Oppositional Defiant Disorder

Abel Keller is an English-speaking and physically healthy four-year-old boy. He lives with his mother and eighteen-year-old sister, and attends preschool during the week. Abel’s mother works seven days a week and he is supervised on the weekends by a nanny. His current nanny began working for the family fairly recently; the two nannies prior to her both worked for less than two months before quitting. Abel’s parents have been divorced for two years. His mother is his primary care-giver and his father sees him infrequently. Lately, Abel’s mother and preschool teacher have been unable to cope with his disruptive and distressing behaviors.

Abel’s teacher estimates that his disruptive behaviors began at the beginning of the school year, which was approximately eight months ago; his mother says that the behaviors began roughly one year ago and have been increasing in severity and frequency since then. Abel’s sister has also voiced concerns regarding her brother’s spiteful actions towards her due to the strain his recent behaviors have put on their relationship (APA, 2013). Abel’s mother reports that Abel cannot go more than two days without becoming extremely irritated with necessary daily tasks.

Once, Abel’s mother requested that he go wash his hands before dinner. Abel became irrationally frustrated, blatantly refused to wash his hands, and began lashing out in a manner which she describes as “one of his tantrums. ” Abel’s mother also describes an instance in which their last nanny was on the receiving end of Abel’s disruptive behavior. The nanny took away Abel’s toy at his refusal to brush his teeth and get ready for bed, and later found her toothbrush in the toilet boil. After further acts of blatant defiance by Abel, the nanny resigned and Abel’s mother was forced to find a new nanny.

Abel exhibited a similar behavior towards his sister when she asked him if he could grab her a pencil for her homework. Abel was instantly irritated at this request and yelled “Don’t tell me what to do! ” He then OPPOSITIONAL DEFIANT DISORDER: CASE STUDY AND RESEARCH 3 proceeded to rip up her homework and run to his room. According to his mother, destruction of property in such an aggressive manner has been very infrequent in Abel’s behavior. However, his spitefulness resulted in the loss of a nanny and his sister’s increasing emotional distress that her “sweet baby brother” has taken on such a resentful attitude towards her (APA, 2013).

Abel’s preschool teacher told his mother that his behavior will no longer be tolerated and recommended that he be assessed. His teacher explains his behaviors in class as “defiant and disruptive. ” Almost daily, he actively ignores class rules, such as not talking during reading time, and becomes even more defiant when his violations are addressed by the teacher. His teacher has paused class multiple times to stop him from distracting either the whole class or individual students. She reports that the most troublesome aspects of Abel’s behavior are the frequency of the disruptions and his responses to being reprimanded.

Once, when a classmate went to the teacher after Abel ignored her plea that he stop poking her arm, Abel became outwardly more motivated to continue poking her relentlessly. When his teacher explained why his behavior is unacceptable, Abel accused the classmate that he had been poking of initiating the incident and provoking him by being “annoying. ” Abel’s teacher reports that he has yet to accept blame or responsibility for any of his misdoings and that he is often ostracized by his peers.

Classmates have called him “annoying” and “ a tattle-tale. ” Teachers discourage this taunting behavior, but the discrimination has led to further emotional distress within Abel which has been exhibited by more frequent moods of frustration and irritability at home (APA, 2013). Abel’s behavior has been extremely distressing at home and in school over a duration of at least eight months, but has not presented a problem elsewhere thus far. His teacher has felt stress due to her inability to get him to obey rules, a lack of time to address his disruptions, and phone calls from parents whose children claim to have been harassed in some way by Abel.

His OPPOSITIONAL DEFIANT DISORDER: CASE STUDY AND RESEARCH 4 sister has become distraught over his behavior and his mother has been put under enormous pressure to maintain a trustworthy and reliable nanny. Due to the duration of his irritable, defiant, and occasionally vindictive behaviors, which have occurred at home and at school, have had negative consequences in his academic, social, and emotional functioning, and have caused distress for several people in his life, Abel has been diagnosed with Oppositional Defiant Disorder of a moderate severity.

Abel’s defiant, argumentative, and vindictive symptoms put him at risk for developing Conduct Disorder, and his increasing emotional distress due to peer issues at school increases his risk of developing an emotional disorder (APA, 2013). Recent research of oppositional defiant disorder (ODD) is characterized by the emergence of two themes: developmental precursors to the disorder and the dimension of irritability. The study of precursors to ODD are discussed by Dinolfo and Malti (2013) in their research study which examines the relations between interpretative understanding, moral emotional attribution, and sympathy with the ability to predict ODD symptoms.

Burke, Boylan, Rowe, Duku, Stepp, Hipwell, and Waldman (2014) discuss varying dimensionality models of ODD, the identification of irritability by certain symptoms, and the implications of the results for further research on ODD. Dinolfo and Malti (2013) suggest that the limited success of current ODD treatments may be attributed to the lack of empirical research on the disorder’s developmental antecedents. Their research responds to this insufficiency by assessing supposed key components in the genesis of antisocial behaviors: social-cognitive development and moral emotions (Dinolfo &Malti, 2013).

The study analyzes a sample of 128 four- and eight-year-old children with ODD and investigates the links between the symptoms of ODD and interpretative understanding, or theory of mind skills, in children (Dinolfo & Malti, 2013). The research of Dinolfo and Malti OPPOSITIONAL DEFIANT DISORDER: CASE STUDY AND RESEARCH 5 (2013) also analyzes ODD symptoms in relation to sympathy and moral emotion attribution (MEA), and examines the mediating role that each of these may have on each others’ development.

The participants of the study include 128 English-speaking children and one caregiver each parent assessments (Dinolfo & Malti, 2013). The only exclusion criterion is a child with autism spectrum disorder, and the ethnicities of the participants vary (Dinolfo & Malti, 2013). Symptoms of ODD in the children are rated by caregivers using DSM-oriented scales, interpretive understanding ratings are obtained by professionals using the Lalonde and Chandler’s puppet activity, sympathy is measured by caregiver and child self-reports, and MEA is evaluated using each child’s negative or positive responses to the presentation of hypothetical vignettes of varying lapses in morality (Dinolfo & Malti, 2013).

The procedure of the research study involved each child and their caregiver attending one session at the research lab, the parent providing written consent and the child providing oral agreement, and the child being interviewed for a duration of approximately forty-five minutes by psychology undergraduate students (Dinolfo & Malti, 2013). The caregiver for each child filled out the symptom questionnaires outside of the interview room during the process (Dinolfo & Malti, 2013).

Dinolfo and Malti (2013) find that interpretive understanding, sympathy, and MEA all influence ODD symptoms. Ratings of child sympathy by the caregivers play a mediating role on the effect of interpretive understanding on ODD symptoms, and MEA strength significantly influences interpretative understanding in the domain of rule violation (Dinolfo & Malti, 2013). The research of Dinolfo and Malti (2013) indicates the necessity of further research on social- cognitive and affective-moral factors that could potentially precede ODD and help with early OPPOSITIONAL DEFIANT DISORDER:

CASE STUDY AND RESEARCH 6 prediction, and highlights a possible origin of the rule-violating behavior so prevalent in Abel’s case as a deficit in MEA. Recent research on ODD also focuses on the importance of irritability and on reaching a consensus regarding which symptoms best identify irritability (Burke et al. , 2014). Burke et al. (2014) introduces the study by explaining how existing data purports that symptoms of ODD represent a unidimensional assembly and are distinct from those of other disorders.

Recently, studies have found conflicting evidence regarding the dimensions ODD symptoms are categorized by, which questions the reliability of assessment using the existing ODD model (Burke et al. , 2014). Also, inconsistencies exist concerning which symptoms of ODD comprise which dimensions (Burke et al. , 2014). Burke et al. (2014) suggests that a bifactor model of the disorder may help solve these conflicts surrounding the concept of diagnostic irritability.

The study tests single and multi-dimensional models of ODD including bifactor and competing models, analyzes various elements of measurement within symptoms, and aims to identify the extent to which specific dimensions relate to each other and general ODD symptoms (Burke et al. , 2014). The study also attempts to determine if there is a distinguishing dimension of irritability within ODD, if one model of ODD is superior to all other models, and if there is an additional general dimension of ODD (Burke et al. , 2014).

ODD symptom data of five community samples of five- to eighteen-year-old boys and girls is evaluated by Burke et. al (2014) using assorted measurement scales and care-giver reports. Methods of assessing symptom presence, frequency, and severity are the Revised Diagnostic Interview Schedule for Children, Parent Version, Child Symptom Inventory-4, Child and Adolescent Psychopathology Scale, Developmental and Well-Being Assessment, and Emory Diagnostic Rating Scale (Burke et al. , 2014). The data is analyzed using five models of ODD OPPOSITIONAL DEFIANT DISORDER:

CASE STUDY AND RESEARCH 7 dimensionality and two models of irritability, which identify irritability as either touchy, angry, and spiteful, or touchy, angry, and frequent loss of temper (Burke et al. , 2014). Burke el al. (2014) concludes that the best model for symptoms of ODD is a general bifactor model in which irritability and oppositional behavior factors exist alongside a general ODD factor, and in which irritability and oppositional behaviors significantly correlate with each other (Burke et al. , 2014).

This model is consistently better across multiple samples and is made up of eight general ODD items, each correlated with either an irritability or an oppositional behavioral dimension (Burke et. al, 2014). The irritability dimension includes temper, touchiness, and anger; the oppositional behavior dimension includes argumentativeness, defiance, annoyance, blamefulness, and spitefulness (Burke et. al, 2014).

Burke et. al (2014) also finds that irritability is most accurately characterized by touchiness, anger, and temper loss. The implications of the results are the emergence of strong evidence for a multidimensionality within ODD, and support for an identification of irritability characterized by loss of temper, touchiness, and anger (Burke et al. , 2014). Although the research is unable to answer potential questions regarding the existence of a third dimension, the initial questions are addressed concerning the underlying structure of symptom dimensions and provide evidence for a superior set of characteristics of irritability (Burke et al. , 2014).

Lastly, Burke et al. (2014) addresses that possible limitations in the study were due to the variability of the questionnaires, the variability of the scaling systems, and the different research structure for boys and girls in the samples. OPPOSITIONAL DEFIANT DISORDER: CASE STUDY AND RESEARCH 8 References American Psychiatric Association. (2013). Section II: Disruptive, impulse-control, and conduct disorders.

Diagnostic and statistical manual of mental disorders (5th ed. ). New York: APA Press. Burke, J. D. , Boylan, K. , Rowe, R. , Duku, E. , Stepp, S. D. , Hipwell, A. E. , & Waldman, I. D. (2014). Identifying the irritability dimension of ODD: Application of a modified bifactor model across five large community samples of children. Journal of Abnormal Psychology, 1-11. Dinolfo, M. & Malti, T. (2013). Interpretive understanding, sympathy, and moral emotion attribution in oppositional defiant disorder symptomatology. Child Psychiatry & Human Development, 44, 633-645.

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