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Runninghead: Practice Parameters for ODD

Practice Parameters for School Psychologists; Oppositional Defiant Disorder


Lindsay A. Birchall
University of Calgary

Interventions to Promote Social-Emotional and Behavioural Well-Being EDPS 674


Dr. Erica Backenson
January 22nd, 2015

Runninghead: Practice Parameters for ODD


Practice Parameters

Importantly, White & Kratochwill (2004) support the use of practice parameters as a
mechanism to promote the use of evidence based interventions within the field of school
psychology practice and training, (p.99). Fortunately for school psychologists, The American
Academy of Child and Adolescent Psychiatry (AACAP) has created a valuable series of practice
parameters based on ongoing evaluation of scientific literature. These guidelines for school
psychologists promote proficient patient management, assist in ethical decision-making and
describe effective approaches to assess and treat of specific disorders, (Steiner & Remsing,
2007). Although the prevalence of Oppositional Defiant Disorder (ODD) may be considered low,
with an estimation of 3.3% of the population diagnosed with the disorder (APA, 2014), it is
important to note that disruptive behavior disorders are regularly encountered within clinical
practice (Steiner & Remsing, 2007).
Practice Parameters identified by the AACAP for the assessment, diagnosis and
intervention for a child diagnosed with ODD will not be discussed.
Successful Assessment and Treatment of ODD Requires the Establishment of Therapeutic
Alliances With the Child and Family, (Steiner & Remsing, 2007, p.131). Ideally, the clinician
should focus on building a therapeutic alliance with the parents and the child separately, while
avoiding being drawn into any power struggles; this requires patience and perseverance (Steiner
& Remsing, 2007; Steiner, 1997).
Cultural Issues Need to Be Actively Considered in Diagnosis and Treatment, (Steiner &
Remsing, 2007, p.132). There is a substantial body of literature affirming different standards of
parenting in different ethnic subgroups as well as the efficacy and risks of such practices, (Steiner

Runninghead: Practice Parameters for ODD


& Remsing, 2007). This is imperative to consider as discipline and parenting practices often play
an integral part in the development of ODD, (Linensein, 2008).
The Assessment of ODD Includes Information Obtained Directly From the Child As Well
As From the Parents Regarding the Core Symptoms of ODD, Age at Onset, Duration of
Symptoms, and Degree of Functional Impairment, (Steiner & Remsing, 2007, p.132).
Obtaining information about maladaptive behaviours in multiple domains is imperative because
challenging behaviours may occur at differing intensities and frequencies across settings (Steiner
& Remsing, 2007). The school psychologist should also assess if the childs oppositionality is
contextually driven; from experiences of abuse or neglect or excessive and unrealistic
expectations (Steiner & Remsing, 2007).
Clinicians Should Carefully Consider Significant Comorbid Psychiatric Conditions When
Diagnosing and Treating ODD, (Steiner & Remsing, 2007, p.133). Delineating true ODD from
co-morbid disorders, or other disorders (e.g. Conduct Disorder) is an important predecessor to
recommending treatment, (Steiner & Remsing, 2007). For example, rates of ODD are high within
samples of youth with Attention Deficit Hyperactivity Disorder, ODD often precedes Conduct
Disorder and those diagnosed with ODD are at higher risk for substance use disorder, mood
disorders, anxiety and major depressive disorder, (APA, 2014).
Clinicians May Find It Helpful to Include Information Obtained Independently From
Multiple Outside Informants, (Steiner & Remsing, 2007, p.133). Individuals in the childs
environments (e.g. parents, teachers, peers) may be reinforcing avoidant, oppositional or coercive
behaviours, (Linseisen, 2008). Functional Behavioural Analysis is a useful tool to investigate
potential payoffs for disruptive behaviours. Linseisen (2008), recommends considering a
complex reciprocal nature of interactions between the child and their family, peer group,

Runninghead: Practice Parameters for ODD


neighborhood and school, as factors in the development of maladaptive behaviours. Obtaining
information directly from the child, about their behaviour, is also suggested, (Linensein, 2008).
The Use of Specific Questionnaires and Rating Scales May Be Useful in Evaluating
Children for ODD and in Tracking Progress, (Steiner & Remsing, 2007, p.133). A wide
range of instruments and interviews have been developed that measure oppositional behavior and
other forms of aggression in childhood and adolescence in many different settings. Steiner &
Remsing (2007), and Linensein (2008), both identify valid and reliable standardized measures for
this purpose. Linensein (2008) also endorses the use of multiple instruments for diagnosis,
baseline measures and to track response to interventions.
The Clinician Should Develop an Individualized Treatment Plan Based on the Specific
Clinical Situation, (Steiner & Remsing, 2007, p.136). Intervention plans should target all
domains that are assessed as dysfunctional, (Steiner & Remsing, 2007). As recommended by the
AACAP, interventions should be, multitarget, multimodal, and extensive, combining individual
psychotherapy, family psychotherapy, pharmacotherapy, and ecological interventions (including
placement and school-based interventions), especially when symptoms are severe and persistent,
(Steiner & Remsing, 2007, p. 136).
The Clinician Should Consider Parent Intervention Based on One of the Empirically
Tested Interventions, (Steiner & Remsing, 2007, p.136). Among others, strategies such as
reducing positive reinforcement for disruptive behaviours, increasing reinforcement for
compliant and prosocial behaviours and making the parental response predictable, contingent and
immediate show evidential support in the treatment of ODD symptoms, (Steiner & Remsing,
2007; Linseisen, 2008).
Medications May Be Helpful as Adjuncts to Treatment Packages, For Symptomatic
Treatment and to Treat Comorbid Conditions, (Steiner & Remsing, 2007, p.137). At present,

Runninghead: Practice Parameters for ODD


medications for youth with ODD are mostly considered to be adjunctive, palliative, and
noncurative, (Steiner & Remsing, 2007, p. 137). Notably, medication should never be the sole
intervention for ODD (Linseisen, 2008; Steiner & Remsing, 2007).
Intensive and Prolonged Treatment May Be Required If ODD Is Unusually Severe and
Persistent, (Steiner & Remsing, 2007, p.138). Simply, there is no magic cure. Those involved
in provided ODD interventions should be informed of the possibility of long term care, Linseisen,
2008).
Certain Interventions Are Not Effective, (Steiner & Remsing, 2007, p.138). Experts agree
that any dramatic, one-time, time limited, or short-term intervention is usually not going to be

Runninghead: Practice Parameters for ODD


References

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth
Edition. Arlington, VA: American Psychiatric Association; 2013:265-70.
Linseisen, T. (2008), Effective Interventions for Youth With Oppositional Defiant Disorder. In
Franklin, C., Harris, M. B.& Allen-Meares, P. (Eds.), The School Practitioners Concise
Companion the Mental Health (pp.1-15). Oxford University Press, Oxford Scholarship
Online: April 2010. doi:10.1093/acprof:oso/9780195370584.001.0001
Steiner H, ed. (1997), Treating School Age Children, San Francisco: Jossey-Bass
Steiner, H. & Remsing, L. (2007). Practice Parameter for the Assessment and Treatment of
Children and Adolescents With Oppositional Defiant Disorder. Journal of the American
Academy of Child and Adolescent Psychiatry, 46(1), 126-141. doi:
10.1097/01.chi.0000246060.62706.af
White, J. L. & Kratochwill, T. R. (2005). Practical guidelines in school psychology: Issues and
directions for evidence-based interventions in practice and training. Journal of School
Psychology, 43(2), 99-115. doi: 10.1016/j.jsp.2005.01.001

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