5-3 Milestone Three_ PSY 314

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Outline Rachel Marsh Outline 5-3 Final Project Milestone Three Southern New Hampshire University Disorders of Child and Adolescence PSY 314 Dr. Megan Baril November 26, 2023 1

Outline I. Introduction (Oppositional Defiant Disorder) ● Oppositional-defiant disorder (ODD) is classified as a disruptive behavioral disorder in the DSM-V, and it is a common disorder found in children and adolescents. ● ODD is a precursor to Conduct Disorder (CD). ● ODD increases the likeliness of engaging in risk-seeking behaviors and a higher tendency for impulsivity (Lawrence & Mcfield, 2022). ● Early intervention is generally subjective to stimulant medications. ● New-age therapies, such as Cognitive Behavioral Therapy and parental education and strategization, have shown positive outcomes and efficacy in treating and managing ODD. II. Presentation and Diagnosis of ODD ● Characteristics of ODD: argumentative, hostile, vindictive, and antagonistic (Lawrence & Mcfield, 2022). ● Individuals with ODD are typically described as actively defiant and tend to annoy others or become annoyed with others easily (Wolford & Ohrt, 2018). ● Research has indicated that ODD may be a product of a maladaptive family environment or it is sustained on account of a maladaptive environment based on the presence of chronic stressors (Lin et al., 2022). ● The diagnosis of ODD follows a similar pathway to ADHD. ● Parents and teachers are interviewed in regard to the child’s behavior while observation is conducted to understand the presence and situational behavior of the child (Lin et al., 2022). ● In some cases, a psychiatrist or behavioral analyst may request mental health testing to further evaluate the premise and severity of ODD. III. Thesis Statement ● Alongside therapeutic interventions, such as Cognitive Behavioral Therapy, the combination of screening and parental education programs or strategies, such as Amaka Amasanyufu , can generate a holistic approach to combating the internalization and externalization of Oppositional Defiant Disorder in children of lower socioeconomic status or adverse childhood backgrounds. IV. Assertations and Evidence 2

Outline A. Addressing the Externalization and Internalization of ODD with Assimilated Integrative Therapy 1. The chronic stressors associated with low-income or impoverished families and communities implicate the therapeutic process on a systemic level by changing the brain's functioning and internal biology (Wolford & Ohrt, 2018). 2. ODD presents both internally and externally; therefore, therapeutic measures should come from both inside and outside the office. 3. The use of assimilated integrative therapy has shown efficacy in incorporating various therapeutic approaches to address the symptomology and core deficits of ODD, including internal biology, chronic stressors, and family dynamics or functioning (Wolford & Ohrt, 2018). 4. In a 2018 (Wolford & Ohrt, 2018) meta-analysis, it was found that therapies derived from a compilation of cognitive-behavioral therapy (CBT), structural family therapy, and play therapy encourage a more inclusive and comprehensive environment to address strengths to improve growth rather than remiss symptoms. 5. The limitations in simplicity associated with CBT can be addressed by applying a more holistic, integrative approach to the therapeutic process, as indicated by the research on assimilative integrative therapy. B. Amaka Amasanyufu in Family Intervention and ODD 1. Children from low-income or poverty-impacted communities are four times more likely to experience ODD or other behavioral disorders. 2. The psychological issues and obstacles that stem from ODD intensify stress in the family dynamics, which may increase harsh parenting. 3. Caregiver stress is directly correlated to child inattentiveness, as well as child and caregiver depression, resulting in child behavioral disorders (Bornheimer et al., 2021) 4. Amaka Amasanyufu was designed to target family strengthening through intervention and strategy of the “ 4R’s and 2S’s ”. 3

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Outline 5. R ules, R esponsibilities, R elationships, R espectful C ommunication (4Rs), and S tress and S ocial Support (2Ss) (Braithwaite et al., 2022). 6. In a 2022 academic journal, a sub-Saharan Africa poverty-impacted population found that Amaka Amasanyufu is effective in reducing the symptoms and impaired functioning associated with ODD (Braithwaite et al., 2022). C. Cognitive-Behavioral Factors, Parent Management Training, and ODD 1. Oppositional Defiant Disorder (ODD) is accompanied by cognitive- emotional factors or “lagging skills”, such as emotional dysregulation (Murrihy et al., 2023). 2. The presence of “lagging skills” generates psychological vulnerability that when paired with extreme parental expectations increases the risk for behavioral disorders (Murrihy et al., 2023). 3. Communities with a high prevalence rate for social problems and infectious diseases, and family dynamics with inconsistent discipline, poorer communication, financial strain, and less healthy family roles distinguish a marginalized group in the presentation and treatment of ODD (Bornheimer et al., 2021; Murrihy et al., 2023) 4. Collaborative and Proactive Solutions (CPS) paired with Parent Management Training (PMT) emphasizes the recognition of cognitive- emotional factors, meaning it implicates the child and the family in therapeutic measures (Murrihy et al., 2023). 5. When targeting impoverished communities, the collaboration of CPS and PMT has been found to exhibit statistically significant improvements in the symptomology of ODD holistic approaches of behavioral therapy and proactive parenting strategies. V. Implications of the Disorder on Children and Caregivers A. The Family and Caregiver 1. Families living in poverty or are of lower socioeconomic status are least likely to benefit from parenting programs designed to target ODD and family functioning. 4

Outline 2. Lower socioeconomic status and poverty-impacted families are underserved in relation to mental health 3. The limitations in resources and public coverage implicate the services and availability of holistic approaches and integrative therapies. 4. Caregivers of children with ODD experience frustration and burnout, which increases child and caregiver depression (Bornheimer et al., 2021). B. The Child 1. Poor academic functioning is correlated to children with ODD, due to the characteristics of impulsivity, inattentiveness, and defiance (Bornheimer et al., 2021). 2. Children with ODD are at a higher risk for criminality, specifically children with ODD from low-income families or communities (Bornheimer et al., 2021). 3. ODD diagnosis is higher in African-American communities, which indicates correlations between critical race theory, racial bias, and ODD (Ballentine, 2019). 4. Children diagnosed with ODD are at a higher risk for developing CD, as well as displaying traits of aggression, delinquency, and substance abuse (Shubina, 2016). VI. Opportunities for Treatment A. Cognitive Behavioral Therapy 1. Cognitive Behavioral Therapy (CBT) is an effective treatment model for addressing the symptoms of behavior in ODD (Shubina, 2016). 2. The purpose of CBT is to decrease the presence of maladaptive behaviors and coping skills while increasing the presence of adaptive behaviors and coping skills (Shubina, 2016). 3. CBT is a problem-oriented approach that utilizes various approaches to identify thoughts and beliefs while correlating these factors through the relationship between thoughts, emotions, external symptoms, and behavior (Shubina, 2016). 4. In treating ODD, CBT is one of the most effective treatments, as it 5

Outline addresses the cognitive-emotional factors associated with ODD, such as emotional dysregulation, and encourages children to engage in problem- solving and communication. B. Parent Management Training and Programs 1. Parent Management Training (PMT) is a recommended treatment for children who are diagnosed with Oppositional Defiant Disorder (ODD) (Helander et al., 2023). 2. PMT is a structuralized approach that aids parents in developing healthy coping skills and parenting strategies to address behavioral problems while developing new skills. 3. Research has substantiated the long-term effectiveness of PMT and PMT paired with CBT in reducing the disruptiveness of symptoms associated with ODD and harsh or strict parenting strategies (Helander et al., 2023). 4. Although PMT is effective in treating ODD, its efficacy is greatly enhanced when paired with alternative therapeutic measures, such as CBT. C. Assimilative Integrative Therapy 1. Assimilative Integrative Therapy (AIT) is a contextualized based approach to treating ODD. 2. AIT seeks to understand the origin of the behavior while adopting therapeutic measures from various dimensions and disciplines to address the symptomology and core functioning of ODD through contextual or situational settings. 3. As ODD is directly correlated to environmental stimulants, AIT allows for a more comprehensive understanding of how the disorder developed. 4. AIT does not apply therapy to the disorder rather it applies therapy to the context of the disorder, the family structure surrounding the disorder, and the individual. VII. Summary of Research A. ODD is one of the most common behavioral disorders diagnosed in children and adolescents. B. ODD is a precursor to Conduct Disorder (CD) if left untreated; therefore, early 6

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Outline intervention is a key component to remediating or rehabilitating ODD. C. Various studies, systematic analyses, and meta-analyses have substantiated that ODD is more prominent in children from maladaptive environments and lower socioeconomic or impoverished communities. D. The correlation of chronic stressors associated with low socioeconomic status contributes to poor family dynamics, which increases the risk and incidence of ODD in children. E. Multifactorial or multi-dimensional treatment plans prove to have positive efficacy in treating the symptomology of ODD while strengthening family dynamics and reducing caregiver and child strain and stress. References 7

Outline Ballentine, K. L. (2019). Understanding Racial Differences in Diagnosing ODD Versus ADHD Using Critical Race Theory. Families in Society: Journal of Contemporary Social Services, 100(3), 282–292. https://doi-org.ezproxy.snhu.edu/10.1177/1044389419842765 Bornheimer, L. A., Acri, M., Li Verdugo, J., & McKay, M. M. (2021). Family Processes and Mental Health among Children and Caregivers in a Family Strengthening Program. Journal of Child & Family Studies , 30 (11), 2903–2912. https://doi- org.ezproxy.snhu.edu/10.1007/s10826-021-02035-w Brathwaite, R., Ssewamala, F. M., Sensoy Bahar, O., McKay, M. M., Neilands, T. B., Namatovu, P., Kiyingi, J., Zmachinski, L., Nabayinda, J., Huang, K., Kivumbi, A., Bhana, A., Mwebembezi, A., Petersen, I., & Hoagwood, K. (2022). The Longitudinal Impact of an Evidence‐Based Multiple Family Group Intervention (Amaka Amasanyufu) on Oppositional Defiant Disorder and Impaired Functioning Among Children in Uganda: Analysis of a Cluster Randomized Trial from the SMART Africa‐Uganda Scale‐Up Study (2016–2022). Journal of Child Psychology & Psychiatry , 63 (11), 1252–1260. https://doi- org.ezproxy.snhu.edu/10.1111/jcpp.13566 Helander, M., Enebrink, P., Hellner, C., & Ahlen, J. (2023). Parent Management Training Combined with Group-CBT Compared to Parent Management Training Only for Oppositional Defiant Disorder Symptoms: 2-Year Follow-Up of a Randomized Controlled Trial. Child Psychiatry & Human Development , 54 (4), 1112–1126. https://doi- org.ezproxy.snhu.edu/10.1007/s10578-021-01306-3 Lawrence, T. I., & Mcfield, A. A. (2022). Does Conduct, Oppositional Defiant, and Panic Disorder Symptoms Associate with Suicidal Ideations Among African American Adolescents? Journal of Child & Adolescent Trauma , 15 (4), 1179–1189. https://doi- org.ezproxy.snhu.edu/10.1007/s40653-022-00452-7 Lin, X., He, T., Heath, M., Chi, P., & Hinshaw, S. (2022). A Systematic Review of Multiple Family Factors Associated with Oppositional Defiant Disorder. International Journal of Environmental Research and Public Health , 19 (17), 10866. https://doi.org/10.3390/ijerph191710866 Murrihy, R. C., Drysdale, S. A. O., Dedousis-Wallace, A., Rémond, L., McAloon, J., Ellis, D. M., Halldorsdottir, T., Greene, R. W., & Ollendick, T. H. (2023). Community-delivered collaborative and proactive solutions and parent management training for oppositional 8

Outline youth: A randomized trial. Behavior Therapy , 54 (2), 400–417. https://doi- org.ezproxy.snhu.edu/10.1016/j.beth.2022.10.005 Shubina, I. (2016). Counseling and Therapy of Patients with Behavioural Disorders Using the Cognitive-behavioural Approach. Procedia - Social and Behavioral Sciences , 217 , 1008– 1018. https://doi-org.ezproxy.snhu.edu/10.1016/j.sbspro.2016.02.094 Wofford, J. R., & Ohrt, J. H. (2018). An Integrated Approach to Counseling Children Diagnosed With ADHD, ODD, and Chronic Stressors. Family Journal, 26(1), 105–109. https://doi- org.ezproxy.snhu.edu/10.1177/1066480718756594 9

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