Question

NM230 In-Class Case Study 2

Mr. and Mrs. Lahud have come to the clinic to initiate family therapy. The whole family is under stress because their youngest daughter, 10-year-old Elia, loses her temper "almost constantly," the parents say.

"In fact, she seems to be always seething under the surface, even when she's laughing and seeming to have a good time, just waiting to explode. She argues about the simplest things-you can try to give her choices, like, instead of saying, 'time to get dressed for school,' you might say, 'Elia, do you want your green sweater or your yellow one today?' She just starts screaming and says, 'You can't tell me to get dressed!' And she's ten."

Jaival, their new therapist, asks, "Can you tell me how often, on average, you'd say Elia loses her temper? Can you make an average guess at, say, how many times a week?"

Elia's mother says, "It would be easier to estimate how many times per day."

Mr. Lahud nods, "Yes, I'd say about 18 times a day, at least once for every hour that she's awake."

"And that's on a daily basis?" says Jaival.

Both parents nod without hesitation.

"How long has it been like this?"

"Well," Mrs. Lahud tilts her head. "She was always kind of a fussy baby. She's never slept much and has just kind of always thrown tantrums and never stopped."

Jaival takes some notes and then asks, "Is there anything else about her behavior that fits a pattern that's fairly long-standing?"

Mr. Lahud sighs. "It just feels like she wants a big fight, then blames everyone else for something that she started-even when it's clear no one else is even participating in the fight. It's getting to be really hard on the other two kids because she just never lets up from the time she wakes up until late into the night; she tries to annoy us and them pretty equally, and now they're having trouble with her at school too. She's not getting along with other kids there either.

"We've tried positive reinforcement, like a sticker chart for good behavior—"

"-but after a while," Mrs. Lahud adds, "we just took it down. The other two kids would have rows of stickers, but she defies even the simplest of rules, so she'd have maybe one or two stars to their eight or ten. It started to feel like the sticker chart was just making her feel worse about herself. Her teachers say the same thing."

Mrs. Lahud's eyes fill with tears. "We don't know what to do any more. I feel sorry for her. We can't help feel that this is not the 'real' her, if you know what I mean."

She looks at her husband, who nods and squeezes her hand.

"She does some pretty mean, spiteful things to 'get even with everyone.'" Mrs. Lahud continues, "but then the other night, she was quiet and thoughtful when I cuddled with her at bedtime, and while we were alone, she whispered, 'Mom, why does it have to be so hard to be good? It's really hard.'"

She breaks down and cries, and her husband hugs her.

1. Jaival meets with Elia subsequently, and though she is very charming and intelligent at first, she does make an effort to annoy him, but he doesn't take the bait. The next day, with her parents' permission, the school counselor also calls Jaival, asking if she can share some concerns of her own, which confirm for Jaival that Elia's parents have pretty accurately described her behavior. Subsequent testing does not reveal a psychotic or mood disorder, and Jaival initially makes a tentative diagnosis of "oppositional defiant disorder." Do you agree or disagree? What criteria would you cite to support ODD your opinion?
2. What can cause oppositional efiant disorder?
3. Over a period of years, Elia continues to see therapists; and as adolescent hormones are added into the mix, times get a little rougher for her and her family. What kinds of comorbidity might she be at risk for?

Answer 1

1A)

yes i agree, ODD is a condition in which a child displays an ongoing pattern of an angry or irritable mood, defiant or argumentative behavior, and vindictiveness toward people in authority. The child's behavior often disrupts
the child's normal daily activities, including activities within the family and at school.

javal was their new thearapist and he was treating her. javal asks to Elia mother on average, you'd say Elia how many time loses her temper?
- Elia's mother says, "It would be easier to estimate how many times per day."
- Mr. Lahud nods, "Yes, I'd say about 18 times a day, at least once for every hour that she's awake."

Jaival takes some notes and then asks, "Is there anything else about her behavior
that fits a pattern that's fairly long-standing?"

- We've tried positive reinforcement, like a sticker chart for good behavior. but after a while, Mrs. Lahud adds, "We just took it down. The other two kids would have rows of stickers, but
she defies even the simplest of rules, so she'd have maybe one or two stars to their eight or ten. It started to
feel like the sticker chart was just making her feel worse about herself. Her teachers say the same thing."

- The Opinion of Odd is to meet the Diagnostic and Statistical Manual of Mental Disorders, diagnostic criteria for
ODD, the child must have at least four symptoms of angry/irritable mood, argumentative/defiant behavior, or vindictiveness.

2A)

Causes of oppositional defiant disorder :

- ODD typically begins by age 8. It is estimated that 2 to 16 percent of children and teens have ODD. In younger children, ODD is more common in boys. in older children,
it occurs about equally in boys and in girls. Your doctor will also probably wait until your child is at least 4 to diagnose oppositional defiant disorder. This kind of behavior can be normal at 2 or 3 years old, but it becomes a problem if it continues as your child gets older.

- Oppositional Defiant Disorder (ODD) is thought to be caused by a combination of biological, psychological, and social factors. ODD tends to occur in families with a history of Attention Deficit.
Hyperactivity Disorder (ADHD), substance use disorders, or mood disorders such as depression or bipolar disorder.

- Genetically, It has been shown that ODD is likely a hereditary condition and that if an individual has a close relative with this mental illness, they have a predisposition to the development of oppositional defiant disorder. Family history of mental illness.

Children who have ODD will have a well-established pattern of behavior problems, including the following symptoms:

- Being unusually angry and irritable.
- Frequently losing their temper.
- Being easily annoyed.
- Arguing with authority figures.
- Refusing to follow rules.
- Deliberately annoying people.
- Blaming others for mistakes.

3A)

Tough time to Elia and her Family:

- We don't know what to do anymore. I feel sorry for her. We can't help feeling that this is not the 'real' her if you know what I mean."
She looks at her husband, who nods and squeezes her hand. "but then the other night, she was quiet and thoughtful when I cuddled with her at bedtime, and while we were alone, she whispered, 'Mom, why does it have to be so hard to be good? It's really hard.'" She breaks down and cries, and her husband hugs her.

Adolescent hormones :

The hormones that change around puberty starting between age 8 and 14—and last until the early 20s when adolescence
ends may affect you in more ways than you realize.

Dealing someone those who are have ODD :

- Lifestyle and home remedies.
- Recognize and praise your child's positive behaviors.
- Model the behavior you want your child to have.
- Pick your battles and avoid power struggles.
- Set limits by giving clear and effective instructions and enforcing consistent reasonable consequences.

There are no tools specifically designed for diagnosing ODD, but multiple questionnaires can aid in diagnosis while assessing for other psychiatric conditions.
ODD is often comorbid with attention-deficit/hyperactivity disorder, conduct disorder, and mood disorders, including anxiety and depression.

- ODD is treatable, usually with behavioral therapy or a combination of behavioral therapy and medication. Psychotherapeutic: When treating a child for ODD, repairing the parent-child relationship is a priority. This means that parents play a big role in treatment.

Kinds of comorbidity:

- Comorbidity is the simultaneous coexistence of multiple disorders alongside a primary disorder. Common comorbid conditions are depression, anxiety, schizophrenia and addiction. In children, we often see comorbid conditions of ADHD, learning disabilities and others.

- comorbidity refers to the presence of more than one disorder in the same person. For example, if a person is diagnosed with both social anxiety disorder (SAD) and major depressive disorder (MDD),
they are said to have comorbid (meaning co-existing) anxiety and depressive disorders. It's normal to hope that your child will grow out of ODD, but ODD won't go away by itself. Your child needs
professional diagnosis and treatment early on. This will help your child develop the skills he needs to make and keep friends, get and keep a job, and build a support network later in life.