Children with Oppositional Defiant Disorder - Term Paper Example

Children with Oppositional Defiant Disorder Almost all children exhibit moody or destructive behaviors at some point during their adolescence. Door slamming, talking back to adults, bursting into tears, and sudden swings in mood are just a part of growing up. For some children, these behaviors become destructive toward themselves or other people. Those children just cross the line too often and in too powerful a way. The younger the child and the more disruptive the behavior, the more likely it is that a professional could diagnose oppositional defiant disorder (ODD). What is ODD? Oppositional Defiant Disorder is a conduct disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). It is related to ADD and ADHD, and often, a diagnosis of ADHD leads to a diagnosis of ODD. About 30 to 50 percent of children diagnosed with ADHD also may have ODD (Lindstrom, Tuckwiller, and Hallahan 2008). ODD is considered a psychiatric disorder, and ADHD is considered a development disorder (Arzubi 2008). Oppositional defiant disorder is usually diagnosed in preadolescent children, and is sometimes lumped under other conduct disorders. Hostility and negativity is shown in any or all of the following ways: 1. The child loses his/her temper frequently. 2. The child argues with adults. 3. The child breaks rules or refuses to comply with adult requests. 4. The child annoys other people deliberately. 5. The child blames others for his/her mistakes. 6. The child is easily annoyed. 7. The child acts angry and/or resentful. 8. The child exhibits spiteful and vindictive behaviors. Robb and Reber (2007) state a diagnosis stems from a pattern of defiant behavior continuing for at least six months and the behaviors must interfere with the child’s home life and school life. Frequency of the behavior set is the main clue. For a separate or singular diagnosis of ODD, these behaviors must not arise from a psychotic or a mood disorder. Risk factors. The Mayo Clinic (2007) lists the following risk factors for ODD: Having a parent with a mood or substance abuse disorder Being abused or neglected Harsh or inconsistent discipline Lack of supervision Poor relationship with one or both parents Family instability such as occurs with divorce, multiple moves, or changing schools or child care providers frequently Parents with a history of ADHD, oppositional defiant disorder or conduct problems Financial problems in the family Exposure to violence Substance abuse in the child or adolescent Van Acker (2007) adds that peer group variables such as bullying and isolation are also a factor, and community transformation such as influx of immigrants or concentrated poverty also have a role. In addition, there may be a genetic component or a biochemical factor (although this has not been determined by structured studies, only anecdotal evidence) and there most certainly are environmental factors at work in the child with ODD. Two interesting studies shed some light upon specific situations that may result in an ODD diagnosis. Adopted children are twice as likely as non-adopted children to be diagnosed with oppositional defiant disorder (Keyes, 2008). A Minnesota study looked at 540 adolescents who were not adopted and a similar-age group of 692 adolescents who were adopted in Minnesota. The adoptee group included 514 foreign children and 178 domestic adoptions. The study found that adolescents who were adopted as infants were significantly likely to be diagnosed with ODD in their teen years; twice as likely, in fact. The rates were 7 percent for adoptees and 3.5 percent diagnosis rate for non-adoptees. Another small study (155 subjects) conducted in obese children (Mental Health Weekly, 2003) found that chronically obese children are more likely to be diagnosed with depression and ODD. There was an association with types of obesity and the age of obesity, and the diagnosis of a disorder. Vila, et. al. (2004) distinguished between obese children and non-obese children suffering from diabetes (the control group). Of the obese children, 58 percent had at least one diagnosed psychiatric disorder, most often anxiety and social phobia. Sixteen percent of the obese children had disruptive behavior disorders (18 were diagnosed with ODD). They were more likely to have a disorder if one or both parents also had a psychiatric disorder or if there were other family problems. Treatment. Parents are the first line of defense in the treatment of ODD behaviors. By learning coping skills such as effective discipline and rewards, avoiding power struggles and defining clear and consistent boundaries, allowing children acceptable risks and rewards, and establishing family routines, negative behaviors are more easily managed (Mayo Clinic, 2007). It is important for the child to receive a complete professional assessment to determine if the ODD behaviors arise from other conditions such as ADHD, depression, or anxiety. Treating these co-occurring illnesses can alleviate symptoms of ODD. Once a definite diagnosis of ODD has been made, therapists, teachers and families can begin to cope with the disruptive behaviors. Stimulant medications given to children diagnosed with ADHD may help control the symptoms of oppositional defiant disorder, if the two conditions happen together. Cognitive behavioral therapy (CBT) is the preferred treatment for ODD and many other behavior disorders (Robb and Reber, 2007; Van Acker, 2007). The detailed ins and outs of cognitive-behavior therapy are not really appropriate to the classroom setting, nor is it understood by very young children. It is, however, an excellent way to frame behavior interventions, especially with students who do not have multiple cognitive-based learning disabilities. Long-term prognosis. As with most psychiatric disorders and learning disabilities, the long-term prognosis is usually that problems will continue into adulthood. Some children respond to treatments such as cognitive-behavioral therapy and learn a skill set that allows them to manage their behaviors in positive, successful ways. This requires that everyone involved be working consistently toward the common goal of managing the behaviors. Even if ODD is addressed by treatment, conduct disorders including anti-social behavior, drug use and criminal activity are common in adulthood (Rogge, 2008). School and Family Working Together Parents can provide valuable clues as to what strategies might or might not work with a particular student. The more information available to teachers, therapists, and administrators, the more chance the student with ODD has for success. It is always best for students, teachers and families to have a consistent home and school life (Huerta 2008), so parent input into the child’s individualized education program, as appropriate, is an essential step. This is not to say that parents should design the child’s school life; professionals must take the necessary steps to integrate children with learning disabilities and mental disorders into the regular classroom, while keeping the safety and learning needs of all students in mind. Perhaps the first step in maintaining an orderly learning environment is setting clear boundaries and following through with discipline consistently. Teachers build on success by having realistic expectations and using the basic ideas of CBT. For young children, small rewards for positive behavior are good motivators. Behavior charts and a sticker or point system works well, especially when the system is applied to the whole class. Bigger rewards, such as free time or a small prize the child can take home and keep follow the accumulation of stickers or points. Encouraging respect and teaching children to follow directions are skills that must be developed in young children with oppositional defiant disorder (Robb and Reber 2007). Older children with a recent diagnosis or long-term patterns of behavior are a bigger challenge for the teacher and parents. Adolescents are motivated by rewards of electronic playtime, such as television or computer games. Each child is different. The teacher or parent must find out what the child enjoys doing, and consistently show that the reward comes after meeting expectations. Referring back to the ideas of CBT, if teachers and parents show the ODD child that there are rewards and consequences for their behaviors, just as there are for adults, an older child can begin to grasp these concepts as they mature toward adulthood. Ainsworth and Baker comment, “Maladaptive behaviors—such as aggression, property destruction, self-abusive behaviors, or hyperactivity—represent important considerations when planning educational and support services” (63). An Individualized Education Plan (IEP) is a necessity when teaching children with disabilities, but is especially important for setting ODD students up for success. Knowing that an individual student has been diagnosed with ODD helps teachers understand that a student is disruptive for a reason, and gives teachers, administrators, and parents a place to work from when designing an IEP. When a student with ODD transitions to a new classroom, a new school, or into a post-secondary institution, a current IEP and evaluation is very important to make sure there are no gaps or overlaps in services (Rose, 2008). Finding pockets of success. Students diagnosed with ODD benefit from their teachers using a variety of teaching styles (Nabuzoka 2008). If the school’s budget and policies allow, co-teaching (involving a generally trained teacher and a specially trained teacher) is an ideal situation for all students, including those with disruptive behaviors. Teachers trained in special education often know more about these alternative methods than regular classroom teachers. Co-teaching helps manage behavior throughout the classroom, and studies show students learn better when taught by more than one teacher using a variety of delivery methods. Rea, McLaughlin, and Walther-Thomas (2002) compared learning disabled students in inclusive classrooms with LD students who participated in pullout programs, where they were removed from the general education environment for at least part of the day. They found students who learned in an inclusive co-teaching environment earned higher grades and did better on standardized tests than the pullout group. Included students also attended more days of school and committed no more behavioral infractions than students in the pullout program. Alternative schools. Alternative schools are sometimes seen as the ideal environment for students with a wide variety of learning and conduct disorders to receive proper educations and learn to manage their disorders. More and more, general classroom teachers are incorporating “alternative” methods into the learning environment, to the benefit of all students. Using multiple methods is especially helpful for children who lack the skills to manage their negative behaviors. When the mainstream school system finds an individual child unmanageable, an alternative school might help. Van Acker (2007) states that only about 2 percent of all young people attend alternative schools in the United States. (This statistic does not include students who participate in pullout programs or other special education settings inside the mainstream school.) For some of these students, mainstream schools send them to alternative schools as a continuation of exclusion, cloaked in good intentions. Antisocial behavior can prove dangerous for the larger student body, and at the very least disrupts the classroom environment. As in the mainstream classroom, proper teacher training is essential, and Van Acker notes that even in alternative school settings, if staff members lack training and facilities, materials and budgets are inadequate, the alternative school simply serves as a place to push difficult students off. Legislation Requiring Inclusion of All Students Please refer to Appendix A of this document for an overview of educational law changes since 1965. Historically, students with continuous behavior problems were sent to separate classrooms. Each step of legislation since 1965 has been designed to address this issue, and to refine delivery methods to meet individual needs. The most recent laws have come about because of increased knowledge on the part of educators and everyone’s desire for social justice. Rather than looking at educating children with psychological disorders from a medical or psychology standpoint, educational policies take a social justice standpoint: all children deserve an education (Nabuzoka 2008). The basic foundations of IDEA and the No Child Left Behind laws is the ideal of zero reject (Arzubi 2008). Every child with learning disabilities should be accommodated in the public school system. Students must be treated as individuals and teachers must design education plans that reflect the student’s actual learning needs. IEPs or something very similar are required for learning disabled students under current legislation. Teachers do more than teach reading, writing, and arithmetic: they must be skilled in managing social behaviors and in moving past behavior difficulties so students can learn these concepts. Learning is the desired outcome; not only reading, writing and arithmetic, but also learning to manage destructive behaviors. Concluding Remarks Working with children who have ODD is not easy. The behavior patterns that warrant a diagnosis are extremely challenging and it may seem to school personnel that the child is just impossible. Teachers must try to reduce frustration and see children as individuals worthy of receiving an education. Developing an individualized education plan is an excellent first step, and teachers, administrators and parents, working together, can manage the school environment so the ODD child has the opportunity for success. It is important for teachers to have at least a basic knowledge of ODD; its behaviors, causes, and prognosis; and the basic ideas of cognitive behavioral therapy. Learning these skills could help a child transform from defiance into a successful student. Current legislation requires schools to include all students, so the tendency to push off those with disruptive behaviors must lessen. General classroom teachers, special education teachers, school administrators, professional psychologists or medical doctors, and parents must all learn to work together to help the ODD child learn reading, writing and arithmetic, and learn to manage disruptive behavior. APPENDIX A: The History of Educational Law through 1997 It is perhaps easiest to condense the historical progress of special education law into a chart (taken from Clair, Church and Batshaw, 2007, 525). Elementary and Secondary Education Act of 1965 Attempted to correct unequal educational opportunities that resulted from a child’s economic condition Education of the Handicapped Act (EHA) of 1970 Amendment to earlier legislation that established a core grant program for local education agencies (LEAs) to provide services for children with disabilities Pennsylvania Association of Retarded Citizens (PARC) v. Commonwealth of Pennsylvania, 1971 PARC proved All children with intellectual disability are capable of benefitting from a program of education and training Education cannot be defined as only the provision of academic experiences for children Having undertaken to provide all children with a free appropriate education (FAPE), the state could not deny students with intellectual disability access to FAPE The earlier students with intellectual disability are provided education, the better the predictable learning outcomes (Yell 1998) Education for All Handicapped Children Act of 1975 Provided FAPE to all school-age children, regardless of their disability Was a funded program Defined the disabilities that would be covered and established guidelines for fair evaluation and assessment Education of the Handicapped Act Amendments of 1986 Extended special education services to infants and preschoolers Developed an individual family service plan (IFSP) for infants and toddlers in early intervention programs (Mercer 1997) Individuals with Disabilities Education Act (IDEA) of 1990 Used person-first language and replaced the word handicap with disability Arranged or transition planning to occur to help students progress from high school into adulthood (Mercer 1997) Emphasized meeting the needs of ethnically and culturally divers children with disabilities Indicated early intervention programs to address the needs of children who were exposed prenatally to maternal substance abuse (Mercer 1997) Individuals with Disabilities Education Act Amendments of 1997 Strengthened the role of parents Gave increased attention to racial, ethnic, and linguistic diversity to prevent inappropriate identification and mislabeling Ensured that schools are safe and conducive to learning Encouraged parents and educators to work out their differences by using non-adversarial means References Ainsworth, P. and Baker, P. (2004). Mental retardation. Jackson, MS: University of Mississippi. Arzubi, E.R. (2008). How private practice should respond to IDEIA 2004. Educating Individuals With Disabilities. E.L. Grigorenko, ed. New York: Springer. Clair, E.B., Church, R.P., and Batshaw, M.L. (2007). Special education services. Children with Disabilities 6th edition, Batshaw, Pellegrino, and Roizen eds. Baltimore: Paul H. Brookes. Huerta, N.E. (2008). The promise and practice of the individuals with disabilities education act. Education for All, T. Jimenez and V. Graf, eds. San Francisco: Jossey-Bass. Keyes, M. (2008, June). Adopted youth more likely to have mental disorders. Policy and Practice, 66(2). Accessed 13 April 2009 from Gale database. Lindstrom, J.H., Tuckwiller, E.D., and Hallahan, D.P. (2008). Assessment and eligibility of students with disabilities. Educating Individuals With Disabilities. E.L. Grigorenko, ed. New York: Springer. Mayo Clinic staff (2007, 19 December). Oppositional defiant disorder (ODD). Accessed 13 April 2009 from http://www.mayoclinic.com/health/oppositional-defiant-disorder/DS00630#. Mental Health Weekly (2003, June). Obese children may be prone to some psychiatric disorders. Mental Health Weekly, 13(14). Accessed 13 April 2009 from Gale database. Nabuzoka, D. (2008). Issues and developments in special education. Educating Individuals With Disabilities. E.L. Grigorenko, ed. New York: Springer. Rea, P.T., McLaughlin, V.L., and Walther-Thomas, C. (2002). Outcomes for students with disabilities in inclusive and pullout programs. Exceptional Children, 68, 203-222. Robb, A. and Reber, M. (2007). Behavioral and psychiatric disorders in children with disabilities. Children with Disabilities 6th edition, Batshaw, Pellegrino, and Roizen eds. Baltimore: Paul H. Brookes. Rogge, T.A. (2008, 26 May). Conduct disorders. Healthline information website. Accessed 13 April 2009 from http://www.healthline.com/adamcontent/conduct-disorder. Rose, E. (2008). Transition services and education for all. Education for All, T. Jimenez and V. Graf, eds. San Francisco: Jossey-Bass. Van Acker, R. (Winter 2007). Antisocial, aggressive, and violent behavior in children and adolescents within alternative education settings: prevention and intervention. Preventing School Failure, 51(2). Accessed 13 April 2009 from Gale database. Vila, G., Zipper, E., Dabbas, M., Bertrand, C., Robert, J.J., Ricour, C., and Mouren-Simeoni, M.C. (2004). Mental disorders in obese children and adolescents. Psychosomatic Medicine, 66(3). Accessed 13 April 2009 from http://www.psychosomaticmedicine.org/cgi/content/abstract/66/3/387. Read More