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May 14, 2010

Diagnostic Criteria for Oppositional Defiant Disorder

Posted by Nathen under adolescents, antidepressants, Attention-Deficit/Hyperactivity Disorder, children, diagnostic criteria, drugs, DSM-IV-TR, family assessment, family therapy, insurance companies, lists, mental disorders, obedience, Oppositional Defiant Disorder, practicum, psychopathology, psychotropic medication, SSRIs, stimulants
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According to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, Text Revision (DSM-IV-TR), there is a mental disorder that is usually diagnosed in childhood or adolescence called Oppositional Defiant Disorder. It afflicts somewhere between 2-16% of people, more boys than girls before puberty, but equal numbers of boys and girls after puberty. Family therapists are not into giving medical-model diagnoses in general, but in many cases, a DSM diagnosis is the only way for a family to get their insurance companies to pay for them to get help. In one of my internship sites, for example, I will need to provide a DSM diagnosis after the first session with a family in order to get the clinic paid for our work. As I understand it, this is a common diagnosis for kids who are giving their parents and teachers a hard time.

Note that the word “often” is used to mean something like “more than usual,” so whichever kids who are most like this will qualify for this Disorder, as long as someone important believes that their behavior is significantly impairing their social or academic functioning. Note also that these symptoms could be occurring in just one setting (say, just at school) and the kid will still qualify for ODD, unlike the symptoms for ADHD, which have to occur in at least two settings to qualify for the diagnosis.

Outside of family therapy, ODD is very commonly treated with Ritalin for “comorbid” ADHD. Kids diagnosed with ODD are also fairly commonly given antidepressant and/or antipsychotic medication, on the guess that they have an underlying Mood Disorder or Bipolar Disorder, though there is little to no research on these medications for children, especially in combination.

The following is word-for-word from the DSM-IV-TR, page 102:

Diagnosis criteria for 313.81 Oppositional Defiant Disorder

A. A pattern of negativistic, hostile, and defiant behavior lasting at least 6 months, during which four (or more) of the following are present:

(1) often loses temper

(2) often argues with adults

(3) often actively defies or refuses to comply with adults’ requests or rules

(4) often deliberately annoys people

(5) often blames others for his or her mistakes or misbehavior

(6) is often touchy or easily annoyed by others

(7) is often angry or resentful

(8) is often spiteful or vindictive

Note: Consider a criterion met only if the behavior occurs more frequently than is typically observed in individuals of comparable age and developmental level.

B. The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.

C. The behaviors do not occur exclusively during the course of a Psychotic or Mood Disorder.

D. Criteria are not met for Conduct Disorder, and, if the individual is age 18 or older, criteria are not met for Antisocial Personality Disorder.

 

March 4, 2010

Headlines From Psychology, Part 5

Posted by Nathen under advice, behavior reinforcement, children, conformity, decisions, ethics, family, headlines, identity, intelligence, lists, obedience, parenting, psychology, punishment, reading, Solomon Asch, Stanley Milgram, video
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Here’s part 5 of the stuff I learned in my undergrad in psychology that I thought should have been headlines. If you missed them, here are part 1, part 2, part 3, & part 4. As always, if you are interested or skeptical, leave me a comment and I’ll give you my sources.

If You Punish Your Kids, Use the Mildest Effective Punishment: Do the mildest thing you can that stops the behavior you don’t want. The reason is that a punishment that is harsher than necessary takes the child’s initiative for stopping the behavior out of the picture. If you say “Hey, don’t do that,” and the child responds, they come to think that they didn’t really want to do that thing anyway, since such a mild rebuke got them to stop. Psychologists call these principles “insufficient punishment” and “self-persuasion.” These are research findings, not just speculation. If you sit on and beat your child to get them to stop doing something (as suggested by Mike & Debi Pearl), they will believe something more like “That activity was so great that I’ve only stopped because of that horrible punishment.” In other words, the form of the punishment affects the identity of the child–do they behave well because they think of themselves as well-behaved, or do they behave well only because they fear punishment?

You May Want Your Kids To Be Less Blindly Obedient Than Most People: One of the most famous psychological experiments of all time found that most people risked killing someone they barely knew, given an institutional setting and an authority telling them to do it. The Nazis were mostly not evil, just obedient, like most of us.

Humans Can Be Conformist to the Point of Doubting Their Own Senses:

Each Ethical Decision You Make Affects Your Future Ethical Decisions and Your Identity: If you, say, decide to cheat on a test, you will be more likely to cheat on tests in the future, think of yourself as someone who cheats on tests, and form permissive attitudes about cheating. The opposite is true if you decide not to cheat on a test.

Complement Your Kids For the How Hard They Work, Not How Smart They Are: Getting attention for being smart tends to make kids want to appear smart, which makes them choose easier challenges and lighter competition; it’s the success that matters. Getting attention for hard work does the opposite. This means that these kids will end up smarter than the kids who got attention for being smart.

Teach Your Kids to Think About Intelligence as a Fluid Property: That is, teach them that they can become more intelligent by trying. The more they believe it, the more it will be true for them.

If Your Kids Read, Don’t Reward Them For Reading: They will be more likely to stop, if you do, because they will start to think of reading as something they do to be rewarded, not because they like it. If they don’t read, reward them for reading. This goes for other activities, too.