CLINICAL PSYCHOLOGY

C A S E S T U DY I N C H I L D H O O D D I S O R D E R

CASE STUDY
Ten year-old Jessie has been irritable and easily
annoyed for over a year now. She often talks back to
adults or is generally disrespectful. Her parents feel
like she is constantly testing boundaries by blatantly
breaking rules, such as staying up past her bedtime or
going to friends houses without permission. Over the
past year at school, Jessie has been sent to detention
about once a week for arguing with the teacher or
picking fights with other students. Her grades have
also declined considerably in the past year but she
blames her teacher, complaining she gives me a hard
time because she hates me.

OPPOSITIONAL DEFIANT DISORDER

Oppositional Defiant Disorder Disorder (ODD) is a
condition in which a child displays an ongoing
pattern of uncooperative, defiant, hostile, and
annoying behavior toward people in authority.
The childs behavior often disrupts the childs
normal daily activities, including activities within
the family and at school. The behavior usually is
evident by age 8 and is much more common in
boys than girls, and it affects almost exclusively
boys by adolescence.

DIAGNOSTIC CRITERIA OF ODD

A. A pattern of angry/ irritable mood,
argumentative/defiant behavior, or
vindictiveness lasting at least 6 months as
evidenced by at least four symptoms from any
of the following categories, and exhibited during
interaction with at least one individual who is
not a sibling.
Angry/ Irritated Mood
1. Often loses temper
2. Is often touchy or easily annoyed
3. Is often angry and resentful

DIAGNOSTIC CRITERIA OF ODD

Argumentative/ Defiant Behavior
4. Often argues with authority figures or, for
children and adolescents, with adults
5. Often actively defies or refuses to comply with
requests from authority figures or with 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 6 months

DIAGNOSTIC CRITERIA OF ODD

A. The disturbance in behavior or associated with
distress in the individual or others in his or her
immediate social context, or it impacts
negatively on social, educational, occupational,
or other important areas of functioning.
B. The behaviors do not occur exclusively during
the course of a psychotic, substance use,
depressive, or bipolar disorder. Also, the criteria
are not met for disruptive mood dysregulation
disorder.
Specify current severity: Mild, Moderate or Severe

OPPOSITIONAL DEFIANT DISORDER

Prevalence
Ranges from 1% to 11%, with an average
prevalence estimate of around 3.3%.
The disorder appears to be somewhat more
prevalent in males than in females (1.4:1) prior to
adolescence.
The prevalence of the disorder in children and
adolescents is relatively consistent across countries
that differ in race and ethnicity

OPPOSITIONAL DEFIANT DISORDER

Risk and Prognostic Features
Temperamental factors related to problems in emotional
regulation have been predictive of the disorder
Environmental Harsh, inconsistent, or neglectful childrearing practices are common in families of children and
adolescents with oppositional defiant disorder, and these
parenting practices play an important role in many causal
theories of the disorder
Genetic and physiological A number of neurological
markers have been associated with oppositional defiant
disorder. However, the vast majority of studies have not
separated ODD from those with the Conduct disorder. Thus,
it is unclear whether there are markers specific to
oppositional defiant disorder.

THEORIES OF PERSONALITY
Development Theory Suggest that for some reason the child fails to
go through normal developmental stages that should occur during the
first 3-4 years and the child remains at a 2-3 year old level in dealing
with stress and with others.
Coercion Theory has been the longstanding theory relating parenting
styles to behavioral problems in children. This theory based in operant
conditioning, gives credit to individual differences but emphasizes
family interactions as the main factor in the development of behavioral
problems in children.
Genetic disposition- Familial tendencies for ODD and ADHD are evident,
but the degree to which biology determines ODD is not clear. Some
researchers have noted that ODD may be related to prefrontal
dysfunction, resulting in lack of inhibition. Interestingly, aggressive
behavior has correlated with a low resting heart rate, possibly reflecting
altered neurotransmitters with decreased noradrenergic functioning
that results in fearless, stimulation seeking behavior.

TESTING
House Tree Person Test A projective technique
developed by John Buck to assess intellectual
functioning. He believed that through drawings,
subjects objectified unconscious difficulties by
sketching the inner image of primary process.

PSYCHOTHERAPY
Individual and Family Therapy Focuses on
making sure that the child can learn to manage
their feelings more effectively and in a healthy
manner. Family Therapy may improve the
communication and relationships.
Parent- Child Interaction Therapy (PCIT)- Parents
work with a therapist to interact in a more
constructive manner. Some of the benefits include:
Parents learn more-effective parenting techniques
Parent-child relationship improves
Problem behaviors decrease

PSYCHOTHERAPY
Social Skills Training
Parent Training
Cognitive Problem-solving Training- To reduce
inappropriate behaviors by teaching the child
positive ways of responding to stressful
situations. Cognitive problem solving skills
training teaches how to see situations and
respond appropriately.

ANALYSIS
Parents of ODD kids often play a role in the development of the
condition. Strong parenting styles- such as being too lenient or
too strong can contribute to the disorders development that
the parents should be part of the treatments and workshops
that will teach and help them in disciplining their children.
Prevention of ODD begins with Good Parenting.
It was once thought that most children with Oppositional
Defiant Disorder will outgrow the disorder, studies shows that it
is not always true. While many children outgrow the disorder,
some children with ODD might develop into a more serious
behavioral problem such as conduct disorder or even Antisocial
Personality disorder. Early Identification of ODD is necessary to
obtain help for the child. The earlier the ODD is treated the
more likely it wont develop into a serious behavioral problem.

REFERENCES
Diagnostics Statistical Manual of Mental Disorders 5
ODD: A Guide for Families by the American Academy of Child and
Adolescent Psychiatry
www.liahonaacademy.com
WWW.RN.ORG. Oppositional Defiant Disorder (ODD)
McKinney, Cliff & Limberly Renk. Emerging Research and Theory in
the Etiology of Oppositional Defiant Disorder: Current Concerns
and Future Directions. International Journal of Behavioral
Consultation and Therapy, Volume 3, No. 3, 2007
http://www.intelligentietesten.com/house_tree_person_drawings.htm
http://effectivechildtherapy.org/content/oppositionaldefiantdisorderodd