Oppositional Defiant Disorder (ODD) commonly affects children and adolescents. Symptoms of this disease include negativistic and hostile behavior, vindictiveness, insurrection, and other modes of associated aggression such as verbal intimidations and physical action (Steiner & Remsing, 2007, p.126).
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At this stage, these individuals are dependent and ODD can lead to undesirable adulthood. ODD can lead to delinquent behavior, substance abuse, and conduct disorders (CD).
Steiner and Remsing (2007) assert that, the aforementioned situation makes ODD assessment and treatment a challenging affair that requires multimodal approaches, including drug and psychosocial therapy (p.126).
Because of the complications associated with this disorder, clinicians often encounter challenges in diagnosis and treatment of ODD. Therefore, this paper gives recommendations for child and adolescent patients’ assessment and treatment per the American Academy of Child and Adolescent Psychiatry.
A clinician addressing an ODD case should establish therapeutic alliances with the patient and family members for successful assessment and treatment of ODD is sufficient to treat the disorder. ODD therapy can achieve favorable results when the patient (child or adolescent) accept the therapy. It requires coupled efforts from clinicians and family members to compel the patient to accept ODD therapy.
Secondly, active consideration of cultural values in diagnosis and treatment of ODD is sufficient to treat the disorder. This recommendation is valid since it determines the compliance of the child and parent to the ODD therapy. Patient’s disrespect and parent’s cultural values may lead to rejection of the therapy. Therefore, clinician should be aware of the existing cultural differences that might hinder the acceptance of the therapy.
The third recommendation is adequate to treat ODD because the information can help the clinician establish the risk factors of the disease and develop the relevant intervention. Clinicians can determine root cause of the condition and develop intervention to include elimination of the risk factors from the child’s surroundings; moreover. Addressing the root causes of abuse can produce desirable outcomes.
The fourth recommendation is also ample to treat ODD because delineation of co-morbid condition from ODD can help the clinician to establish accurate therapy. Comorbid condition can cause misdiagnosis and mistreatment of ODD.
The fifth recommendation regarding inclusion of information from various outside informants is not sufficient to treat the disorder. Outside informants cannot describe the feelings or emotion of the sufferer accurately. What an outsider may see as a deviant or oppositional behavior may have a different meaning to the sufferer. Therefore, this situation may lead to misdiagnosis and subsequent incorrect treatment of ODD.
Use of questionnaires and rating scales in evaluating ODD is not sufficient to treat it. Information given by a sick child is not very reliable since it may have malicious intents or prejudices, given the oppositional characteristics of ODD sufferer. In addition, parents’ views about the child’s condition may not be objective because of the event.
The seventh recommendation on developing an individualized treatment plan depending on the exact situation is sufficient to treat the disease because different cases of ODD have unique etiology; therefore, the clinician can identify the risk factor underlying the disease and work on their elimination. In addition, the clinician can identify co-morbid psychiatric conditions and design a holistic approach to cure all the conditions.
The eighth recommendation to consider parent intervention depending on a particular tested intervention is sufficient to treat ODD. A child is more likely to cooperate with his/her parents because s/he trusts them. Besides, a parent can best read a child’s mood and act considerately taking caveat not to provoke unfavorable behavior.
The ninth recommendation, which supports use of drugs adjuncts in conjunction with other treatment packages including symptomatic and co-morbid condition treatment, is sufficient to treat ODD. Drugs help in normalizing baseline arousal and dysfunction of neurotransmitters at the prefrontal region of the brain.
The tenth recommendation, which supports the use of intensive and prolonged treatment for severe and persistent ODD, is sufficient to treat ODD. Severe and persistent ODD is detrimental tot the social and academic aspects of the child. The child exhibits extreme oppositionality and substance abuse such that, s/he becomes a nuisance the people around him/her.
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The eleventh recommendation, which holds that certain interventions are not effective, is not sufficient to treat ODD. This argument is valid because sometimes the child may be in frenzy condition and administering therapy may be difficult unless s/he is calmed. Onetime or short-term intervention may be useful in such situation.
I believe that the key treatment to ODD is one that targets the biological factors responsible for the condition. Scientist should design medications that can arouse baseline for ODD treatment.
Due of exogenous factors, including toxins and nicotine have been implicated for ODD (Steiner & Remsing, 2007, p.128); therefore, evaluation of the child for involvement of this factors should be performed and steps taken to eliminate them from the child’s access.
Clinicians should use agents that target serotonergic, dopaminergic, and noradrenergic systems to treat ODD in cases involving dysfunction of the prefrontal cortex. In addition, hormonal therapy may also be useful to restore cortisol and testosterone levels.
Effects of psychosocial factors
Psychosocial factors will determine the extent to which a child and parent will cooperate with the clinician involved. Clinicians must develop a harmonious relationship with the parents and the child in order to obtain accurate and useful information to determine treatment. Understanding of this factor forms the basis for successful evaluation and treatment of ODD.
Ethics on ODD assessment and treatment
Clinicians must place the affected child in a safe environment so that s/he does not harm other people. In addition, clinicians must not use unprecedented measures such as exposure to frightening events to induce calm (Steiner & Remsing, 2007, p.131). Finally, clinicians should safeguard other children from the harassment by ODD sufferers if they conduct assessment and therapy at school.
Research on ODD intervention
Various studies have been performed on interventions for ODD. One study comparing use of collaborative problem solving (CPS) and parent training (PT) intervention was done on 50 affectively dysregulated children suffering from ODD.
Only 47 children met the criteria of study. Of the 47 children, 28 children were subjected to CPS intervention and 19 to PT interventions. Diagnostic eligibility test was done using two-staged assessment procedure through a telephone diagnostic screening proceeded by a diagnostic interview of those who satisfied the entry criteria.
The results of this study favored the use of CPS as it yielded important improvement across various domains of performance at four-month follow up and post-treatment. Although these improvements were similar to PT in most cases, they were superior in many cases. Therefore, CPS is a better intervention for ODD treatment relative to PT. Further research on CPS should be done to develop it.
The second article evaluates the effectiveness of Therapeutic Assessment (TA) model on preadolescent boys with ODD and their families. The researchers investigated the effects of TA and followed the process of change using a replicated single-case time-series methodology on a daily basis measures.
A sample of three families was used for the study and all participated in TA in all areas of activity (Smith & Handler, 2010, p.593). However, the way in which change occurred was specific to each family. Therefore, this study substantiates the efficacy of TA intervention in handling adolescent boys with ODD and their families.
The two articles support the recommendations postulated in the AACAP practice parameters. They both recognize the importance of family involvement in dealing with ODD and the effectiveness of establishing alliance with child and parent.
The research validates use of a cognitive-behavioral model of treatment that supports collaborative parent-child approach in yielding important improvement in various areas of performance (Greene, Ablon, Goring, Blakely, Markey, Monuteaux, Henin, Edwards, & Rabbitt, 2004, p.1162) on the one hand, and benefits of family participation in therapy assessment on the other (Smith & Handler, 2010, p.600).
Clearly, parents’ involvement in ODD treatment is very beneficial. Indeed, when I face an ODD case, I will use the approaches postulated in this two articles because I am convinced that families play a great role in alleviating or exacerbating this problem.
Oppositional defiant disorders are very complicated and require a lot of experience and knowledge by clinicians. It takes patience and diligence to assess and treat ODD. In addition, it is important to keep track of ODD treatment change to assess if the intervention method is useful and if not; clinicians should consider another therapy.
Greene, R. W., Ablon, S. J., Goring, J. C., Blakely, R. L., Markey, J., Monuteaux, M. C., Henin, A., Edwards, G., & Rabbitt, S. (2004). Effectiveness of Collaborative Problem Solving in Affectively Dysregulated Children with Oppositional-Defiant Disorder: Initial Findings. Journal of Consulting and Clinical Psychology, 72(6), 1157–1164.
Smith, J. D., & Handler, L. (2010). Therapeutic Assessment for Preadolescent Boys With Oppositional Defiant. Psychological Assessment, 22( 3), 593–602.
Steiner, H., & Remsing, L. (2007). Practice Parameter for the Assessment and Treatment of Children and Adolescents with Oppositional Defiant Disorder. J. Am. Acad. Child adolesc. Psychiatry, 46(1), 126-141.