Devon: Oppositional Defiant Disorder

Personal Reaction

I have never fully understood oppositional defiant disorder (ODD). Until I saw this video, I believed that people with ODD choose to act the way the do. I never before believed that people could not control their actions. However, after listening to Devon, I have come to realize that the control does not come easily to everyone. Some people have to be taught anger management techniques and other behavioral management skills so they can control their disorder. I am able to see that Devon shows remorse when he has lost control. In comparison to Ashley, he does seem to fully understand the implications of his actions and does care how his disorder affects how others view him.

Essential Points

Characteristics of ODD. Devon states that he swears too much and gets in fights at school. Devon argues with his parents and has to take medication to help him control his anger. Devon states that he does not think when he fights, he just reacts. Once he becomes angry, he pushes anything that gets in his way. He said it was like he could not control his arms and legs and they react in a way that he did not want. It has taken three teachers to hold Devon down when he is angry. He states that he does not become afraid when he is restrained and often has to be out of the sight of the person who has angered him in order to regain control. Devon knows that kids fear him and that brings him down.

Impact of ODD on Education. Devon has been expelled from his school. He is no longer able to attend the private school that he loves. He states that he misses his old teachers and his friends. Devon often reacts negatively when he is playing sports. He feels that teachers could be more helpful by providing warnings and giving him time and space for regrouping. He feels that teachers who argue with him push the issue too much and cause the problems to worsen. Devon worries about his grades and is afraid his mood disorder will prevent him from playing college basketball and being a NBA basketball star. Other students at school fear Devon, and he has very few friends.

Positive Impacts of Therapy. Devon states that he is now beginning to understand his disorder. In counseling, he is being taught behavior management skills as well as anger management techniques. Devon knows that he has choices when he is angered and knows that he should walk away when confronted. Though Devon still engages in fighting, he is able to calm down once he is pulled off of other kids and teachers. Devon does say that counseling has taught him to calm his anger by counting to ten, thinking of something else to do, or thinking happy thoughts. Sometimes Devon is able to stop his rage when prompted to stop. He does not like getting into fights and tries to forget about them, but counseling helps him to own up to his behavior, as well as helping him to get things off of his chest. Devon knows if he could control his anger, school would be much better and he would not be grounded as much.

Application of the Essential Points

I feel this video helped me to understand oppositional defiant disorder to an extent. I will probably teach students that have anger issues in my classroom to use the anger management tools taught to Devon. I would also be sure to give space to students once I realize that an outburst is about to happen. I will not push students who are being defiant and will give them space to regroup.

DSM Categories: Schizophrenia and Psychotic Disorder

DSM Category 1: Schizophrenia

            Diagnostic Features:

A.    Two or more of the following each being present for a significant portion of time during a one-month period

1.)  Delusions

2.)  Hallucinations

3.)  Disorganized speech

4.)  Grossly disorganized or catatonic behavior

5.)  Negative Symptoms

Note: Only one criterion is required if numbers 1-2 are overwhelming and impede normal functioning.

B.    Social occupational dysfunction: One or more areas of major functioning are affected due to regression

C.   Duration: Continuous disturbance for at least 6 months, with 1 month of Criterion A Symptoms and may include prodromal or residual symptoms

D.   Schizoaffective and Mood Disorder Exclusion: Ruled out due to no major depressive, manic or mixed episodes occurred with active phase symptoms or mood episodes occurred during active phase symptoms for a brief period of time.

E.    Substance/General Medical Exclusion: Disturbance that is not due to drug abuse or a medical condition

F.    Relationship to a Pervasive Developmental Disorder (PDD): If there exists an autism spectrum disorder there must exhibit prominent delusions or hallucinations for at least 1 month.

Associated Features:

1.    Inappropriate Affect

2.    Depression, Anxiety, or Anger

3.    Loss of Interest or Pleasure

4.    Disturbances in Sleep Pattern

5.    Changes in Eating Routine

6.    Abnormal Psychomotor Activities

7.    Concentration, Attention, and Memory Difficulties

8.    Poor Insight towards Illness (manifestation rather than coping)

9.    Depersonalization, Derealization and Somatic Concerns

10. Phobias

11. Motor Abnormalities

12. Short life expectancy (suicide, stress, etc.)

13. Assaultive and Violent Behavior

14. Substance Abuse (Rates of comorbidity are high with Substance-Related Disorder)

15. Other Comorbid Disorders- Anxiety disorders, obsessive-compulsive disorder, panic disorder, schizotypal disorder, schizoid disorder, paranoid personality disorder, etc.

16. An increase has been found due to prenatal and childhood factors, exposure to illness, famine, obstetric complications, etc.

Specific Culture, Age, and Gender Features:

            Culture

Cultural differences should be considered for example delusions in one culture might not be seen as delusions in another. Hallucinations may be acceptable in other cultures (religion, sorcery, witchcraft, etc.). Disorganized speech may be due to not speaking in one’s native tongue. Be cautious of cultural bias and insensitivity.

                        Age

Onset occurs between late teens and mid-thirties, early onset is rare.  Children’s hallucinations and delusions are less elaborate, where as adults most commonly experience visual hallucinations. 

Gender

Proportion of late onset cases is greater in women.  Schizophrenia differs in men and women.  For men the age of onset is 18-25 years old and for women onset is around 25-35 years old.  Women may experience a late life second peak, however women have a better premorbid functioning than men.  Women express more affective symptomatology, paranoid delusions and hallucinations.  Men have more negative symptoms; therefore women tend to have a better prognosis.  There is a higher incidence of schizophrenia in men than in women.

Prevalence:

A worldwide condition that affects 0.5%-1.5% of adults. Also more prevalent in urban born adults rather than rural born adults. 

Course:

May be variable, for instance it could become progressively worse over time, go into remission (complete remission is not common), or be consistently chronic. Positive and Negative symptoms exist.

Familial Pattern:

First degree biological relatives are 10 times more likely to have schizophrenia.  There exist a stronger correlation in identical twins rather than fraternal twins.  Schizophrenia is more likely to appear in biological relatives of individuals with schizophrenia, as well as other mental disorders. 

Differential Diagnosis:

·      Psychotic Disorder due to a general medical condition

·      Delirium

·      Dementia

·      Substance Induced Psychotic Disorder

·      Substance Induced Delirium

·      Substance Induced Persisting Dementia

·      Substance Related Disorders

·      Mood Disorders with Psychotic Features

·      Schizoaffective Disorder

·      Depressive Disorder Not Otherwise Specified

·      Bipolar Disorder Not Otherwise Specified

·      Mood Disorder with Catatonic Disorders

·      Schizophreniform Disorder

·      Brief Psychotic Disorder

·      Delusional Disorder

·      Psychotic Disorder Not Otherwise Specified

·      Pervasive Developmental Disorder

·      Childhood Presentations combining disorganized speech (From a communication disorder)

·      Attention Deficit Hyperactivity Disorder

·      Schizotypal, Schizoid, Paranoid Personality Disorder

Schizophrenia Subtypes

            Subtype 1: Paranoid Type

            Subtype 2: Disorganized Type

            Subtype 3: Catatonic Type

            Subtype 4: Undifferentiated Type

            Subtype 5: Residual Type

            Subtype 6: Schizophreniform Disorder

            Subtype 7: Schizoaffective Disorder

                        Bipolar Type

                        Depressive Type

            Subtype 8: Delusional Disorder

                        Erotomanic Type

                        Grandiose Type

                        Jealous Type

                        Persecutory Type

                        Somatic Type

                        Mixed Type

                        Unspecified Type

            Subtype 9: Brief Psychotic Disorder

            Subtype 10: Shared Psychotic Disorder

            Subtype 11: Psychotic Disorder due to General Medical Condition

                        With Delusions

                        With Hallucinations

            Subtype 12: Substance Induced Psychotic Disorder

                        With Delusions

                        With Hallucinations

            Subtype 13: Psychotic Disorder Not Otherwise Specified (NOS)