Oppositional Defiant
Disorder: Empirically
Supported Treatments
Rachel J. Valleley, Ph.D.
Assistant Professor
Munroe-Meyer Institute
Nebraska Medical Center
Oppositional Defiant Disorder
 Enduring
pattern of uncooperative, defiant,
and hostile behavior toward authority
figures that does not involve major
antisocial violations.
 Frequently gets confused with ADHD.
Can have both.
Oppositional Defiant Disorder:
DSM-IV Criteria
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Loses temper
Argues with adults
Actively defiant or refuses to comply with adults’
requests or rules
Deliberately annoys people
Blames others for his or her mistakes or misbehavior
Touchy or easily annoyed by others
Angry and resentful
Spiteful or vindictive
Oppositional Defiant Disorder
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Most common diagnosis given in our clinics in
pediatric practices.
Often setting specific
Occurring more with parents or other caregiver
Difficulties with sleeping, eating, and toileting.
Increased risk for other problems
Coercive Family Process
Oppositional Defiant Disorder
 Misconception
that “He’ll grow out of it”.
 Often leads to Conduct Disorders or
antisocial personality disorder.
 Effective early intervention leads to longterm positive outcomes
 No medication that will effectively work
Oppositional Defiant Disorder
In Short:
 Disruptive and defiant behaviors have paid off
• Attention/Reaction
• Removal of demand
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Often test limits
Have not learned prerequisite skill of
complying to authority
Oppositional Defiant Disorder
 Treatment:
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Parent Training: Forehand & McMahon
Parent-Child Interaction Therapy: HembreeKigin & McNeil
Treatment for ODD:
Parent Training
1. Encourage/increase appropriate behavior
 Differential Attention
 Child’s
Game
 Sticker
Charts/Grab Bag Prizes
Treatment for ODD:
Parent Training
 Differential
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attention
Attend to average behavior
Praise exceptional behavior
Treatment for ODD:
Parent Training
 The
Child’s Game:
A relationship-building activity that makes
children want to earn your POSITIVE
attention.
Treatment for ODD:
Parent Training
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DO
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Describe
Reflect
Imitate
Praise
Touch
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DON’T
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Command
Reprimand
Question
Treatment for ODD:
Parent Training
 Sticker
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Charts/Grab Bag Prizes:
Bedtime routine, morning routine
Daily for overall behavior
Magic circle chart
Dot-to-dot’s
Grab Bag Prizes
Treatment for ODD:
Parent Training
 Effective
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Commands:
Simple
Direct
One at a time
Start small
“Do” commands
Treatment for ODD:
Parent Training
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Bad Commands
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“Don’t jump on the bed”
“Bring your shoes to the bedroom, put your clothes in
the hamper, make your bed, and take all the dishes to
the sink.”
“Could you please turn off the T.V.”
“Watch out”
“I need you to pick up the toys because grandma is
coming over.”
Treatment for ODD:
Parent Training
2. Decrease inappropriate behavior
 Time
 Job
out
Card Grounding
Treatment for ODD:
Parent Training
 What
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is time out?
Time out is the removal of attention, tangibles,
or anything interesting to the child for a brief
amount of time.
Treatment for ODD:
Parent Training
 Misconceptions
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and mistakes with time out
Not the chair
Have to sit quietly before time starts
1 minute per year
Think about what did wrong and feel sorry
Talking to child in time out
Not expecting extinction burst
Treatment for ODD:
Parent Training
 How
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to do Time Out:
Stop talking once told “Time Out”
Get to chair/spot with minimal guidance
Do not attend to anything in time out
Stay close enough to monitor but be aloof
Child serves 2-3 minutes
Let child out
Follow up with expecting appropriate behavior
Treatment for ODD:
Parent Training
 Common
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problems with Time Out
My child won’t go/stay in time out
My child does not seem to care that they are
in time out
My child will not be quiet in time out
My child won’t get out of time out
Treatment for ODD:
Parent Training
 Common
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uses for time-out
Noncompliance
Aggression
Rule infractions
Tantrums
Treatment for ODD:
Parent Training
 Compliance
training
 Give command, wait 5-10 seconds. If
comply, praise. If not comply, give time out
warning. If comply, praise. If still does not
comply, time out. After time out, go back to
original command and repeat until
followed.
Treatment for ODD:
Parent Training
 Time
out for aggression and rule
infractions
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Do not use warning
Look for positive behavior immediately
following time out to praise. Create contrast!!
Treatment for ODD:
Parent Training
What is job card grounding?
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Discipline program which requires
children to earn their way off grounding,
rather than simply waiting for time to
pass.
Treatment for ODD:
Parent Training
 Common
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uses of job card grounding
Arguing
Noncompliance
Rule infractions
Treatment for ODD:
Parent Training
 Set
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up for Job Card Grounding
Develop house rules
• Do what you are told
• Be respectful
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Develop list of jobs
Develop list of rewards
Set criteria for earning reward
Treatment for ODD:
Parent Training
 Rule
infraction earns job card
 Grounded from all privileges until job is
complete
 Once job is done, no more discussion of
misbehavior
 Reward for following rules
Treatment for ODD:
Parent Training
Trouble Shooting Job Card Grounding
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What if child argues when given job card?
What if grounding seems to be lasting an
excessively long time?
What do you do regarding extracurricular
activities?
Summary of Treatment for ODD
 Just
as important to increase appropriate
behaviors as it is to decrease
inappropriate behaviors