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Mental Health Toolkit Part 1

Jordan Bodnar, Don Claudio, Gailene Rauser, Tanya Henry, Tessa Wiebe

Faculty of Education, University of Winnipeg

EDUC 5440 – Inclusive Education 1

Amy Rasmussen Waluk, MEd, FTT

September 30th, 2022

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Mental Health Toolkit - Part 1

Background Info on Oppositional Defiant Disorder

The DSM-IV defines Oppositional Defiant Disorder [ODD] as “a recurrent pattern of

developmentally inappropriate, negativistic, defiant, and disobedient behaviour toward

authority figures” (American Psychological Association, 1994). General symptoms of ODD

include: frequent temper tantrums, arguing a lot with adults, refusing to do what an adult asks,

questioning and refusing to follow rules, doing things to annoy or upset others, blaming others

for the child’s own misbehaviors or mistakes, and seeking revenge or being vindictive

(Hamilton & Armando 2008). ODD is more common among children in low-income

households, and more common in boys than in girls. However, it has also been shown that

boys exhibit aggression more overtly than girls, which is a possible reason why ODD is more

commonly diagnosed in boys (Hamilton & Armando 2008).

In the American Family Physician journal (2008), Hamilton and Armando point out

the following commonalities in children with ODD:

● They are found to have substantially strained and negative relationships with their

parents, teachers, and peers.

● They are known to have high rates of coexisting conditions, such as ADHD and mood

disorders.

● A child who is diagnosed with ODD at a young age will often transition later on to a

diagnosis of ADHD, anxiety, or depression.

● They are also at a greater risk of developing Conduct Disorder and Antisocial

Personality Disorder later in life.

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ODD is believed to be a precursor to a more serious behavioural disorder called Conduct

Disorder, mainly because children diagnosed with Conduct Disorder tend to have a history of

ODD. Both disorders share similar features, such as aggression towards other people and

animals, a disregard for the rights of others, and the theft or destruction of others’ property

(Hamilton & Armando 2008).

ODD can be a challenge to diagnose, since the research agrees there is no single

identifiable cause or risk factor. According to Johns Hopkins Medicine (2022), the two

leading theories are:

1. Developmental theory – ODD develops when children are toddlers, if they have

difficulty learning to become independent from parents or caregivers.

2. Learning theory – ODD is from learned attitudes. Children mirror the effects of

negative reinforcement used by parents and other people in power.

A child psychologist or other qualified mental health expert would be responsible for

diagnosing ODD in a child. In general, the child’s behaviour(s) must be present for more than

six months and must not be caused by psychosis or by a mood disorder. As well, the

behaviour must be shown to negatively impact the child’s social, academic, or occupational

functioning (Hamilton & Armando 2008). ODD normally appears in early childhood or

preschool years, but the initial challenge in diagnosing would be to distinguish the child’s

behaviours from normal, “troublesome” behaviours that are developmentally appropriate. It is

agreed that a stable pattern of oppositional behaviour during early childhood often leads to

ODD in elementary school years (Hamilton & Armando 2008).

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Pseudo-student Profile:

Shianne is a 13 year old girl. She is in a grade 7 classroom in Hidden Valley Middle

School. Shianne has two step siblings who also attend the same school in grade 6 and 5.

Shianne has been part of this blended family for the past five years when her father, the

primary caregiver, married her stepmother. Shianne visits her mother on the Moose Lake

Reservation every summer but does not get to see her often during the school year and has

limited contact with other family members throughout the rest of the year.

When Shianne was 9 years old she was diagnosed with ADHD. This was treated with

medication for a few years but she has become resistant to taking the medication in the past

year and takes it infrequently.

Last school year Shianne was removed from class and changed teachers as there was

an incident with her teacher as well as some peers in the classroom. This took place in March

and the rest of the school year seemed to be without any more incidents until the end of June

where some new issues developed.

Shianne’s family discussed concerns regarding her behavior to her pediatrician who

referred her to a child psychologist. It was after several meetings and assessments with the

child psychologist that Shianne was diagnosed with Oppositional Defiant Disorder.

Signs of the mental health concern in the school setting:

Shianne faces many challenges in life as she has ODD. Shianne is often angry and in

an irritable mood. She quickly loses her temper and is easily annoyed by those around her. In

turn, she purposely annoys and upsets those who are around her. Shianne has a difficult time

making friends as her classmates shy away from befriending her. If she gets in trouble for her

behavior, Shianne is unable to take responsibility and blames her “friends”. Shianne’s peer
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group sees how she treats her teachers and other people in authority. They see how she defies

or refuses to comply with adult requests and rules. Shianne’s peers have observed that she is

frequently spiteful or vindictive. These are common behaviors attributed to ODD (Mayo

Foundation for Medical Education and Research, 2018)

Shianne’s behaviors make going to school difficult for her. Other students do not wish

to be around her for any length of time as she is not pleasant to spend time with. Things

always need to be her way, otherwise she gets angry and starts saying mean things.

Unfortunately, Shianne doesn’t have any strong friendships/relationships. She sabotages the

friendships she has by always blaming others when something goes wrong. She does not take

responsibility for her behavior as it’s always someone else’s fault. Shianne is very

disrespectful to her teacher’s and other adults in authority. She enjoys having a friendly chat

with her teachers or supporting EAs, but as soon as there is an expectation of any sort,

Shianne becomes defiant and refuses to comply with what is asked of her. Eventually

Shianne’s peer groups start excluding her from participating in any activities. They no longer

want to have her around them and begin to make up rumors about her.

ODD affects Shianne’s school work. She has a very difficult time focusing on her

work and rarely completes her assignments. When support is offered to her, Shianne rudely

turns down the offered help and says that she’ll do it later or at home. However, it rarely

happens. There is always an excuse as to why she couldn’t complete her work. Shianne’s

marks are very low, and she barely squeaks by in her classes.

Physically Shianne is not doing well. Her self esteem is low, and it shows in the way she

carries herself. She has started to think about turning to the use of substances. Once is a while,

she even thinks about suicide.

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Impacts and risks to learning environment

There are many impacts and risks to a child’s learning environment when living with

Oppositional Defiant Disorder. Often these risks are more social in nature than academic.

Children living with ODD have difficulty forming relationships with adults and peers. This is

due to their struggle to be in control and increased occurrences of arguments or tantrums with

the people around them. Other children may be more hesitant to build a relationship with a

child living with ODD because of the disruption caused during classroom activities. Females

are more likely to lie and be uncooperative, while males often argue and lose their temper

more. (ODD-AACAP. 2009) It should be noted that the peers of a child living with ODD are

impacted by disruptive outbursts, verbal aggression towards teachers and other adults in the

room, intent to annoy or upset others, and refusal to comply or follow rules. This often

requires adult attention be more focused on the child living with ODD, in order to prevent or

react to a disruptive outburst, thus taking away from the other students access to adult support

and learning opportunities.

Teachers who work with students living with ODD must be knowledgeable in what

ODD is, how to work with students who live with ODD and what it may look like in the

classroom. It is also important that teachers view students through a lens of the whole child,

and that they know they need to demonstrate patience in all situations and remind themselves

that they cannot take this child’s behavior personally. These children need an adult in their life

who is calm and patient, firm but fair with rules and boundaries, and will show up for them

day after day.

Children living with ODD are often also diagnosed with ADHD, anxiety, and mood

disorders. This may also affect the child’s ability to complete academic tasks, participate
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socially in classroom activities or build relationships during breaks and other unstructured

times.

Interventions

A behavioral intervention plan has been created to support Shianne to develop

sufficient self-control and social skills to thrive in various learning spaces. The behavioral

intervention plan consists of clear interventions. A consistent collaborative planning time with

classroom teachers, student service teachers, clinicians, EA's, administrators and the child's

safe adults will be key in successful outcomes in Shianne’s well being and becoming.

Soft Landing

● Shianne will enter the building and go directly to the resource room to touch base

with Student Service Teacher/Counsellor.

● Mindfulness activities such as relaxation and imaging can be facilitated and led by

SST.

EA 1 on 1 support

● Shianne will meet with the EA at the beginning of class to go over work and any

change in routines.

● EA will go over the visual schedule with Shianne.

● EA will use a timer as a way to structure work time.

Programming

● Teachers have programmed learning activities that allow student choice when

appropriate.
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● Teachers have leveraged breakout spaces to regulate Shianne unexpected blow ups.

● Programming will integrate Social Emotional Learning and Cultural Responsiveness

in daily lessons and curriculum.

● Teachers has programmed with positive alternatives to high risk activities particularly

replacing unstructured activities that involve physical contact.

Clinician Support

The school psychologist will continue to attend regular meetings with the school team

to provide support and strategies that may be beneficial to Shianne’s development.

Community and Home Support

In collaboration with the family, Family Services will help support and identify

resources required such as

o crisis support during the times Shianne is out of control within the home
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References

American Academy of Child and Adolescents Psychiatry . (2019). Odd - AACAP.

https://www.aacap.org/App_Themes/AACAP/docs/resource_centers/odd/odd_resource
_center_odd_guide.pdf. Retrieved September 30, 2022, from
https://www.aacap.org/App_Themes/AACAP/docs/resource_centers/odd/odd_resource
_center_odd_guide.pdf

Diagnostic and Statistical Manual of Mental Disorders. 4th ed. rev. Washington, DC:
American Psychiatric Association; 1994.

Education and early childhood learning. Student Services | Manitoba Education and Early
Childhood Learning. (n.d.). Retrieved September 27, 2022, from
https://www.edu.gov.mb.ca/k12/specedu/bip/sample.html

Hamilton SS, Armando J. Oppositional defiant disorder. Am Fam Physician. 2008 Oct
1;78(7):861-6. PMID: 18841736.
https://www.aafp.org/pubs/afp/issues/2008/1001/p861.html

Mayo Foundation for Medical Education and Research. (2018, January 25). Oppositional
defiant disorder (ODD). Mayo Clinic. Retrieved September 30, 2022, from
https://www.mayoclinic.org/diseases-conditions/oppositional-defiant-disorder/diagnosi
s-treatment/drc-20375837

The Johns Hopkins University. 2022. Oppositional Defiant Disorder (ODD) in Children.
Johns Hopkins Medicine.
https://www.hopkinsmedicine.org/health/conditions-and-diseases/oppositional-defiant-
disorder