Oppositional Defiant Disorder (OCD) Refers Essay

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One work specifically isolates a type of treatment that is helpful for ODD or milder CD:

In this book our focus is on supportive-expressive play psychotherapy for a particular kind of patient: the school-aged child who meets the criteria for oppositional defiant disorders and mild or moderately severe conduct disorders (DSM-III-R). There are, however, important qualifications. First, the child must demonstrate some capacity for genuine guilt, remorse, or shame about his stealing, lying, or hurting others. Further, he must manifest during the diagnostic evaluation some potential for engaging in a therapeutic alliance; the therapist can best make this judgment by reflecting on the child's willingness to come and interact with her at some level, albeit a negative one. Finally, parental and school cooperation with the treatment plan should be available. We have conceptualized SEPP for children in the spectrum of conduct disorders. This specific approach has not been tried systematically with other patient populations. (Kernberg & Chazan, 1991, p. 24)

Under the ise of qualifications one can see that children must be a of a particular character to seriously gain from the type of treatment suggested (supportive-expressive play psychotherapy) and that in many ways these are the "best case scenario" children, i.e. those who make emotive connections to the people in their environment and feel remorse with regard to their disruptive actions.

Treatment options for children lacking these characteristics seem to be exceedingly difficult, and those who mask these feelings could be hard to spot and easily given up on in treatment. This is especially true of adolescent onset ODD/CD as the nature of the adolescent mind, even with "abnormal" is often associated with limiting culpability, as one does when they are a child by refusing to take accountability for actions, even when guilt is felt. In my opinion this characteristic of guilt should be assumed in many cases as children often gain the ability to lie and manipulate as they age, as a normal aspect of growth and development (for real everyday survival) and therefore should still be given opportunities for treatment options that would normally exclude them based on external assumptions regarding remorse or lack their of. (Kernberg & Chazan, 1991, p. 216)

In other situations children with or without ODD/CD might be unfairly discriminated against as a result of diagnosis, by peers teachers and others or could even be allowed to set a standard of behavior that is far beyond the norm, but is dependant upon the child's diagnosis.
In other words diagnosis with ODD/CD must not be allowed to become a crutch or a free license to produce behaviors that can be altered through treatment and normal cognitive developmental growth. Yet, on the other hand lack of a diagnosis should not challenge a child (and his or her parents) from getting treatment and services they need. Creating simple solutions for this problem is clearly not an option. Very educated, experienced and highly skilled diagnosticians should always be employed to make diagnostic determinations with children. Real environmental factors such as major home changes, unresolved grief or limitations of parenting time need to be addressed and ruled out prior to an assessment for ODD/CD or at the least as an aspect of assessment.

References

Avila, C., Cuenca, I., Felix, V., Parcet, M., & Miranda, a. (2004). Measuring Impulsivity in School-Aged Boys and Examining Its Relationship with ADHD and ODD Ratings. Journal of Abnormal Child Psychology, 32(3), 295.

Dick, D.M., Viken, R.J., Kaprio, J., Pulkkinen, L., & Rose, R.J. (2005). Understanding the Covariation among Childhood Externalizing Symptoms: Genetic and Environmental Influences on Conduct Disorder, Attention Deficit Hyperactivity Disorder, and Oppositional Defiant Disorder Symptoms. Journal of Abnormal Child Psychology, 33(2), 219.

Kernberg, P.F., & Chazan, S.E. (1991). Children with Conduct Disorders: A Psychotherapy Manual. New York: Basic Books.

Loney, B.R., & Lima, E.N. (2003). Chapter 1 Classification and Assessment. In Conduct and Oppositional Defiant Disorders: Epidemiology, Risk Factors, and Treatment, Essau, C.A. (Ed.) (pp. 3-26). Mahwah, NJ: Lawrence….....

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