ASSESSMENT AND TREATMENT

OF ODD AND CD

Lecture By:
Dr. Tehreem Arshad
ETIOLOGY OF CONDUCT
DISORDER
 Biological Theories
 Several biological theories have been
proposed for CD with mixed empirical
results.
 Most children with CD are boys although,
whether this is a biological (e-g., hormonal)
or cultural factor is not yet known.
 Slow hear rate has also been linked to
conduct problem.
 CD children may be less responsive to
external stimuli and may need a higher
level of external stimulation.
 Additionally,researchers have found
correlations between frontal lobe
functioning and delinquency.
 Family-Behavioral Theories
Allmajor psychological theories of
etiology of CD cite a role for parent
and family functioning in the
emergence of symptoms.
Attachment problems have been
suggested as predictive of later CD.
Disruption in the attachment
process may produce later
problems with social interaction and
adherence to social norms.
 Insecure attachment patterns, for
example, are related to harsh, punitive and
abusive parenting.
 Many insecurely attached CD children also
have histories of negative parent-child
interactions characterized by lack of
warmth and negotiation, high
defensiveness, harsh discipline and
inconsistent discipline.
 Out of these negative interactions, a
feeling of distrust and suspicion of
authority may develop.
Instead of nurturance, a child
expects rejection and punishment
from authorities and society.
Thus, the child attempts to meet his
or her own needs, with little regard
for the advice or rules of society.
Broader family factors may also
predispose the child to CD.
Children of criminal or alcoholic
parents are more likely to have CD.
 Family factors such as;
Large size
Parental discord

Substance abusing parents

Parental psychopathology

Parental depression predict CD in

the child.
 These factors may contribute to CD by;

 disrupting attachment
 reducing parental attention to child

 delaying gratification of the child’s

needs
 encouraging inconsistent parenting

and/or
 by providing a negative model for the

child.
 Patterson’s coercion theory is one
of the best known and well-research
explanations of how poor discipline may
lead to ODD and CD.

 Coerciontheory suggest that

oppositional, aggressive and antisocial
behaviors emerge through a process of
reciprocal, negative, coercive
interchanges between child and parent.
 Thescenario begins with a child who
exhibits distress behavior as a result of
temperament, stress or other factors.

 Suchbehaviors may be developmentally

normal or responses to a negative
environment.
 In
healthy parent-child relationships,
child distress behavior quickly shapes the
behavior of caretakers, who respond to
the needs of child.

 Asthe child matures, more appropriate

social and verbal skills replace the
negative distress behaviors and child
learn to respond appropriately and
positively to caretakers.
 For
some children, this negative distress
behavior is irritating to caretakers, who
avoid and /or harshly discipline the child.

 The child responds to the avoidance or

harsh discipline with increasingly hostile
and unrewarding behavior, leading to
further avoidance and maltreatment from
parents.
 Ashe parents’ avoidance and
maltreatment increase, the child must
increasingly escalate his or her behavior
to gain their attention and force them to
attend the child’s needs.

 Eventually,the parent unintentionally

reinforces the child’s coercive behavior
by giving in or modifying demands placed
on the child whenever the child displays
escalating, oppositional behavior.
 This
pattern of interaction evolves into a
simple power struggle.

 Theescalation of conflict between child

and parent may involve screaming,
threats and even physical fighting, but
the child persists in the conflict until the
parent gives in.
PSYCHODYNAMIC THEORIES

 All psychodynamic theories of CD are

based on the assumption that children
adopt rule-following behaviors as a result
of “internalizing” and “identifying” with
the beliefs and behaviors of significant
others.
 In some cases, the development of the
internalized caretaker is disrupted.
 Traumatic events, inconsistent or harsh

parenting, separation from parents,

emotionally distant parenting and family
conflict may disrupt the internalization
process, leaving the child with little
regulation of his or her needs or impulses.
 ASSESSMENT PATTERNS AND
TREATMENT OPTIONS
 Although, research supports the existence
of ODD and CD as separate syndromes,
they share the major characteristics of
oppositionality, defiance, authority
problems and rule breaking.
 Hence, ODD and CD are assessed and

treated similarly.
 Furthermore, because ODD may develop it

to CD, any ODD assessment must take into

account the possible presence of CD
symptomatology.
 CD often warrants closer monitoring,
involvement of authorities and more
intensive treatment than does ODD, but
the basics of the interventions for the
disorders are quite similar.
ASSESSMENT BATTERY FOR ODD AND
CD
 Psychological Assessment
 Thematic Apperception Test
 Behavioral Assessment

 Child Behavior Checklist

 Teacher Report Form
 Family Assessment

 Family Environment Scale

SYNDROME-SPECIFIC TESTS

Child Report
 Means-End Problem Solving Procedure
 Social Situation Analysis (SSA)
 Buss Durkee Hostility Inventory (BDHI)
 Novaco Ager Inventory (NAI)
 Adolescent Antisocial Behavior Checklist
(AABCL)
Parent Report
 Eyberg Child Behavior Inventory (ECBI)
 Parent Daily Report (PDR)
 Original Ontario Health Study (OCHS)
 Generalized Parental Expectancies
Questionnaire (GPEQ)
 Over Aggression Scale (OAS)
 TREATMENT OPTIONS
 Behavioral Interventions
 Social Learning Family Interventions (SLFI)
 The rationale for SLFI is founded in theory

that coercive parent-child interchanges

and environmental contingencies are
instrumental in the development and
maintenance of oppositional and
antisocial behaviors.
 Eventually, behavioral programs based

on Patterson’s and other similar

approaches include combination of
following six steps;
1. Psycho education
 Teaching of basic behavioral and
ODD/CD concepts such as coercion,
reinforcement, punishment, rule
violation and operationally defined
behaviors.
2. Observation and Monitoring
 Target problem behaviors are identified
and parents are asked to monitor the
occurrence of these behaviors at home.
3. Reinforcement of Prosocial Behaviors
 Parents learn reinforcement techniques
to focus the child’s (and parents’)
attention away from antisocial behavior.
 Examples of reinforcement include;
 social rewards (smiles, hugs and praise)
 material rewards (points, tokens and
other that may be used by child to
purchase tangible objects)
 activity rewards (access to favored
games, areas or other things to do)
4. Discipline of unaccepted behavior
 Parents are taught the correct use of time-
out.
 Time-out consists of removal of the child
from a reinforcing or stimulating situation
and placement in a situation that is free of
stimulation.
 Time-out should occur for a discrete period
of time.
5. Supervision-monitoring
 Parents are encouraged to provide close
supervision for their child
6. Communication Strategies
 Parents learn problem solving,
negotiation strategies and effective
communication.
 Patterson’s and related programs are used
for children in middle grade schools (grades
3-4) through junior high or high school
(grades 7-10)
 A second parent training program targets

noncompliant behavior in younger children,

ages 3-8 years.
 This program also includes a series of steps

as follows;
1. Nondirective play
 Parents are taught to play with their
children in a nondirective lay
 This is accomplished by teaching the
parent to watch the child play as opposed
to encourage a certain type of play by the
child.
 In this way, the parent behaves in the
manner suggested by the child.
2. Reinforcement of prosocial behavior
 The preferred reinforcers are praise and
attention
3.Simple, effective commands
 Parents are taught to state commands
simply and one at a time.
 This is accomplished by the parent being
in proximity to child and having a stern
facial expression (e.g., laughing and
shouting from another room are
discouraged)
4. Use of time-out for noncompliance
 Parents are taught basic principles of time-
out which immediately follows a period of
noncompliance.
PSYCHOTHERAPY
1. Social Skills Training
 The rational for social skills training
approach with ODD/CD children is
suggested by research findings that these
children demonstrate social behavioral
deficits.
 Most socially oriented cognitive-behavioral
approaches attempt to teach the child
social behaviors based on a hypothesized
social-skills deficits.
 These programs coach children in play skills,
friendships and conversational skills,
academic skills and behavior control
strategies.
 The addition of a response-cost component

improves the effectiveness of a

reinforcement program but response cost
lone is ineffective.
 Response-cost component is a technique in

which a child loses a previously gained

reinforcer following performance of an
undesired behavior
SPECIFIC SOCIAL SKILLS INCLUDE;

 eye contact
 Smiling
 physical space
 voice volume and inflection
 content of conversation
 Compliments
 Acknowledgements
 conversational openers
 assertive requests
 ignoring.
2. Problem Solving
 This intervention combine cognitive and
behavioral techniques to teach problem-
solving skills.
 Typically such intervention teach children
to approach s problem using some
variant of a five-step process.
This process includes;
1. Define the problem
2. Identify the goal
3. Generate options
4. Choose the best option
5. Evaluate the outcome
3. Anger Management
 Goldstein et al. (1987) developed a
10-week anger-control program
emphasizing ten techniques that are
designed to increase insight, skill and
motivation in managing anger.
1. Increasing personal power by self-control
 This technique introduces children to the
concept that anger can create problems
in the child’s life.
 Admired people who have achieved
success with self-control are introduced
as role models.
 Children are taught that they are more
powerful when they do no react angrily
or respond to provocation.
2. The A-B-C Model
 It teaches children to identify situations
and cues that lead to anger behavior
 Trigger (Antecedent): What led up to it?
 Response (Behavior): How did the child
react to problem?
 Consequence: What were the results of
the conflict situation and the child’s
behavior?
3. Cues of being angry (muscle tension,
clenched fists)
 Children identify the physical signs
that indicate anger in themselves and
others.
4. Anger reducers 1, 2 and 3
 Children are taught to use an anger
reducer to increase self-control and
personal power
 Reducer 1: Deep breathing can increase
concentration and relieve physical
symptoms of anger
 Reducer 2: Backward counting is used to
distract the child
 Reducer 3: Pleasant imagery is a
relaxation technique used to reduce
tension.
5. Internal and external triggers
 Children are reminded that each conflict
situation begins with a trigger.
 Internal triggers are typically self-
statements that consists of cognitive
distortions.
 External triggers are verbal or non verbal
communications by another person.
 Children are taught to identify or monitor
these triggers, eventually pairing then with
an anger reducer.
6. Using reminders (Reducer 4)
 Children are taught positive self-
statements to increase control in
pressure situations.
 For example; “Slow down,” “Chill out”)
7. Self-evaluations
 These self-statements are used after a
conflict situation to assess response and
prepare for next time.
 Self-reward (e.g., “I really kept myself

cool” for successful behavior.)

 Self-coaching )e.g., “I need to tune in to

my cues” for failure or undesired

behavior)
8. Thinking ahead (Reducer 5)
 Children are encouraged to think of the
“C” (consequences) component of anger
situation.
 This reducer increases both motivation
and insight.
9. Angry behavior cycle
 Children are instructed to identify
behaviors that are likely to anger others.
 Using the thinking-ahead procedure,
children agree to try to change their
provoking behaviors in order to avoid
creating conflict situations.
 Using structured learning skills to
10.
replace aggression
 In this final skill, children review the
implementation of the skills they have
been taught.
 Fourbroad techniques are used to
accomplish the learning goals of
Goldstein et al.’s (1987) program:
1. Modeling
2. Role Playing
3. Performance feedback: A brief
feedback period follows each role
play.
4. Transfer training
MEDICATION
 Neuroleptics

 These are sometimes used when

agitation or excessively violent
behavior is a primary feature of
CD/ODD.
 Antidepressants

 These are occasionally used for

CD/ODD with a strong affective
component.
INPATIENT HOSPITALIZATION
 In some cases the child’s oppositional or
antisocial behaviors are of sufficient
severity or threat to warrant more
intensive interventions.
 The most common of these interventions

are;
 hospitalization

partial hospitalization (day treatment)

residential hospitalization
REFERENCES
American Psychiatric Association. (2022).
Diagnostic and Statistical Manual of Mental
Disorders-Text Revision (5th ed.; DSM-5-TR)

Kronenberger, W. G., & Meyer, R. G.

(2001). The Child Clinician’s Handbook.
Addison-Wesley Longman.