Oppositional Defiance Disorder - Case Study Example

Running Head: ODD A Sample Case Study in Oppositional Defiance Disorder The Case Study The sample case is about a ten-year old boy d Paul and hiscounselor, who is a fresh graduate. The counselor has just earned her masters degree and has little or no experience in handling cases such as Paul, except in theory. On her first week of interacting with the child, she was pleased to see that he displayed normal behavior (McKurdy, 2009). A guidance counselor is faced with the task of handling children with various behavior dysfunctions or abnormalities. Even with their years of training and competence, some counselors may find themselves at a loss when faced with children displaying disruptive behaviors which seem to worsen with time. This is exactly what transpired with the counselor who was handling Paul. She expected the good behavior presented during their initial week of interaction would continue, which prospectively will allow the child to interact with other children in a normal manner. However, this has not been the case and she became more concerned as the child’s behavior became more violent and disrupted over the next few weeks (McKurdy, 2009). Upon analysis of the case scenario, there were some plausible approaches which the counselor may have carried out in order to effectually deal with the child’s behavior. Moreover, the following pages will discuss some legal and ethical issues when the counselor agreed to isolate the child when he displayed disruptive behavior (McKurdy, 2009). First, there were some questions posed by the author at the end of the case study. The first question was if the educational needs of the child were met by the behavioral treatments given by the school administrators and the special education teachers. From my perspective, the educational needs were definitely not addressed adequately to meet the individual needs of the child. There was an excerpt where the counselor, upon the recommendation of her supervisor, placed the child on timeouts or isolation whenever he turned violent or disruptive. The child even had to spend a whole day in isolation, not being able to learn or participate in class. This punishment has even more damaging implications because the child over the next few weeks spent more time in the isolation room rather than in class (Mckurdy, 2009; Knoster, Wells, & McDowell, 2007). The second question pertained to her referral to her supervisor regarding the abrupt behavior change of Paul. The current system employed by her organization and her supervisor strictly adhered to a behavioral modification approach. As a fresh graduate who may be inexperienced still, she may ask or consult her supervisor for possible approaches or therapies that may work. However, she may also have the fresh theoretical base that may be complemented with her supervisors or colleagues experience. This means that she can apply new approaches and techniques in modifying the disruptive and abusive behavior of the child (Common Treatments for Aggression and ODD, 2009; McKurdy, 2009). Theoretical Approaches toward ODD There are many approaches for a counselor or psychologist who is tasked to attend to children with oppositional defiance disorder. One of them is anger management. Other treatments include behavior modification which entails the active participation of parents. It is worthwhile to note that the most important aspect in treatment is to bring back the self esteem of the child or teenager diagnosed with this conduct disorder (Peterson, 2009). In the case given, Paul has already been diagnosed with oppositional defiance disorder by previous school counselors, and was even recommended for admission to special education services. Moreover, the prognosis was that his behavior, despite being enlisted to behavior modification in the two years prior, has not changed substantially. Instead, he displayed more aggressive behavior towards school personnel (Mckurdy, 2009). In addition, there was no means of including Paul’s parents into the behavior modification program. This is critical, as it is important for children with oppositional defiance disorders to have strong family support at home. The support and behavior modification efforts being done at school are only supplements so that the child can interact socially at school. However, it is still imperative for behavior restructuring to start at home ( McKurdy, n.d.; Common Treatments for Aggression and ODD, 2009).        In this case since both parents cannot be depended on for giving strong family support to Paul, the support, care, attention and behavior modification have to be done by the school and state counselors. The severity of conduct disorder among children is defined by a psychologist; not all teachers or counselors are trained to assess the severity of conduct disorders. If a counselor is able to assess severity levels, it can help them make further recommendations on the special needs of children. This knowledge can help counselors and teachers discriminate between conduct disorders and psychological problems that may manifest common symptoms (Demanchick, Rangan, & Douthit, 2007).        Since the school program administrators place children like Paul under strict behavioral modification techniques, there may be no room in order for the child or the counselor to try different approaches to modify the disruptive behavior of the child. The supervisor has already concluded that Paul has anger issues and that by continuing his anger management therapies, he will soon be able to come to terms with his behavior and mellow down (McKurdy, 2009).        Anger management is one of the treatments for oppositional defiance disorder. However, there are also other therapies that can be opted in Paul’s case. For one, the child may be angry because of lack of parental care. The counselor may try individual psychotherapy or social-behavior or problem-solving skills. In this manner, the counselor can try to narrow down the cause of the undesirable behavior that Paul is manifesting, and which causes his anger (Common Treatments for Agression and ODD, n.d.).        There is nothing wrong with anger management therapy for ODD children. However, in Paul’s case, it may just distract him for the meantime but not address his underlying issues. The supervisor has even suggested to the counselor to subject Paul to “timeouts” (Knoster et al, p. 387) so that the child can work on his behavioral issues. The only setback was that the child spent more time in timeouts rather than in class learning. Teachers who employ this measure are also concerned that students are left out from their school work during the time they spend in isolation (Knoster et.al., 2007).        There are many variations on “timeout” (Knoster et al, p. 387) and when used in the correct manner, it can effectually reinforce good behavior. Timeout in concept means that children who display disruptive behavior in class are set in isolation and left out from class activities. This is a form punishment where the child cannot participate in the current activities enjoyed by the class (Knoster et al, 2007).        There is an ethical and legal concern with the way the counselor suggested timeouts for Paul. Timeouts should amount to a minute according to the age of the child. In this case, it should last for 10 minutes since Paul is ten years old. There should also be a written consent to the parents, explicitly indicating their agreement with the school administrators that timeouts can be given as a consequence for rash behavior. It was noted that Paul spent more time in the timeout room for the next two weeks, in which case the use of isolation or timeout seemed inappropriate or overly used. Educators have tested that children should spend less time in timeouts to make these more effective as a behavior modification technique (Knoster et al, 2007). Multicultural Issues        There are also multicultural issues regarding the behavioral modification trreatment of children with oppositional defiance disorder. According to statistics, African-American children have a higher rate of anxiety disorder. Moreover, they have limited contact with mental health care providers because these services are either unavailable or cannot be afforded by minority groups (An Overview of Multicultural Issues in Childrens Mental Health, 2007). In addition, cultures differ in their ways of disciplining their children. What may seem harsh or abusive to Westerners may be acceptable to other cultures. American schools are also culturally sensitive, and have become increasingly conscious about disciplining a child hailing from another ethnic background (An Overview of Multicultural Issues in Childrens Mental Health, 2007). Schools should also develop multicultural approaches. This is important for those teachers and counselors who belong to culturally diverse schools. By knowing the prevalent culture of these children and how their parents deal with them in terms of discipline, teachers and counselors can also develop culturally sensitive strategies in behavioral modification (Demanchick et al, 2007). These culturally sensitive strategies can assist counselors, allowing them to teach parents how to handle children with conduct disorders. One of the more common traits of parents of children with conduct disorders is their affiliation to a lower socioeconomic group; causing them to have little or no access to mental health care (Peterson, 2009). Conclusion In an emailed response to one of the authors in my research, I asked about how isolation or timeouts affect children with multicultural backgrounds. He responded that numerous cultures are not accustomed to timeouts, and have not really used them as a form of behavior modification. He also pointed out that in the case I presented (i.e. Paul), it will be very difficult for him to associate with a constant, authoritative figure, since neither parent can be made a model for good behavior (Peterson, 2009). Counselors should not take it personally when the child they are counseling is not responding well to therapy. Similar to the counselor in the case study, she felt somehow that she needed to give more attention to Paul and was struggling to find out how to change his behavior over a short period of time. It is also not commendable to be too impersonal like her supervisor who seemed to stereotype the child as “angry” (McKurdy, 2009, p. 387). The child may be angry, but his anger may be caused by multiple issues that need to be addressed one by one. Moreover, he needed assurance. He may be an angry child, but he may also be confused and lonely since he has not had any father figure for the last eight years. This is aggravated by the fact that the mother is in rehabilitation most of the time. The other relative, the grandmother, seems to provide inadequate care to Paul and his siblings. This has made them constantly feel neglected and rejected (McKurdy, 2009). The need to acknowledge the uniqueness of each child and their needs is crucial for counselors. By making sure that these peculiar needs are met, there is an increased chance for improving the behavior of children afflicted with oppositional defiant disorder ( Peterson, 2009).   References An overview of multicultural issues in children’s mental health. (2007). Multicultural Action Center, 1-22. Common treatments for aggression and ODD (2009). Retrieved June 22, 2009, from www.msu.edu: https://www.msu.edu/course/cep888/Agression/Agression1b.htm Demanchick, S., Rangan, M., & Douthit, K. (n.d.), Addressing conduct disorder in elementary school children. Retrieved June 22, 2009, from The American School Counseling Association: http://www.jsc.montana.edu/articles/v4n9.pdf Knoster, T., Wells, T., & McDowell, K. (2007). Using timeout in an effective and ethical manner. Iowa Department of Education, 1-48. McKurdy, K. (2009), “And who’s gonna make me?”: Defiant behavior. In School Based Counselling, 387-390. Peterson, S. (2009), Oppositional defiance disorder. Retrieved June 22, 2009, from Oppositional-Defiant-Disorder.org: http://www.oppositional-defiant-disorder.org/odd_treatments.html Read More