Oppositional Defiant Disorder and Conduct Disorder CLINICAL PEARLS • Opposition Defiant Disorder (ODD) and Conduct Disorder (CD) are considered a spectrum of disruptive behavior disorders. • First-line treatment should include a culturally-sensitive, family-based therapy. • Conduct Disorder with callous and unemotional traits holds a worse prognosis. • Co-Morbidity with ADHD, anxiety, substance use, depression, and trauma-related symptoms is common. If indicated, pharmacological treatment should focus on co-morbid diagnosis if therapy is not effective. • Medications are typically reserved for severe disruptive and aggressive behavior. RATING SCALES • Vanderbilt Assessment Scales https://www.nichq.org/sites/default/files/resource-file/NICHQ_Vanderbilt_Assessment_Scales.pdf • Children’s Aggression Scale https://www.parinc.com/products/pkey/38 TREATMENT APPROACH Stage 1: Family-based therapy (e.g. parent-child interaction therapy for ODD, multisystemic therapy, functional family therapy for CD) is considered first-line, including school and other systems when indicated.* THERAPY PRINCIPLES 1. Reduce positive reinforcement of disruptive behavior. 2. Increase reinforcement of prosocial and complaint behaviors (parental attention is imperative). 3. Apply consequences for disruptive behavior. 4. Make parental responses predictable, contingent and immediate. 1A: Monitor for treatment response with rating scale. If improvement is noted, continue therapy. Otherwise, follow up with therapist.
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