Impulse Disorders: ODD, Conduct Disorder, and IED Overview

Oppositional Defiant Disorder (ODD)

A disorder that impairs the child's life and makes school functioning, friendships, and family life extremely difficult.

Conduct Disorder

A more severe disorder than ODD that includes aggression toward people or animals, destruction of property, stealing, and deceit.

Intermittent Explosive Disorder (IED)

A pattern of behavioral outbursts characterized by an inability to control one's aggressive impulses, which can be verbal or physical.

DSM-5 Criteria for ODD

Must show at least four symptoms for 6+ months in angry/irritable mood, argumentative/defiant behavior, or vindictiveness, with distress or negative impact on functioning.

Common Comorbid Conditions with ODD

ADHD, anxiety, and depression often occur with ODD.

Comparison of ODD and Conduct Disorder

ODD is characterized by anger and defiance, while Conduct Disorder is more severe, aggressive, destructive, and deceitful.

Manifestation of Aggression in IED

Aggression can be verbal or physical and is targeted toward other people, animals, property, or even oneself.

DSM-5 Criteria for IED

Recurrent behavioral outbursts representing a failure to control aggressive impulses, with outbursts grossly out of proportion and not premeditated.

IED outburst feelings

A pattern that commonly emerges is going from rage to remorse... Delayed consequences include feelings of remorse, regret, and embarrassment over the aggressive behavior.

Conduct Disorders characteristics

Conduct disorder is a persistent pattern of behavior in which the rights of others are violated and societal norms or rules are disregarded... abnormally aggressive... leads to destruction of property or physical injury.

Conduct Disorders formula

CD = persistent aggression + rule-breaking + harming people, animals, or property.

DSM-5 Criteria for CD

Must show at least 3 of 15 criteria in the past 12 months (aggression, property destruction, deceit/theft, or serious rule violations) with impairment in functioning.

CD criteria summary

Aggression, rule-breaking, lying, stealing, vandalism lasting 12+ months.

Impulse disorders and suicide rates

Impulsivity and aggression in this population make the possibility of suicide attempts more likely.

Suicide risk factors

Because impulsivity + aggression increase suicide risk.

Assessment tools for ODD & CD

Oppositional defiant and conduct disorder... can be examined more carefully with the questions in Fig. 21.1. They are subsets of an ADHD scale.

Screening tool for ODD/CD

Vanderbilt ADHD Teacher Rating Scale can screen for ODD/CD.

Assessment guidelines for ODD

Identify issues that result in power struggles and triggers... assess the child's view of behavior... explore control, responsibility, empathy, and motivation to change.

Key assessment focuses for ODD

Look for triggers, empathy/remorse, responsibility, and motivation.

Psychosocial interventions for ODD, CD & IED

General interventions include... promote safety, establish rapport, set limits, consistently follow through with consequences, provide structure and boundaries, provide activities to promote purpose.

Intervention strategies summary

Use structure, safety, clear limits, consistency, and purposeful activities.

Techniques for managing disruptive behaviors

Includes behavioral contracts, counseling, modeling, role-playing, planned ignoring, redirection, positive feedback, limit setting, restitution, and—if needed—seclusion/restraint.

Management tools summary

Tools = contracts, role-play, positive feedback, limit-setting, time-out, redirection.