DSM-IV definition.
Questions:

1.
2.
3.
4.
5.

Is ODD a Useful Diagnostic Construct?

Does CD exclude the diagnosis of ODD?
Are there dimensions of symptoms?
Should there be a pervasiveness criterion?
Should there be developmental frequencies?

13

ODD in DSM-5:
Is ODD a Useful Diagnostic
Construct?
Issues:

An overmedialization of normal-range behaviour?

Often comorbid with other disorders does it exist alone?

Research:

Factor analysis

Predictive value of ODD

Controlling for comorbid disorders:

ADHD - more likely to show CD, substance use, and
emotional disorders
CD more likely to show emotional disorders

Conclusion : ODD supported as separate

clinical entity
14

ODD in DSM-5:
Should CD exclude ODD diagnosis?

Developmental progression of ODD to CD

Shared risk factors

But, a large population of children with ODD do

not have CD and do not develop it.

ODD predicts many outcomes controlling for CD

injuries/maltreatment, anxiety/depression,
substance use, ADHD, etc.
Conclusion : Do not exclude diagnosis of
ODD if a child meets criteria for CD may be
a subgroup
15

ODD in DSM-5:
Are there dimensions of
symptoms?

Multidimensional conceptualization.
All dimensions highly correlated.
Emotional
Emotional
Symptoms
Symptoms
(angry/
(angry/
irritable)
irritable)
Spiteful/
Spiteful/
Vindictive
Vindictive

Mood disorders
Anxiety disorders

Callous and
Unemotional Traits
Severe conduct
problems of CD

16

ODD in DSM-5:
Pervasiveness of Symptoms

Current criteria doesnt require ODD to be

present in more than one setting.
Risk of medicalizing parent-child
relationship problems if only diagnosed in
home.
Youth meeting ODD criteria in 3 settings
had greatest impairment compared to 2
or 1.

17

ODD in DSM-5:
Developmental Frequencies

Under consideration for DSM-5

Advantages:

Behaviours are developmentally common, so may be

helpful to give clinical reference points.

Disadvantages:

Extensive prior research based on these symptoms.

How to generalize developmental thresholds across
age, gender, and cultural groups?

Class Survey How common

are ODD signs in children?
18

Class Survey

In the past week, how many of you who interact with

children have experienced a child who:
(1) has
(2) has
(3) has
rules?
(4) has
(5) has
(6) has
(7) has
(8) has

lost their temper?

argued with an adult?
defied or refused to comply with adults' requests or
deliberately annoyed others?
blamed others for his or her mistakes or misbehavior?
been touchy or easily annoyed by others?
been angry and resentful?
been spiteful or vindictive?

19

Conduct Disorder

Behaviour common in variety of settings

Little empathy or concern for feelings of
others
Misperceive intentions of others as hostile
Poor frustration tolerance, irritability,
temper outbursts, recklessness, higher
accident rates
Early onset of sexual and reckless behaviour
Suicide at higher-than-expected rates
Less severe behaviours emerge first
20

Conduct Disorder: DSM-IVTR

A. A repetitive and persistent pattern of behavior in which the basic rights of others or major age- appropriate societal
norms or rules are violated, as manifested by the presence of three (or more) of the following criteria in the past 12
months, with at least one criterion present in the past 6 months:
Aggression to people and animals
(1) often bullies, threatens, or intimidates others
(2) often initiates physical fights
(3) has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle,
(4) has been physically cruel to people
(5) has been physically cruel to animals
(6) has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery)
(7) has forced someone into sexual activity

knife, gun)

Destruction of property
(8) has deliberately engaged in fire setting with the intention of causing serious damage
(9) has deliberately destroyed others' property (other than by fire setting)
Deceitfulness or theft
(10) has broken into someone else's house, building, or car
(11) often lies to obtain goods or favors or to avoid obligations (i.e., "cons" others)
(12) has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering;
forgery)
Serious violations of rules
(13) often stays out at night despite parental prohibitions, beginning before age 13 years
(14) has run away from home overnight at least twice while living in parental or parental surrogate home (or once without
returning for a lengthy period)
(15) is often truant from school, beginning before age 13 years

21

Conduct Disorder: DSM-IVTR

B. The disturbance in behavior causes clinically significant impairment in social, academic, or
occupational functioning.

C. If the individual is age 18 years or older, criteria are not met for Antisocial Personality Disorder.

Code based on age at onset:

312.81 Conduct Disorder, Childhood-Onset Type: onset of at least one criterion characteristic of
Conduct Disorder prior to age 10 years
312.82 Conduct Disorder, Adolescent-Onset Type: absence of any criteria characteristic of Conduct
Disorder prior to age 10 years
312.89 Conduct Disorder, Unspecified Onset: age at onset is not known

Specify severity:
Mild: few if any conduct problems in excess of those required to make the diagnosis and conduct
problems cause only minor harm to others
Moderate: number of conduct problems and effect on others intermediate between "mild" and "severe
Severe: many conduct problems in excess of those required to make the diagnosis or conduct problems
cause considerable harm to others

For individuals over age 18 years, a diagnosis of Conduct Disorder can be given only if the criteria are not
also met for Antisocial Personality Disorder. The diagnosis of Antisocial Personality Disorder cannot be
given to individuals under age 18 years.

22

Conduct Disorder in DSM-5:

Callous/Unemotional Specifier

An specifier added to CD in DSM-5

A personality dimension of psychopathy

Youth with CU and CD represent important subgroup of

severity

Aggressiveness is more pervasive, premeditated,

instrumental

Differences in social, cognitive, emotional, and

personality traits

Response to treatment worse outcome

Early onset group of CD show more CU

traits

Frick & Moffitt (2010)

23

Conduct Disorder: Gender

CD is 2-3 times more likely in boys

Adolescent onset more common in girls, and
early onset more common in boys
Is criteria appropriate for girls?
Levels of subclinical impairment
Relational aggression more common in girls
High relational aggression associated with high
ODD and CD impairment
Not enough research to support genderspecific criteria for CD in DSM-5

24

Social & Environmental Context

Is the disorder within the individual, or is the

environmental a poor fit with the child?

The Conduct Disorder diagnosis should be

applied only when the behavior in question is
symptomatic of an underlying dysfunction within
the individual and not simply a reaction to the
immediate social context It may be helpful for
the clinician to consider the social and economic
context in which the undesirable
behaviors have occurred.(DSM-IV-TR, 2000)
25

Your Turn!
Discuss:

What diagnostic
symptoms of ODD
and/or CD can you
identify in the
youth in your case
study?

26

Child vs. Adolescent Type

Description

Prognosis

Child-Onset

Antisocial behaviour symptoms

prior to age 10
Children show increasingly
severe pattern of conduct
problems over time
Vulnerabilities include:
dysfunctional family
environment, low cognitive
ability, problems of impulsivity
and hyperactivity, cold and
callous interpersonal style

Poor- children have a

high risk of showing
severe and violent
antisocial behaviour into
adulthood
life course
persistent

AdolescentOnset

Abrupt onset of antisocial

behaviour
Ability to maintain social
relationships
Reject traditional status
hierarchies and associate with

Good- generally better

adjusted than childonset group
Adolescent limited
27

Onset of ODD/CD

Where did these two distinctions come

from?

Moffitt (1993)

What does current research say?

Some disagreement regarding adolescentlimited type

28

Developmental Paths
1.

ODD develops to CD

2.
3.

minority

ODD does not progress to CD

Severe diagnosis of CD are usually
preceded by ODD

about 90% of the time

Childhood CD develops
into Antisocial Personality
Disorder (ASPD) in adulthood

4.

29

Adult Outcomes: Antisocial

Personality Disorder (ASPD)
Definition: pervasive pattern of disregard for,
and violation of rights of others occurring since
age 15.
Almost always met criteria for a CD diagnosis
however, only a minority of adolescents
diagnosed with CD will go on to develop ASPD
Must be preceded by variety of aggressive and
antisocial behaviours in childhood.

The relationship between CD and

ASPD is different for males and females

30

Comorbidity: ADHD

Hyperactivity-impulsivity dimension of
ADHD correlates with the overt and covert
dimensions of CD
Although both externalizing disorders
display similar symptoms, ADHD and CD
are both independent aspects of childhood
psychopathology
Prognosis:

more severe psychopathology:

More aggressive and antisocial
More prevalent academic difficulties and
underachievement
Higher rates of peer rejection
31

Comorbidity: ADHD

What makes these two conditions so

dangerous?
Presence of ADHD propels earlier onset
CD
Heritable temperaments
More irritable, impulsive, hyperactive and
sensation seeking
Characteristics elicit negative environmental
reactions
Sets into motion events that escalate CD and
increase its persistence

32

Comorbidity: Academic
Underachievement
Academic
Academic
Underachieveme
Underachieveme
nt
nt

CD
CD
ADHD
ADHD

In early to middle childhood: underachievement and

inattention-hyperactivity more strongly associated.
Adolescence: antisocial behaviour and
underachievement associated without ADHD influence
Importance of third variables that may mediate the
relationship between ODD/CD and underachievement
Developmental trajectory depends on a number of
variables both individual and familiar

33

Comorbidity: Academic
Underachievement

Snowball effects across development

Example: Child presents with language

deficits and later on has trouble reading and
comprehending parental requests. The strain
on the childs relationship with caregivers and
peers translates to poor academic preparation
and increases the likelihood the child looses
motivation for school. The child is now more
likely to seek out friendships with deviant,
antisocial peers which reciprocally intensifies
their own aggression and ASB patterns.

34

Comorbidity: Internalizing
Disorders (Anxiety)

Contradictory findings about the connection

between anxiety and ASB
Possible because there are two anxiety
subgroups:

inhibition/fear
social isolation/withdrawal

Social isolation and withdrawal predicts the

severity of aggression
Anxiety also plays a role in mediating the
relationship between ASPD, depression,
suicide attempt and substance use disorders
35

Comorbidity: Internalizing
Disorders (Depression)

Little is known about the mechanisms of

comorbidity between depression and CD
Studies have shown that depression and
CD together have an increased likelihood
of manifesting suicidal tendencies
Biological factors: reduced serotonin
levels are associated with both
impulsivity and aggression as well as
suicidal behaviour

36

Comorbidity: Internalizing
Disorders (Substance Abuse)

Substance abuse and delinquency during

adolescence is predicted by
oppositionality during childhood followed
by internalizing problems such as
depression, shyness, withdrawal and
anxiety in middle or late childhood

37

Your Turn!
Discuss:

Is there evidence of
comorbidity in your case
studies?

Keep in mind ADHD,

Academic
Underachievement and
Internalizing Disorders
(Anxiety, Depression,
Substance Abuse)

What do you feel are the

possible developmental
trajectories for your case?
38

CONDUCT DISORDER
Risk Factors and
Etiology

39

Mash & Barkley (2003)

40

INDIVIDUAL FACTORS Genetic Influences

Mash & Barkley

(2003)
No specific gene has been
identified that indicates a higher
risk of ODD/CD
Shared environmental and
hereditary factors appear to
contribute more towards ADHD,
ODD and CD
Stronger genetic influence with
property crimes but not with violent
crimes
Hereditary ties for childhoodonset forms of aggression is more

41

INDIVIDUAL FACTORS
Genetic Influences
TWIN STUDIES

FINDINGS

Virginia Twin Study of

Adolescent Behavioral
Development (1997)

-Monozygotic (MZ) twins showed a stronger correlation

of CD symptoms and aggression than disygotic (DZ)
twins, similar findings for ODD are not as significant
-Larger sample size and wider age-range indicates that
genetic factors play a greater role in CD/ODD.
However, environmental factors still have an influence

Genetic and Environmental

Influences on Conduct
Disorder, Attention Deficit
Hyperactivity Disorder, and
Oppositional Defiant Disorder
Symptoms (2005) (>600
Finnish Twin Pairs, age 14)

- Covariance of these disorders can largely be

attributed to a shared genetic influence, shared
environmental effects were generally non-significant
- Shared genetic influences primarily contribute to the
covariation among externalizing disorders
- Nonshared environmental influences did contribute to
the covariation between ADHD and ODD

Australian Twin Study of

ADHD, CD, ODD, and Reading
Disability (2006) (2040 twin
pairs)

- ODD and CD had the strongest genetic link with ADHD

(the Hyperactive/Impulsive Subtype)
- Shared family environment was determined to play an
insignificant role

42
Hewitt, J.K. et al. (1997); Dick, D.M. et al. (2005); Martin, N.C. et al.(2006)

INDIVIDUAL FACTORS Psychbiological Influences

Biological risk factors

for ODD/CD:
Atypical frontal lobe
activation pattern
Lower levels of cortisol
produced by the adrenal
cortex
Low levels of serotonin
metabolite (5hydroxyindoleacetic acid) in
the cerebrospinal fluid,
leading to abnormal serotonin
levels in the blood
Under/Overarousal of
Autonomic Nervous System
(Heart Rate)

Burke, J.D., Loeber, R., & Birhmaher, B.

(2002)

Hormonal Influences?

McKinney, C. & Renk, K. (2007)

43

INDIVIDUAL FACTORS - Dispositional Risk

Factors
Difficult
Temperament

Negativi
ty
Short Attention
Span

Restlessn
ess
Reward
Dominance
Behavioral
Style

44
McKinney, C. & Renk, K. (2007), Burke, J.D., Loeber, R., & Birhmaher, B. (2002)

Prenatal and Perinatal Problems

Smoking during pregnancy

Parental substance abuse

Low birth weight and birth

complications

Premature birth

Maternal depression

Burke, J.D., Loeber, R., & Birmaher, B. (2002), Chronis, A.M.45

et al.

FAMILIAL FACTORS
ABUSE and NEGLECT

PARENTING STYLES

Physical and sexual abuse can

significantly increase the risk of
CD in children

Coercive/lenient parenting and

improper supervision show an
increased risk of ODD and CD

Parental neglect shows links to

increased likelihood of ODD in
adolescents

Lack of affection also shows an

increased risk of ODD and CD

Childhood victimization is
predictive of higher rates of
criminality and violence
associated with Antisocial
Personality Disorder (APD) and
Psychopathy

Parental stress, low behavioral

responsiveness, and use of harsh
discipline have been related to
DBD symptoms

Overall, research on family environment variables demonstrated

consistently that there is a relationship between negative family
environment, such as low cohesion and high conflict, and behavioral
problems in children (Burke, B.D., Loeber, R., & Birhamer, B., 2002).
46
McKinney, C. & Renk, K. (2008)

COMMUNITY FACTORS
Low Socioeconomic Status (SES): Direct or
Indirect Relationship with ODD/CD?
ODD/CD Risk Factors Linked to
Low SES:
High rates of community and domestic
violence
Negative peer influences
Poor Parenting
Low Level of Social Support
Limited Educational Opportunities

Research found that low SES is a risk factor for almost 60% of families of
children with behavioral problems in contrast to 23.8% of families of children
without behavioral problems.
47
Loeber, R., Burke, J.D., & Pardini, D.A. (2009)

COGNITIVE AND
SOCIAL- COGNITIVE VARIABLES

Frontal lobe dysfunction trouble regulating

aggression
Lower verbal and executive functioning skills
(lower IQ) can lead to uninhibited behavior
- deficits in executive functioning are more prevalent in
comorbidity of ADHD and ODD/CD than just ODD/CD alone

Intellectual deficits and poor academic

achievement more likely to react negatively to perceived
threats, difficulty with distinguishing consequences, less positive
interaction with others

Problems encoding social cues, less empathy

for others
48
McKinney, C. & Renk, K. (2007)

PEER INFLUENCES
Peer Rejection vs. Association with Deviant Peers
Peer Rejection

Deviant Peer Association

Chronically mistreated
children are more likely to be
aggressive with peers

Usually leads to the

beginning of delinquency for
boys

Combination of peer
rejection and aggression was
found to be a predictor of
delinquency in boys

May enhance antisocial

behavior with late-starting
delinquents

Only aggression predicted

delinquency in girls

Delinquency appears to
have a stronger relationship
on peer associations rather
than the reverse

49
Burke, J.D., Loeber, R., & Birmaher, B. (2002)

Correlations of Risk Factors

with Latent ODD/CD

50
Boden, J.M., Fergusson, D.M., & Horwood, J.L. (2010)

IDEA Model

51
McKinney, C. & Renk, K. (2007)

Biology influences
behavior at the same
time that behavior
influences biological
mechanisms;
persons both shape
and are shaped by
the environment.

52

Your Turn!
Discuss:

1.

2.

In your groups, review your

case study and discuss the
following:
Identify the risk factors that
your child is experiencing
in relation to ODD/CD.
Which of these risk factors
do you believe is a direct
link towards their
diagnosis?
53

What can be done?

Treatment Options and Obstacles

54

Diagnostic is
critical for
planning

We must recognize that

behavior disorders are
influenced by a number
of bidirectional forces.
For any success we
must address the
contributing factors to
each unique expression
of behaviour disorder.

Individual Factors

Skills deficits,
biological
predisposition to
aggression and
impulsivity,
comorbid
conditions

Family Factors

Family function,
stability, history

Peer Factors

Association, gang
involvement, social
skill and grouping

School Factors

Past experiences,
success, attachment

Community Factors

Safety, attachment,
organization,
options
55

Consider Types of Behavior &

Trajectories
Overt Behavior
Aggression
Argumentative
Purposefully hurtful
Uncontrolled frequent
anger
Defiance

Covert Behavior
Stealing
Lying
Fire setting

Adolescent Limited

Life Course Persistent

Typically peaks in adolescence

and subsides.

Often symptoms begin with an

ODD diagnosis in childhood
and continues into adulthood.

56

Family Interventions
1. Intervention is primarily with the parents- less therapist
child contact.
2. Attempts to refocus attention from a preocuppation with
undesired behaviors to pro-social goals.
3. Instruction in social learning principles, defining,
monitoring and tracking targeted behaviours,
reinforcement and extinction, problem solving.
4. Highly didactic, presents opportunities for role modeling
and role playing, home work.
EXAMPLES: Parent-Child Interaction Therapy, The Incredible
Years, Triple P, OSLC , Functional Family Therapy, Brief
Strategic therapy, Problem-solving Communication Therapy,
Problem Solving Skills Training and Parent Management
Training- Kazdin, solution focused family therapy.
57

Does it work?

The Good News

Success has been
documented- especially
when these programs are
in tandem with other
interventions.
This form of treatment
pushes others in the
childs environment to
take ownership of their
contributions to the
problems.
More successful with
younger children.

For further
consideration
There is often trouble
with social validity.
Many families in this
population do not
commit to treatment.
This makes success
difficult to measure.
Some programs have
incorporated units to
increase engagement
with some success.
58

Multisystemic Therapy
Principle 1

Assessment focuses on fit between the

behaviour and the broader context.

Principle 2

Interventions are present-solution-action focused.

Principle 3

Closely focused on behavioral transactions within or

between multiple systems.

Principle 4

Developmentally tailors to fit the needs of the

youth.

Principle 5

Family members put in daily and weekly effort.

Principle 6

Interventions are evaluated continuously from

multiple perspectives.

Principle 7

Interventions are designed to promote

generalization and long-term maintenance.

Principle 8

Emphasis is on the positive and systemic strengths

are a primary focus.

Principle 9

Interventions are designed to promote responsible

behavior and decrease irresponsible behavior.

59

Does it work?
Good news

Highly effective in
violent offenders at
home.
Cost effective.

For further
consideration

Still not a lot of

research in Canada. A
2002 study in Ontario
found there was no
difference. However a
2008 review found
otherwise.

Still a highly
recommended therapy
by Justice Canada.
60

Skills Training Approach

Assumes that the behavior is
driven by a lack of skills. Kids
are missing the right tools.
Programs are delivered to
youth in group interventions.
Interventions can target
social skills, cognitivebehavioral skills, problem
solving and anger
management skills, moral
reasoning.

61

Does it work?
Mixed Reviews
there is weak empirical support for the use of skills
training as an isolated intervention for the treatment of
serious CP.
Short term improvement for minor behaviour
Bennett & Gibson reviewed 30 skills treatment programs
and found small treatment affects. More effective with older
children.
Iatrogenic effects high risk adolesence in peer
interventions. Deviantsy training- kids receive group
attention for negative behavior.
Kazdin & colleagues found more success when efforts were
combined with Parent Management training (family
intervention).
62

Community Based
Treatment
Residential programs
Specialized foster care- Multi-dimensional foster care
treatment
Case management services
Day treatment programs
Examples: Teaching Family Model, Multidimensional
Treatment Foster Care,

63

Does it work?
The Good News

This can provide

opportunities to
connect systemscombining treatments
has higher
effectiveness.
Programs with built in
maintenance and
transition planning are
more successful.

Points to ponder

These options should

be used with caution.
Statistically, the further
kids get from their
home environment the
less their chances of
success- this should be
interpreted based on
the negative fit in the
home environment.
64

School Based Treatment

Classroom
Management
Strategies

Token economies
Clear
expectations/routin
es
A classroom quiet
place
Behavior
management
charts

Home Based
Reinforcement

Contingent privileges
Parents become
involved in reinforcing
positive behavior at
school

Whole School
Interventions

Anti-Bullying
programs.
Restructuring the
social environment.
RECESS- Positive

65

What works?
The Good News

Whole school
approaches make a
difference!

Points to ponder

Behavior programs/
token economies have
little generalization
from classroom to
classroom or year to
year.

We need to continue
finding strategies to
meet the needs of kids
who have ADHD/ADD
66

Pharmacological Treatment
Things to consider in regards to
medication
Medication has had success when
comorbid conditions are treated
with medication. ADHD or
depression.
Important to note improvement
has been seen for affective
manifestations- explosive rage
and aggression rather than for
the controlled aggression
Psychostimulants, Lithium,
Clonidine, Antipsychotics
(Neuroleptics), Anticonvulsants
67

Your turn!

You have 4 minutes to

discuss intervention
options for your child.

Remember- using your

imagination is
encouraged!

What ecologies should be

targeted? What other
information do you need?
What strategies would
you put in place?
68

Meet Dylan & Eric

In raising Dylan, I taught him how to protect himself from

a host of dangers: lightning, snake bites, head injuries, skin
cancer, smoking, drinking, sexually transmitted diseases,
drug addiction, reckless driving, even carbon monoxide
poisoning. It never occurred to me that the gravest danger
to him and, as it turned out, to so many othersmight
come from within. Most of us do not see suicidal thinking as
the health threat that it is. We are not trained to identify it
in others, to help others appropriately, or to respond in a
healthy way if we have these feelings ourselves.
69

Prevention
Many options!
So much
easier!
The earlier
the better!
70

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Websites

http://people.ucalgary.ca/~crilf/ Canadian Research Institute for Law and the Family.

Latimer, Jeff. Just Research no.12 Multisystemic Therapy as a Response to Serious Youth

Delinquency http://www.justice.gc.ca/eng/pi/rs/rep-rap/jr/jr12/p5d.html

http://circleofsecurity.net/

http://www9.triplep.net/

http://www.incredibleyears.com/library/show_current_research.asp

74

PRACTICE!

Take the time to develop

your own mindset about
these disorders

Consider the information

youve been given in the past
45 minutes.
How would Ross Greenes fit
with the research that has
been presented?
How does it fit with your own
mindset about dealing with
behavior disorders?
How could we incorporate Kids
do well if they can into
treatment options?

75

M 6 years old
Ms mom says that she cannot manage his behaviour at home. His
teacher has said that he will not follow instructions in the classroom and
is bullying his friends at lunch time. As a toddler M would cry easily and
that it took his mom a long time to settle him. As a toddler M would
throw tantrums lasting for at least half an hour. As he got older, M would
often kick his mother and refuse to do what she asked. Now he argues
with her every day, even about small things. He fights daily with his 8
year old sister, Amy, and always blames her when things get damaged.
His mom reports that she felt inadequate as a parent and became
depressed when M was about 18 months of age. Further questioning
about the home situation determined that Ms father, Barry, often loses
his temper and shouts at his wife and children. The family is
experiencing financial difficulties and Barry is often out of work.
Ms teacher considers that M is able to do his schoolwork but is stubborn
and refuses to join in tasks with the other children. He gets out of his
seat regularly and walks around the room. He will often flick the other
children on the arms and take away their pencils. He has difficulty
making friends as he always wants them to play his games and will yell
at them if they do not do what he wants.
76
M insists that he hasnt done anything wrong and that everyone picks on

S 15 years old
S, was brought to the office by her mother. Her mother
explained that S was suspended from school for assaulting a
teacher and needed a doctor's evaluation before she could
return to class. The history reveals that this is S's 10 th school
suspension during the past three years. She has previously been
suspended for fighting, carrying a knife to school, smoking
marijuana and stealing money from other students' lockers.
When asked about her behavior at home, S reports that her
mother frequently gets on my nerves and, at those times, S
leaves the house for several days. The family history indicates
that S's father was incarcerated for auto theft and assault. S's
mother frequently leaves S and her eight-year-old brother
unsupervised overnight.

77

D- 17 years
D was recently referred to the diversion program- an
intervention for young offenders. He and a friend broke into a van
and stole tools. An He lives with his parents and an older brother.
His parents are both full time professionals. His father runs a real
estate business from their home. Ds mother reports he was an
easy child to parent as a young child. He had an impressive
attention span, he loved order and he loved to learn. In grade 3 he
was moved to a gifted class. He played on community league
baseball teams and regularly beat his dad at chess.
In his early adolescence his parents noted that he was awkward,
shy and uncomfortable with pictures. By junior high it was obvious
he hated school and he lost his love for learning. In grade 11 he
was expelled for hacking into the school computer. His parents
attributed both of his legal violations to his association with
negative peers. He continued to work part-time and maintained
fair grades. His parents found him easily irritated and often quiet.
D maintained he was tired when his parents questioned his

78

E 18
E did not present a problem in his childhood years. In fact, many
commented throughout his years about how smart, how sweet and
how cute he was. But the last two years had brought some strange
new behaviors that conflicted his parents. In his grade 11 year E
had broken into a vehicle, threw a rock to break a car windshield
and made threats of violence on the internet to people who
offended him. He completed a program that included an anger
management training session and restitution for the damages he
causes. Es parents took him to a Psychiatrist who diagnosis E
with obsessive compulsive disorder and prescribed an antidepressant. E was able to explain why many of the behaviors
were not his fault and his parents swung between feeling like others
were unfairly criticizing their son and feeling deceived. Teachers and
peers commented on Es fascination with guns and violence. His
parents felt this was connected to his fathers military history, Es
aspiration to join the marines and his love of a video game that
highlighted guns.
79