6-2 Milestone Four_ PSY 314

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Critical Analysis Rachel Marsh Critical Analysis 6-2 Final Project Milestone Four Southern New Hampshire University Disorders of Childhood and Adolescence PSY 314 Dr. Megan Baril December 3, 2023 1

Critical Analysis I. 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. Oppositional-defiant disorder presents as a pervasive pattern of defiance with the most prominent behaviors being negativity, spitefulness, hostility, and verbal aggression. Individuals with ODD tend to be argumentative, hostile, vindictive, and antagonistic (Lawrence & Mcfield, 2022). In various accounts of research, children with ODD are frequently described as actively defiant and tend to annoy others or become annoyed with others easily (Wolford & Ohrt, 2018). Children with ODD tend to have frequent temper tantrums, consistently question and disobey rules, and blame others for their behavior, As children with ODD develop, research has substantiated that there is a high presence of comorbidity with several other disorders, such as ADHD, anxiety, and mood disorders (The American Academy of Child and Adolescent Psychiatry, 2009). The diagnosis of ODD follows a similar pathway to ADHD. A single measurement or assessment cannot diagnose ODD. In diagnosing ODD, mental health professionals compile information on behavior and symptoms from external sources to use as supporting evidence of the disorder for clinical diagnosis. For instance, the initial process for diagnosing ODD, generally, begins with an evaluation from the child’s primary provider. During this evaluation, providers examine the physical and psychological indicators for the behavior; however, in disorders like ODD, these indicators may not be present, which prompts providers to refer the case to a licensed clinical mental health professional for a confirmed diagnosis (The American Academy of Child and Adolescent Psychiatry, 2009). The mental health professional usually diagnoses ODD; however, the gathering of information from external accounts aids in understanding the behavior occurrence, such as when and where it is present (The American 2

Critical Analysis Academy of Child and Adolescent Psychiatry, 2009). For a more comprehensive understanding of these behaviors, parents and teachers are interviewed regarding the child’s behavior. At the same time, observation is conducted to understand the presence and situational behavior of the child (Lin et al., 2022). The accounts of observations and self-reports allow the mental health professional to determine the disorder in its complexities, such as severity. Furthermore, it allows for a more comprehensive understanding of the social context of the disorder and how it interacts in conflict with daily life, such as peer relationships. Oppositional-Defiant Disorder (ODD) and Conduct Disorder (CD) are two of the most prevalent abnormal childhood disorders affecting behavior in children and adolescents. Research has indicated ODD to be a precursor to CD, which has further demonstrated that children and adolescents who present with ODD are more likely to engage in risk-seeking behaviors and have a higher tendency for impulsivity (Lawrence & Mcfield, 2022). Further research has indicated that there is a strong correlation between the presence of ODD, CD, and low-income families and communities, due to the additional challenges and stressors they face (Lin et al., 2022). Systemic reviews have substantiated that parental stress and family dynamics have a direct correlation to child disruptive behavior, particularly in cases of ODD (Lin et al., 2022). As deviant behavior is prominent in childhood, early intervention and diagnosis are paramount to overall success in the remediation and rehabilitation of disruptive behavior disorders, specifically ODD and CD. Alongside therapeutic interventions, such as Cognitive Behavioral Therapy, the combination of screening and parental education programs, 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. II. Causes and Interventions 3

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Critical Analysis A. Causes Throughout development, children with perpetual ODD symptoms are more likely to have interpersonal conflicts and are at a higher risk for adjustment complications, including antisocial behaviors, impulsivity, and substance abuse (Lin et al., 2022). There is no clear indication of the cause of ODD; however, a growing body of research has found strong correlations between social contexts and the incidence of ODD in children. In a 2022 study, the rate of incidence for ODD was associated with chronic stressors and individual social contexts, such as family dynamics and peer relationships (Lin et al., 2022). The study further 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). In the Center for Disease Control’s report, Mental Health Surveillance Amongst Children , 3.5% of youth met the criteria for a diagnosis of ODD; however, it was also found that males, older youth, and poverty-impacted children were diagnosed more frequently with ODD or exhibited ODD characteristics (Bornheimer et al., 2021). The precedence of research and evidence compounding the environmental stimulants throughout development has substantiated that social contexts and poverty have significant implications on the occurrence of ODD in children and young adults. Despite the environmental implications and stressors, these are not the only factors contributing to ODD development. The majority of the biological factors associated with the increased risk or development of ODD generally place the individual in a predisposition for behavioral or mood disorders. For instance, a child whose parents are diagnosed with attention deficit hyperactivity disorder (ADHD), ODD, or conduct disorder (CD) is at a higher risk for developing ODD in childhood (Bornheimer et al., 2021). Children are also at a higher risk or 4

Critical Analysis predisposition for ODD when the social contexts of their home life are adverse, such as poor nutrition or one or more parents engaging in excessive alcohol consumption and substance abuse. In terms of brain functioning and development, oppositional defiant disorder has been correlated to impairments in aspects of the brain responsible for reasoning, judgment, and impulse control (American Academy of Child and Adolescent Psychiatry, 2009). Oppositional defiant disorder does not have a definitive cause; however, research has substantiated strong correlations to the development of ODD being subjective to underlying biological predispositions being influenced into an active disorder by environmental stimulants. B. Interventions As the cause of ODD has associations and correlations with social contexts, research has found that 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). In treating ODD, there is no definitive market for treatment. As ODD does not have a distinct cause, successful treatment of ODD is a tailored plan designed to meet the needs and behavioral symptoms of the individual (American Academy of Child and Adolescent Psychiatry, 2009). Currently, there is no FDA-approved medication for the treatment of ODD; however, research from clinical experience and practices has shown early intervention of ODD is generally subjective to stimulant medications and atypical neuroleptics, such as aripiprazole (Abilify) and risperidone (Risperdal) (). Despite this, medication alone is not the consistent course of action for ODD unless another disorder is present. Cognitive Behavioral Therapy (CBT) is an effective treatment model for addressing the symptoms of behavior in ODD (Shubina, 2016). The purpose of CBT is to decrease the presence 5

Critical Analysis of maladaptive behaviors and coping skills while increasing the presence of adaptive behaviors and coping skills (Shubina, 2016). In treating ODD, CBT is one of the most effective treatments, as it addresses the cognitive-emotional factors associated with ODD, such as emotional dysregulation, and encourages children to engage in problem-solving and communication. 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). Despite its effectiveness, there are limitations in the simplicity of CBT that some researchers feel can be addressed by applying a more holistic, integrative approach to the therapeutic process, as indicated by the research on assimilative integrative therapy. Assimilative Integrative Therapy (AIT) is a contextualized based approach to treating ODD. 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. ODD presents both internally and externally; therefore, therapeutic measures should come from both inside and outside the office. In a 2018 (Wofford & 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 targeted at improving growth rather than remissing symptoms. 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 (Wofford & Ohrt, 2018). 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 6

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Critical Analysis individual. As ODD is directly correlated to environmental stimulants, AIT allows for a more comprehensive understanding of how the disorder developed. Oppositional Defiant Disorder (ODD) is accompanied by cognitive-emotional factors or “lagging skills”, such as emotional dysregulation (Murrihy et al., 2023). 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). Communities with a high prevalence rate for social and economic problems represent a marginalized group in the presentation and treatment of ODD (Bornheimer et al., 2021; Murrihy et al., 2023). Parent Management Training (PMT) is a recommended treatment for children who are diagnosed with Oppositional Defiant Disorder (ODD) (Helander et al., 2023). PMT is a structuralized approach that aids parents in developing healthy coping skills and parenting strategies to address behavioral problems while developing new skills. Although PMT is effective in treating ODD, its efficacy is greatly enhanced when paired with alternative therapeutic measures. 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). 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). III. Discussion and Reflection Children from low-income or poverty-impacted communities are four times more likely to experience ODD or other behavioral disorders (Braithwaite et al., 2022). The psychological issues and obstacles that stem from ODD intensify stress in the family dynamics, which may increase harsh parenting. ODD is a common disorder among children and adolescents; however, 7

Critical Analysis the cause of ODD is not distinctive. Although biological factors do increase an individual's predisposition for the development of ODD, a vast majority of research suggests environmental constraints implicate the brain’s development and function, increasing the likeliness of developing psychopathology. As such, the treatment for ODD must adopt various dimensions of therapy, which may include medication, contextual therapy, such as Cognitive Behavioral Therapy or Assimilative Integrated Therapy, and parental management training or programs, such as Collaborative and Proactive Solutions (CPS). In most psychological disorders, particularly those in childhood and adolescence, the approach to treatment is a multi-dynamic structure that adopts various disciplines to address the needs of the individual and the disorder. Historically, psychopathology has been perceived as a product of genetics; however, in more current research, psychological disorders are categorized from various origins. Research has substantiated that the vast majority of disorders have some degree of environmental context, which either produces a disorder, sustains it, or impacts its severity (Lin et al., 2022). ODD and other disruptive behavior disorders (DBDs) are prominent in low-income communities; however, lower socioeconomic status and poverty-impacted families are underserved concerning mental health. 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, which is largely attributed to on account of limitations in resources and public coverage implicating the services and availability of holistic approaches and integrative therapies. Resulting of limitations or deficiencies in treatment or care, children with ODD generally have poor academic achievement, are at a higher risk for criminality, and are at a higher risk for developing CD, as well as displaying traits of aggression, delinquency, and substance abuse (Shubina, 2016). Collaborative research sustains the understanding that the combination of screening, 8

Critical Analysis therapeutic interventions, and parental education programs provide individualized frameworks of treatment to combat the i nternalization and externalization of Oppositional Defiant Disorder in children of lower socioeconomic status or adverse childhood backgrounds. Treating ODD does not follow a distinct pathway; however, with individualized care targeted toward the social contexts of behavior and symptomology, providers can rehabilitate or remediate ODD with early, holistic intervention. For instance, research has shown that, 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 (Murrihy et al., 2023). As children of lower-income communities are more likely to receive a diagnosis of ODD, there is a growing body of research that seeks to understand the relationship between socioeconomic status, racial disparities, and ODD, which is a necessary topic of evaluation in future research. References 9

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Critical Analysis American Academy of Child and Adolescent Psychiatry. (2009). O.D.D. - A Guide for Families . American Academy of Child and Adolescent Psychiatry. https://www.aacap.org/App_Themes/AACAP/docs/resource_centers/odd/odd_resource_c enter_odd_guide.pdf 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 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., 10

Critical Analysis Ellis, D. M., Halldorsdottir, T., Greene, R. W., & Ollendick, T. H. (2023). Community- delivered collaborative and proactive solutions and parent management training for oppositional 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 11

6-2 Milestone Four_ PSY 314

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