Psychopathology Assessment: ODD Case Study Analysis

This assignment presents a comprehensive case study focusing on a six-year-old male client, Barry Simpson, diagnosed with Oppositional Defiant Disorder (ODD). The study details the client's demographic information, reasons for referral, and DSM-5 diagnosis, including diagnostic criteria, features, and severity levels. It explores contributing psychosocial and environmental factors, differential diagnoses, and an overview of the literature pertaining to the diagnosis, including prevalence in Australia, development and course, risk and prognostic factors, and gender-related factors. The case study also examines the functional consequences of ODD and proposes a psychological treatment approach. The analysis includes detailed discussions on the client's behavior, emotional state, and social interactions, providing a thorough understanding of the disorder and its implications.

Running head: PSYCHOPATHOLOGICAL CASE STUDY 1
Oppositional Defiant Disorder
Student’s Name
Affiliation

PSYCHOPATHOLOGICAL CASE STUDY 2
Table of Contents
Subject’s Demographic Information and Reasons for Referral.......................................................3
DSM-5 Diagnosis............................................................................................................................4
Diagnostic Criteria and Features..................................................................................................4
Severity........................................................................................................................................6
Contributing Psychosocial and Environmental Factors...............................................................6
Differential Diagnosis......................................................................................................................7
Overview of the Literature pertaining to the diagnosis...................................................................8
Prevalence in Australia................................................................................................................8
Development and Course.............................................................................................................8
Risk and Prognostic Factors.........................................................................................................9
Gender Related Factors................................................................................................................9
Defiant Culture related to Oppositional Defiant Disorder.........................................................10
Functional Consequences of ODD.............................................................................................11
Psychological Treatment Approach...............................................................................................11
References......................................................................................................................................14

PSYCHOPATHOLOGICAL CASE STUDY 3

PSYCHOPATHOLOGICAL CASE STUDY 4
Oppositional Defiant Disorder
Subject’s Demographic Information and Reasons for Referral
The client, Barry Simpson, is a six-year-old male. Barry joined first grade eight months
ago. He lives with his two parents and two siblings; a younger sister and a brother. No member
of the nuclear family or the extended families of the parents have a history of psychological
disorders. The family lives on the father’s average income and is currently experiencing financial
problems.
The client’s mother referred him for treatment because he gets into problems at home and
school constantly. One of the reasons for this is that the client does not like following rules.
According to the mother and father, the client argues with them often and refuses to do as
instructed or requested. At school, the boy constantly refuses to follow some rules. For instance,
he goes to the pool before it is his turn to go. Because of his disregard for rules and instructions,
Barry’s parents and teachers are finding it difficult to control him.
Second, the client has a small social circle. Barry has one friend and constantly upsets his
parents and siblings. He is easily annoyed and reacts angrily when his requests are not met or
when he is provoked. When his parents deny him a request, the client yells at them until they
give in. Similarly, he often yells at other children at school if they refuse his requests to play with
him. In addition to this, the client is rude.
Reportedly, the client often annoys other people on purpose. At school, he refuses to give
other children their turn in some activities and yells at other students who upset him. At home, he
often interferes with his brother and sister when they are playing. Barry does not like expressing

PSYCHOPATHOLOGICAL CASE STUDY 5
himself in public. For instance, he does not like taking part in play and tell because he fears
ridicule.
DSM-5 Diagnosis
According to testimony by the client’s school psychologist, Barry does not have a
learning disorder. The psychologist indicated that the client’s intelligence level was within the
normal range. At the same time, although the client is poor in writing, he is able to finish
mathematics assignments when he is sufficiently motivated.
Testimony by the client’s medical doctor indicates that his mental disorder is unrelated to
an identifiable physiological cause. His health records indicate that the client is in good medical
condition. The doctor added that the client does not have any medical condition that could cause
the mental problems.
Barry’s mental problems are behavioral and emotional. In terms of behavior, the client is
disrespectful, disobedient and rude. With regard to emotions, the boy has anger problems and is
very shy. Therefore, his condition fits into the category of mental disorders in the F90-F91 ICD-
10 code. Generally, disorders under these codes are described as behavioral and emotional
disorders with onset usually occurring in childhood or adolescence (World Health Organization,
2015). Specifically, Barry is diagnosed with oppositional defiant disorder (ODD) (F91.3). The
next subsections provide details regarding the diagnosis.
Diagnostic Criteria and Features
There are three (A, B and C) diagnostic criteria for an individual with ODD. Criterion A
defines the symptoms of ODD. Specifically, an individual with ODD should have shown a
pattern of irritable mood, defiant behavior, and/or vengefulness that has lasted for at least six

PSYCHOPATHOLOGICAL CASE STUDY 6
months. In addition to this, the individual should have shown at least four of eight symptoms
defined under criterion A. These symptomatic behaviors should have occurred in the presence or
during interaction with at least one person who is not sibling of the subject.
Criterion A lists eight distinct symptoms of ODD. Criterion B requires that the aberrant
behavior result from the individual’s distress or distress to other people in his immediate social
circle or have a negative effect on the individual’s educational or social functioning of the
individual. Finally, criterion C specifies that an individual should be diagnosed with ODD if he
meets criteria A and B and that the aberrant behavior is not related to other related disorders
including substance abuse, psychotic disorders, dysregulation disorder, bipolar disorder and
depressive disorder.
The case subject meets all three criteria described above. First, his pattern of aberrant
behavior has lasted for more than six months; at least one year. Second, Barry has displayed
more than four of the symptoms described under criteria A. First, the interview revealed that
Barry loses his temper often. Second, the patient is easily annoyed. Indeed, Barry is annoyed by
typical events in the course of a child of his age. For instance, he gets very angry and reacts
angrily when his friends at school refuse to play with him. Third, the patient often argues with
his parents and teacher. Fourth, the patient has a tendency to refuse request made by authoritative
figures and often refuses to follow rules at school and at home. Fifth, Barry often annoys other
people deliberately. For instance, he yells at fellow students when they refuse to play with him
and sometimes interrupts his brother and sister when they are playing without invitation. The
patient has also demonstrated the tendency to blame others for his misbehavior or mistakes. For
instance, the mother reported that he blamed his brother for failing to complete his chores.
Finally, the patient has demonstrated a tendency to be vengeful when he feels wronged. For

PSYCHOPATHOLOGICAL CASE STUDY 7
instance, his associates his misbehavior at school to the facts that the teacher yells at him and
sends notes to his parents. At the same time, he yells at his fellow students whenever they refuse
to play with him. Therefore, Barry has shown at least six of the eight symptoms of ODD outlined
under criterion A of the diagnostic criteria (Mangum, 2018).
Next, Barry has satisfied the provisions of criteria B and C. With regard to criterion B, Barry’s
condition appears to affect his educational and social functioning. For instance, while the
patient’s intelligence level is normal, his performance in school is below expectations. With
regard to social functioning, Barry has a very small social circle comprising of one friend only.
Next, the client does not have any of the disorders specified in criterion C of the diagnostic
criteria. Therefore, the patient’s condition is correctly diagnosed as Oppositional Defiant
Disorder (Mangum, 2018).
Severity
ODD’s severity is measured on three levels; mild, moderate and severe. In mild cases,
the symptoms of the disorder occur in only one setting such as at school or at home. In moderate
cases, the symptoms manifest in at least two settings. Finally, the symptoms or some of them are
observed in at least three settings. From the interview with Barry’s mother, Barry’s aberrant
behavior is present in at least three settings. These include at home where he is constantly at odds
with his parents and siblings, at school where he often disturbs the teacher and fellow students
and in public places such as shopping malls. Therefore, Barry’s ODD is severe.
Contributing Psychosocial and Environmental Factors
There are a few factors contributing to the development of Barry’s ODD. First, Barry has
experienced hostile parenting. In the interview, Barry indicated that his parents yelled at him

PSYCHOPATHOLOGICAL CASE STUDY 8
often and sometimes smacked him. The behaviour of the parents could be a response to Barry’s
aberrant behaviour or it could be that the parents have had a poor parenting strategy all along.
Second, Barry has notable social deficiencies. For instance, he is very shy and hates
making public appearances during school activities such as show and tell. Similarly, the subject
has difficulties making friends. Reportedly, the boy has one friend only (Clinic, 2019).
Next, the family is experiencing significant financial difficulties. Only the father is
working and he earns a moderate income. As a result, the family has experienced financial
difficulties that could be a contributing factor. For instance, the family lives in a housing
commission house. All of these factors could influence the development of ODD.
Differential Diagnosis
Differential diagnosis is the process of distinguishing a given disease from others that
have similar clinical symptoms (Frick, 2016). A discussed in the previous subsections, the case
subject was diagnosed with oppositional defiant disorder. This disorder shares closely similar
clinical symptoms with conduct disorders that affect younger children.
All conduct disorders under F90-F91 of the ICD-10 involve persistent and repetitive
aggressive, defiant and dissocial behaviors that surpass the social expectations for a person of a
given age category (World Health Organization, 2015). For children, unsocialized conduct
disorder, socialized conduct disorder, conduct disorder confined to the family context and
oppositional conduct disorder. These disorders are all differential diagnoses for the case subject.
However, there are notable features of each that differentiate them from the diagnosed ODD.

PSYCHOPATHOLOGICAL CASE STUDY 9
Overview of the Literature pertaining to the diagnosis
Prevalence in Australia
Approximately 13.9% of Australians aged 4-17 years have a mental disorder. ODD is
among the most prominent forms of mental disorders in the Australian population. According to
Jones (2017), ODD affects an average of 3.3% of the population across different cultures.
Lawrence et al (2015) conducted a government sanctioned national survey of mental wellbeing
among adolescents and children in Australia. The survey results indicated that approximately 2%
of Australian adolescents and children had conduct disorders. This amounts to 84,000 people in
the two age categories across the country. The disorders were less prevalent among females
(1.5%) than males (2.5%). The problem was uniformly prevalent across age groups. Alaos,
Lawrence et al (2015) conducted a government sanctioned national survey of mental wellbeing
among adolescents and children in Australia.
Development and Course
According to Frick (2019), ODD is a precursor for conduct disorder. This implies that
ODD develops beginning as early as preschool. If it is left unchecked, ODD transforms into
conduct disorders. The first is the childhood onset developmental course whereby dissocial
behaviors emerge before the age of 10 years. The second is the adolescent onset developmental
course whereby dissocial behavior emerges during or at the beginning of adolescence. There are
significant differences in how the disorder develops through the two pathways.
Patients whose Oppositional Defiant Disorder follows the childhood onset course begin
to show dissocial behaviors such as temper tantrums and disobedience early in life. Frick (2019)
writes that antisocial behavior can emerge as early as the first stages of a child’s education. The

PSYCHOPATHOLOGICAL CASE STUDY 10
frequency and severity of dissocial behavior increases with time and the increase continues into
adolescence. In addition, the childhood onset category of patients is more likely than the
adolescence onset category to continue engaging in dissocial and delinquent behaviors into
adulthood.
Risk and Prognostic Factors
Research has shown that ODD is predicted by a combination of psychological, social and
physiological risk factors. The main psychological predictors include difficulties to form
relationships, neglectful parents and poor relationships with parents.
There are multiple biological predictors of ODD. Some of the most common ones include
poor nutrition, chemical imbalances in the brain, parent smoking during pregnancy, alcohol and
substance abuse during pregnancy, and a parent with a history of mental disorders. These and
other biological factors can predispose the development of ODD.
Finally, several social factors can predispose ODD. These include poverty, living in a chaotic
environment, family instability, a history of neglect and/or abuse, and lack of adult supervision
among others. From the interview with the case patient, the child has been exposed to a few of
these social factors including poverty, abuse and family instability.
Gender Related Factors
A study by Burnette (2013) investigated how gender influences the development of
oppositional defiant disorder. The study found that there were little to no differences in the
manifestation of ODD symptoms for males and females. However, the study found that there
were significant differences in how the different predictors of ODD influence the development of
the condition in females and males. First, the study found that violence from an intimate partner

PSYCHOPATHOLOGICAL CASE STUDY 11
is associated with an increased risk of ODD for both genders. Similarly, acceptance by close
members of the family was found to have a negative effect on the risk of developing ODD for
both genders (Burnette, 2013).
On the other hand, several predictors of ODD influence its development differently in the
two genders. Chief among these are emotional responsiveness and physical abuse. In this case,
emotional responsiveness refers to how the responsive the members of the family and social
circle are responsive to the child’s emotional problems. Burnette (2018) found that low
emotional responsiveness increased the risk of ODD for boys more than for girls. On the other
hand, physical abuse increased the risk of ODD for girls more than for boys (Burnette, 2013).
Defiant Culture related to Oppositional Defiant Disorder
There is empirical evidence that cultural factors influence the Oppositional Defiant
Disorder. For instance, Patel et al (2018) found that the cultural impact on Oppositional Defiant
Disorder development is highly visible among African American families. This is because
African American families tend to use emotional withdrawal and corporal punishment for
disobedience. Therefore, the parents instill coping skills and use pain as punishment as opposed
to protecting their children from such factors. This is primarily because African Americans value
obedience more than other cultures in USA. As a result, Patel et al (2018) presents that this
cultural orientation could explain the higher levels of Oppositional Defiant Disorder among
African American children.
In a different study, Canino et al (2010) found that strict supervision and monitoring and
close family relations were associated with low levels of Oppositional Defiant Disorder. These
cultural factors characterize Puerto Rican communities living in USA. While these studies have

PSYCHOPATHOLOGICAL CASE STUDY 12
shown that there could be some relationship between cultural factors and the development of
Oppositional Defiant Disorders, multiple compounding factors such as poverty levels and the
characteristics of the neighborhood could explain the development of Oppositional Defiant
Disorders in the communities where Oppositional Defiant Disorders are more prevalent (Clinic,
2019).
Functional Consequences of ODD
According to Mayo Clinic (2019), a child with ODD may face a number of functional
outcomes. Generally, the child will experience problems at home with his siblings and parents,
and problems at school with other children and teachers. If the individual is old enough to work,
he may have problems at work especially with his supervisors and other authorities. Generally,
ODD patients find it hard to make and keep friends and forming long-term social relationships.
School going ODD patients’ record poor academic performance. At the same time, these
children are more prone to abuse alcohol and other substances. The condition predisposes other
disorders including learning disorder, communication disorder and attention deficit disorder.
These disorders can significantly affect the functional capabilities of an individual in multiple
ways.
Psychological Treatment Approach
According to Frick (2016), ODD is treated using an integrated approach. This approach
mostly involves interventions targeting the patient’s family or caregivers and in some cases the
patient’s teacher(s). Involving family members and caregivers is intended to address any
underlying factors that influence the development of ODD in the family setting. In addition to
this, interventions targeting the family are designed to mitigate the effects of the disorder on the

PSYCHOPATHOLOGICAL CASE STUDY 13
members of the family and to help them cope with the problem. In this context, some of the most
common approaches to treating ODD include social skills training, family therapy, parent
training, teacher training and problem solving training.
For the case patient, the main psychological treatment approach appropriate to his case is
social skills training. Due to his condition, Barry has difficulties interacting with his family
members, teachers and fellow students in a positive way. Social skills training can be used to
teach him how to interact positively with other people. The therapy involves interventions such
as positive reinforcements for changes behaviour in the different social settings that the
individual manifests aberrant behaviour and role-play sessions with the therapist among other
interventions.
According to Mangum (2018), positive reinforcement is an effective intervention for
ODD patients for two important reasons. First, the intervention improves a child’s self-esteem as
the individual takes charge of his behaviour change. Second, positive reinforcement is an
effective approach to return the focus of the individual to important tasks. For instance, a school-
going child can be assisted to focus on academics through positive reinforcements. The
intervention can take several forms. For a young child, even small responses such as hugs, social
recognition, small rewards, and praises have been shown to be effective reinforcements.
Mangum (2018) presents that the patient, his family members and teachers should be involved in
identifying an effective positive reinforcement.
For Barry’s case, it is evident that he has problems at home and at school. His behaviour
at home interferes with the activities and mood of other members of his family. For instance, he
interrupts his siblings when they are playing games thereby disappointing them. At the same

PSYCHOPATHOLOGICAL CASE STUDY 14
time, his parents have described him as a very difficult child to control both at home and in
public places. Therefore, family therapy should be considered to complement social skills
training.
Similarly, problem solving training and teacher training should be considered as
complementary interventions for Barry’s treatment. Problem solving training is intended to equip
a child with skills to handle their problems better. For instance, Barry could be taught to deal
with rejection better through problem solving training. On the other hand, teacher training could
help address any underlying issues in the child’s school that contribute to his condition.

PSYCHOPATHOLOGICAL CASE STUDY 15
References
Burnette, M. (2013). Gender and the development of oppositional defiant disorder: contributions
of physical abuse and early family environment. Child Maltreatment , 195-204.
Clinic, M. (2019). Oppositional Defiant Disorder (ODD). Retrieved October 8Th, 2019, from
Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/oppositional-defiant-
disorder/symptoms-causes/syc-20375831
Frick, P. (2016). Current research on Oppositional Defiant Disorder in children and Adolescents.
South African Journal of Psychology , 160-174.
Mangum, B. (2018). A Case Report of the Treatment of Oppositional Defiant Disorder (ODD) in
a Non0specialist, Resource-limited Environment Using the Co-Care Approach.
Abnormal Psychology and Clinical Psychiatry , 12-17.
World Health Organization. (2015). The ICD-10 Classification of Mental and Behavioral
Disorders. World Health Organization.