Ryan is a 12 year old diagnosed with Oppositional Defiant Disorder (ODD). As a small child, Ryan was first diagnosed with Attention Deficit, Hyperactivity Disorder. He had just started preschool and was unable to remain in one place for more than a minute or two. His parents had already had a very difficult time in disciplining him, because he would become very upset and throw temper tantrums when he could not do as he wished. He just seemed to be an unhappy, irritable child. This behavior continued in school. As time progressed, Ryan was diagnosed with Oppositional Defiant Disorder, because he continued to refuse to listen to adults and comply with the rules.

By the age of 12, he has begun to bully and annoy others. His parents have decided that the approaches they have used in the past are not working, and they are more afraid his behavior will only get worse.

 

 

Provide explanations for these questions and statements:

• Describe the behaviors apparent for each disorder in this scenario (Attention Deficit Hyperactivity Disorder and Oppositional Defiant Disorder).
• If this behavior becomes worse and Ryan starts to violate the rights of others, what medical diagnosis will be given and why?
• Discuss at least two types of medication appropriate to treat Ryan and support your choices with rationale and credible resources
• Describe why therapy for the parent is important in this scenario including at least two supporting rationales.

The notable behaviors for ADHD in this scenario include: inattention, hyperactivity, aggression.

Notable behaviors for ODD include: aggression, irritability, defiant behavior, argumentative.

If behavior worsens as he is currently diagnosed with ODD this would be a progression to a new diagnosis of conduct disorder. Conduct disorder is a progression of aggression, irritability and defiant behaviors that start affecting others such as through bullying, stealing, lying , cheating.

Medication management could include: atypical neuroleptics and stimulant medication such as methylphenidate.

Therapy such as parent training and CBT is extremely important to help the child and parent develop strategies to manage and problem solving skills. The child can only be as successful as the parent is in helping to navigate these disorders.

Step-by-step explanation

Medication management: Mostly off label use. Medical management is lacking and used off label for symptom management. There has been evidence of risperdal to be helpful in management. This is an atypical neuroleptic. Risperdal treats the aggressive and irritability symptoms in children with ODD and conduct disorder. Again this is for an off label use. Stimulant medication would be helpful to manage the hyperactivity and inattentive symptoms the child is experiencing.

Therapies are important to not only help the child learn coping skills, problem solving skills and management strategies but to also help the parents learn how to manage condition with the child. This includes social skills training. Trained therapists can see real life interactions between the parents and child and guide them in appropriate verbal responses and collaborative problem solving. See Mayo clinic resource. CBT (cognitive behavior therapy) is also helpful to teach kids ways to evaluate their own thought process and remodel their thinking to produce positive behaviors and outcomes. This type of therapy can also help child learn how to manage stress and how to problem solve. This is important for the parents because it teachs them how to identify a negative thought the child may have resulting in negative behavior and therefore consequence. Parents can then help the child divert negative thinking to positive thinking and subsequent positive behavior. See Johns Hopkins resource below.