Engaging and Treating Youth with Oppositional Defiant Disorder and Conduct

Disorder (and their Parents)

John Sommers-Flanagan, Ph.D.Department of Counselor Education

University of Montana

On behalf of Western Montana Addiction Services – 6/10/14

For more informationEmail: John.sf@mso.umt.edu

Blog: johnsommersflanagan.com

Learning Objectives & Plan

• Briefly review ODD and Conduct Disorder Diagnoses

• Identify and describe two evidence-based relationship strategies for engaging young clients with ODD and/or CD and their parents

• Identify and describe two evidence-based approaches (techniques and models) to treating ODD and CD

• Provide an overview/summary of essential ingredients for “best” practice

Remember ODD Diagnosis . . .

. . . Involves a pattern of . . .

1. angry/irritable mood2. argumentative/defiant behavior, or3. vindictiveness

It lasts at least 6 months as evidenced by at least four symptoms from DSM-5

Remember CD Diagnosis . . .

. . . is a repetitive and persistent behavior pattern in which basic rights of others or societal rules are violated. Three symptoms are needed over the past 12 months involving:

1. Aggression to People and Animal2. Destruction of Property3. Deceitfulness or Theft

4. Serious Violations of Rules

These are “Tough Kids” right?

• Yes, but . . .

• The evidence is clear: If we think of these as tough, difficult, or resistant youth, our outcomes are likely to be poorer

• This is because positive outcomes are based more on relational connection with these youths than specific techniques

• And so, before you get in the room, get straight about . . .

. . . Your Attitude• The “kids” are not tough – the situation is tough

• Young people can track the scent of blame . . . and so unless we ALREADY HAVE a strong and influential relationship . . . Pushing youth to accept responsibility too soon can increase defensiveness

• You really have to battle culture here• Undeveloped brains• Bad attitudes• Disrespectful• Emotionally unstable

Use These EB Relational Ideas• Radical Respect – Satanic Golden Rule

• Radical Acceptance – Rogers and Linehan and 30 min of profanity

• Collaboration – Punching example

• Be transparent (genuine) and non-threatening – This is what I want/know

Questions and Comments

• Now, as we transition from the EB-Relationship factors to EB-Techniques, is a good time for you to pose questions or make comments

Use These EB Techniques• Self-Disclosure and Feedback• Problem-Solving• Brainstorming• Consequential Thinking• Methods for achieving goals using prosocial means

• Asset Flooding• Parenting Interventions• Passionate reinforcement• Boring consequences• Character feedback• Limit-setting, natural consequences, • Regular affection or child-centered play

EST Models (require training)• The Incredible Years:http://incredibleyears.com/

• Multisystemic Family Therapy:http://mstservices.com/

• Functional Family Therapy:http://www.fftllc.com/

• Parent Management Training:http://global.oup.com/us/companion.websites/

0195154290/

EST Models (cont.)

• Overall, jury is out on working most effectively with youth who have ODD and CD diagnoses

• It may be especially important to address the more “treatable” symptoms first (e.g., trauma, clinical depression, substance-related disorders)

Overview/Summary

• EBRs are the foundation for the success of all therapies with these populations

• EBTs can be used separately and in conjunction with EBRs

• EST models are great, but require specialized training

Additional Info• Johnsommersflanagan.com• Books