Running head: OPPOSITIONAL DEFIANT DISORDER: ISSUES i OPPOSITIONAL ... · Oppositional Defiant Disorder: The issues and interventions for positive behavior management This is to certify

Running head: OPPOSITIONAL DEFIANT DISORDER: ISSUES i

OPPOSITIONAL DEFIANT DISORDER: ISSUES AND INTERVENTIONS FOR POSITIVE

BEHAVIOR MANAGEMENT

Derek Cornett

A Capstone Project submitted in partial fulfillment of the

requirements for the Master of Science Degree in

Counselor Education at

Winona State University

Academic Semester, Fall 2012

Running head: OPPOSITIONAL DEFIANT DISORDER: ISSUES ii

Winona State University

College of Education

Counselor Education Department

CERTIFICATE OF APPROVAL

__________________________

CAPSTONE PROJECT

___________________

Oppositional Defiant Disorder: The issues and interventions for positive behavior management

This is to certify that the Capstone Project of

Derek Cornett

Has been approved by the faculty advisor and the CE 695 – Capstone Project

Course Instructor in partial fulfillment of the requirements for the

Master of Science Degree in

Counselor Education

Capstone Project Supervisor Name: ________________

Approval Date: ________________

Running head: OPPOSITIONAL DEFIANT DISORDER: ISSUES iii

Abstract

Children who are diagnosed with oppositional defiant disorder continue to be a struggling

population in schools for educators. The purpose of this paper is to propose an integration of

Choice Theory and operant conditioning to work with students identified as ODD, and to discuss

how utilizing them together in the classroom may be a positive and effective approach to modify

student’s problem behaviors associated with ODD. Evidence has show brain functioning deficits

in children who are diagnosed with ODD in relation to executive functioning and making

positive behavioral choices. Choice Theory and operant conditioning have the potential to work

together and modify behavior positively in the classroom to create a better learning environment.

Running head: OPPOSITIONAL DEFIANT DISORDER: ISSUES iv

Table of Contents

Introduction ……………………………………………………………………………………….1

Review of Literature ……………………………………………………………………………...3

Oppositional Defiant Disorder ……………………………………………………………3

Characteristics of ODD……………………………………………………………3

Neuropsychology & ODD………………………………………………………...5

Current Treatment Methods….……………………………………………………9

Treatment in Schools…….….…………………………………………………...11

Choice Theory ……………………………………………………………………...........11

The basic needs…….…….….…………………………………………………...11

Relationships……….…….….…………………………………………………...14

Quality World..…….…….….…………………………………………………...15

Treatment with Choice Theory and Reality Therapy….………………………...16

Operant Conditioning ……………………………………………………………………16

Reinforcement versus Punishment……..………………………………………...17

Length of Reinforcement………………………………………………………...19

Choice in Operant Conditioning………………………………………………....19

The brain and operant conditioning…...………………………………………....20

Case Study Using Integrated Theory.....…………………………………………………………22

Limitations…………….....………………………………………………………………………29

Conclusion…………….....………………………………………………………………………30

References……………………………………………………………………………………….31

Running head: OPPOSITIONAL DEFIANT DISORDER: ISSUES 1

Oppositional Defiant Disorder:

Issues And Interventions For Positive Behavior Management

One of the main roles of teachers in the classroom is behavior management. Teachers

provide education and assistance to students on a daily basis and often times meet challenges in

doing so. Behavioral disorders can be one of the main challenges of teachers in today’s

classroom according to Keenan (2012). Keenan examined the common referral reasons for

children to mental health clinics; Oppositional Defiant Disorder (ODD) was one of the main

reasons for referral.

Keenan (2012) identified that ODD is defined by the persistence of symptoms such as

loss of temper, annoying others, defiance, and blaming others. The DSM IV-TR (2000) is the

diagnostic tool used for diagnosis of ODD in children and identified the specific criteria and

symptoms. The criterion for ODD to be diagnosed is a pattern of symptoms over a period of at

least six months. These symptoms included arguing, refusal to comply, blaming, and

resentfulness. In the study of 200 3-5 year old pre-school students, who exhibited such

symptoms, Keenan found that misclassification of individuals can often occur. The author noted

that early testing could result in diagnosis leading to modifications needed for development. In

the same study, Keenan also examined how ODD has characteristics similar to those of

childhood disorders including conduct disorder (CD) and attention-deficit/hyperactivity disorder

(ADHD). These similarities could lead to misdiagnosis of these childhood disorders amongst

mental health professionals. School counselors and school psychologists must work together

with teachers to clearly identify such symptoms in students in order to provide proper diagnoses,

and define appropriate comprehensive functional intervention plans including behavior

management techniques for these students to succeed in the classroom. Choice Theory provides a


framework for behavior interventions with students in the classroom and could be a successful

tool when working with children diagnosed with ODD.

Mason and Duba (2009) studied the effects of Choice Theory and Reality Therapy in

schools in relation to the American School Counselor Association’s National Model. The authors

connect the Quality World aspects of Choice Theory in relation to the academic, personal/social

and career aspects of the ASCA Model. In Choice Theory, the creator, William Glasser, focused

on student’s basic needs and how students go about fulfilling those needs (Glasser, 1988). Mason

and Duba pointed out research-based evidence supporting the techniques of Choice Theory and

Reality Therapy in schools and how the emphasis on choice and relationships can correlate to

behavior that is more positive. The authors also point out how school counselors who utilize

Choice Theory can create opportunities for the students along with how the student addresses

choices in their life. These characteristics of Choice Theory can be used with students diagnosed

with ODD to modify their behavior in positive ways. Another possible intervention for children

diagnosed with ODD is the use of operant conditioning.

Kirsch, Lynn, Vigotito, and Miller (2004) studied Operant Conditioning and its

examination of cognition in relation to behavior. They noted the main goals of Operant

Conditioning are to predict and modify behavior. They studied how behavioral change can be

evoked through a response and outcome. Kirsch et al. also discussed how operant conditioning

utilized positive and negative reinforcement for choices in order to modify behavior and make it

more predictable. There are other cognitive methods that can be applied with operant

conditioning such as systematic desensitization and placebo effects, which are covered in Kirsch

et al.’s study. The use of reinforcement through the operant conditioning model can possibly lead

to behavior that is more predictable with students who are diagnosed with ODD. An intervention


with clear and consistent expectations for behavior can be established as a positive behavior

approach with students with ODD.

When working with children who are diagnosed with ODD, it is important to understand

their cognitions and why they are making the choices they are. With the methods of Choice

Theory, school counselors and teachers will have the ability to identify such choices, and

examine them with the student to help the student weight both positive and negative outcomes.

These outcomes can then be reinforced through Operant Conditioning to modify the behavior

and make it more predictable. Therefore, the purpose of this paper is to propose an integration of

Choice Theory and Operant Conditioning to work with students identified as ODD, and to

discuss how utilizing them together in the classroom may be a positive and effective approach to

modify student’s problem behaviors associated with ODD.

Literature Review

Oppositional Defiant Disorder

Characteristic of ODD.

According to the Diagnostic and Statistical Manual of Mental Health (DSM IV-TR)

(2000), Oppositional Defiant Disorder (ODD) is defined as:

A recurrent pattern of negativistic, defiant, disobedient, and hostile behavior towards

authority figures that persists for at least 6 months (Criterion A) and is characterized by

the frequent occurrence of at least four of the following behaviors: losing temper

(Criterion A1), arguing with adults (Criterion A2), actively defying or refusing to comply

with the request or rules of adults (Criterion A3), deliberately doing things that will

annoy other people (Criterion A4), blaming others for his or her own mistakes or


misbehavior (Criterion A5), being touchy or easily annoyed by others (Criterion A6) ,

being angry and resentful (Criterion A7), or being spiteful of vindictive (Criterion A8) (p.

100).

The criterion for this diagnosis is met through a frequent exhibition of such behaviors over a

period of at least six months in relation to their developmental stages according to the DSM IV-

TR. The DSM IV-TR also pointed out how persistent resistance and unwillingness towards peers

and adults are instances of defiant behaviors. ODD has other characteristics that are important to

note with the diagnosis in regards to age, gender, familial patterns, differential diagnosis, and

causes.

As the DSM IV-TR (2000) stated, ODD is diagnosed through the persistence of specific

defiant behaviors towards authority. There are other specifics that go into this diagnosis

including age and gender. Supporting Keenan (2012), the DSM IV-TR also noted the

occurrences of ODD amongst pre-school children through adolescents. De Moura and Burns

(2010) examined the behavior of kindergarten children diagnosed with ODD and wanted to

identify toward whom the target of the defiant behaviors were. They noted how the target of the

behavior might differ at various stages of development and relative age. De Moura and Burns

studied how the behaviors started with parents before kindergarten, progressed towards peers and

siblings during childhood, and then moved on to teachers and authority figures at school

adolescence.

This course of behavior is consistent with a pattern as highlighted by the DSM IV-TR

(2000). The manual suggested how the behavior starts in the home setting and over time might

appear in other settings. The DSM IV-TR stated that between 2% and 16% of children have

symptoms of ODD. These findings were reported by parents and educators to identify patterns


of behavior and prevalence. The cause of ODD is an issue of controversy as parenting as well as

brain functioning has been considered as potential causes.

The DSM IV-TR (2000) reported the prevalence of ODD is higher for children among

families in which at least one parent also had a history of mood disorders. The researchers also

pointed out how mothers who have disorders such as depression may be more likely to have

children with ODD. The most common relationship between ODD and familial factors is the

correlation between children with ODD and families with marital dissension. Even so,

Youngwirth, Harvey, Gates, Hashim, and Friedman-Weieneth (2007) researched and suggested

there is more to ODD than just familial patterns.

Neuropsychology & ODD.

One theory about the cause of ODD is focused more on brain development and

functioning. Brain functioning can be tested in multiple ways. Oosterlaan, Scheres, and Sergeant

(2005) used psychological testing and intelligence tests to study children diagnosed with ADHD

and ODD. Youngwirth et al. (2007) included a behavior assessment and a neuropsychological

ability test when they tested children diagnosed with ADHD and ODD. Both of these studies

looked to identify executive functioning impairments with diagnoses of ADHD and/or

ODD. They both had similar difficulties related to executive functioning, but found different

types of difficulties as results in relation to diagnoses of ADHD and/or ODD.

Oosterlaan et al. (2005) performed a study on three groups of children diagnosed: those

diagnosed with only ADHD, those diagnosed with only ODD, and those with a comorbid

diagnosis of ADHD and ODD. They looked at executive functioning differences, defined as a

cognitive process of execution, verification, goal directed behavior, and planning. They noted

the prefrontal cortex of the brain served as the main catalyst for executive functioning. Reports


suggest the impairments in executive functioning occur in correlation to a diagnosis of ADHD

where ODD may also be present.

Oosterlaan et al. (2005) pointed out the similarities between the diagnoses of ADHD and

ODD along with their frequency to accompany one another in the diagnosis of a child. The

impairment of executive functioning could be due to deficits caused by a diagnosis of just

ADHD, caused by deficits of a diagnosis of just ODD, or could be impaired by both diagnosis.

Their study reported that executive functioning impairments were not reported in the children

diagnosed with ODD. An ADHD diagnosis was associated with more errors in executive

functioning. Youngwirth et al. (2007) performed a study using similar methods of assessments of

behavior and neuropsychological functioning and found different results.

Youngwirth et al. (2007) performed a study on the neuropsychological abilities of

preschool-aged children diagnosed with ADHD and/or ODD. The authors noted high frequency

of a diagnosis of ADHD and ODD amongst preschool-aged children. They also pointed out the

persistence of each diagnosis stating that children who meet the criteria at the ages of four and

six are likely to meet the criteria for the diagnosis for the next two to three years. Youngwirth

discussed executive functioning in relation to children diagnosed with ADHD and ODD.

Youngwirth et al. (2007) discussed executive functioning and the processing that goes

into cognitive abilities such as: self-regulation, goal-directed behavior, planning, and cognitive

flexibility. The authors noted how these abilities could be impaired due to diagnoses of ADHD

and ODD. Their study reported some similarities between executive functioning with children

diagnosed with ADHD and ODD but further research was needed. They discussed how the

reports showed executive functioning deficits in children diagnosed with only ADHD and some

have found that children with ODD also have deficits in executive functioning. The authors also


pointed out how neuropsychological impairments can be identified through testing. A more

recent study by Hobson, Scott, and Rubia (2011) studied executive functioning of children

diagnosed with ODD.

Hobson et al. (2011) noted how often diagnoses of ADHD and ODD overlap with one

another. There are behavioral similarities that are tied into both of these diagnoses in relation to

how children behave and respond to adults. The authors discussed the neurological similarities

and differences between individuals diagnosed with ADHD and ODD namely deficits in the

prefrontal cortex. Hobson and colleagues point out the lack of research done on ODD

independent of ADHD in relation to executive functioning and how their study would aim to

research this subject group.

Hobson et al. (2011) noted research done by Oosterlaan in relation to executive

functioning and had different findings. The authors had two separate categories of

functioning. Cool functioning was related to sustained attention, response execution, and motor

inhibition. Hot functioning was related to risky decision-making. The research concluded that

children diagnosed with ODD were more likely to have hot functioning deficits rather than

children diagnosed with ADHD. The results of these analysis found that children diagnosed with

ADHD do have executive functioning concerns but when ODD was independent of ADHD,

there were also executive functioning impairments. The authors pointed out how these results are

concurrent with MRI testing done in other studies relating to executive functioning.

Fahim, He, Yoon, Chen, Evans, and Perusse (2011) also studied the neuroanatomy of

children who have exhibited disruptive behaviors. They noted the atypical thought patterns of

children diagnosed with ODD, which may lead to mistakes in decision-making. Fahim et al. also

pointed out the issue of comorbidity of disorders of children diagnosed with ODD in relation to


anxiety and depression, and to ADHD. The authors noted how anger and disobedient behavior

were areas of ODD, which needed to be studied. Their study through MRI scanning and IQ

testing found evidence that activity in specific areas of the brain is related to specific disorders

such as conduct disorder (CD) and ODD. The cerebral cortical thickness was observed as being

thinner in the brains of children who exhibited disruptive behavior disorders, including ODD.

Fahim et al. (2011) also examined violent behavior and its correlation to brain

functioning. They noted the prefrontal deficits in humans in relation to how this area of the brain

has an effect on behavior. The results showed how the subjects reacted impulsively and

aggressively to situations which may be based off emotional responses. Fahim et al. reiterates

the importance of a differential diagnoses between disorders such as conduct disorder (CD) and

ODD. The neural findings from neural imaging of brain functioning support his reasoning in

relation to how the subjects escalated and have persistent disruptive behaviors. They note the

findings suggested that children diagnosed with ODD lack control over their actions due to the

overstimulation of the front cortex (Fahim et al.) After this overstimulation, individuals with

ODD lose control, which authors suggest lead to their lack of judgment and poor decision-

making.

These findings continue to bring up questions on the brain functioning and subsequent

diagnoses of children with ODD. The similarities and differences among children diagnosed

with ODD, CD, and ADHD continue to be the subject of debate (Oosterlaan et al., 2005;

Youngwirth et al., 2007; Hobson et al., 2011; and Fahim et al., 2011). These studies support the

need for ongoing research of the neuropsychological effects of the brain on children diagnosed

with ODD and their level of functioning. With brain functioning possibly being an issue for

children diagnosed with ODD, there are multiple treatments when working with these children.


Current Treatment Methods.

Research-based recommendations in areas of pharmacological and behavior management

have been delineated for the treatment of ODD. The pharmacological method of treatment is

similar to the treatment of ADHD. Turgay (2009) examined such pharmacological treatments of

both ODD and ADHD. The author discussed the importance of treating ODD early with

medication, as ADHD is often times a concurrent diagnosis with it. Turgay pointed out psycho-

stimulant medications like Adderall, Concerta, and Ritalin as appropriate pharmacological

treatments for a longer period of time, but do not show significant improvements if used on a

short-term basis. While pharmacological treatments have shown success, there are other

approaches to treatment. This study is aimed to identify more behavioral approaches to working

with families and children diagnosed with ODD.

Larsson, Fossum, Clifford, Drugli, Handegard, and Morch (2008) conducted a study on

treatment for children diagnosed with ODD and discussed how medication for ADHD was used

regularly in the subjects as a positive treatment method. Larsson et al. utilized two separate types

of treatment; that is, one for parents and one for children. The parent training was a twelve-week

process including weekly meetings for two hours. The training included methods in discipline,

parenting skills, coping with stress and also ways to build their children’s skills. Larsson et al.

examined how the therapist and the families worked in collaboration on the similar issues they

had with their children. The child therapy treatment worked directly with the child and their

ODD diagnosis.

A group therapy method for the children in the study who were diagnosed with ODD

involved on improving conflict resolution and social skills with peers (Larsson et al., 2008).

Larsson et al. used role-plays, vignettes, and discussions as ways for the children to interact.


While the child therapy group was meeting, the parent-training group was also working on the

same topics to allow for the families to make progress together. The study was able to conclude

that there were reductions of aggressive behaviors in multiple settings. There were also

improvements over a period of time with the child’s behavior due to parent reporting from these

methods. With the effectiveness of parent training, MacKenzie (2008) also utilized the method

when working children diagnosed with ODD and their parents.

MacKenzie (2008) discussed how Behavioral Parent Training (PBT) has been validated

through research as a positive intervention for ODD. She pointed out how setting, groups,

individual therapy, and techniques are all utilized as ways to treat ODD with families. The

functioning of the child is the most important aspect of PBT. The training of the parents is also

an important aspect covered by MacKenzie in order for them to distinguish between positive and

negative behaviors and also being able to respond to them appropriately. Kelsberg and St. Anna

(2006) also emphasized the importance of parent training including behavioral therapy for the

child diagnosed with ODD.

Kelsberg and St. Anna (2006) noted the positive results of parent training, parent

modeling, and individual therapy with the children. They also noted a decrease in disruptive or

aggressive behaviors over a continued period of time when appropriate parenting and behavioral

skills were utilized. These findings support the approach to work parents and the child on ways

to modify their behavior in specific settings. Behavioral therapy was cited as a way to decrease

disruptive behaviors through the findings. The behavioral approach included problem solving,

skills training, and cognitive-behavioral therapy. The authors found that an array of methods that

helped to help with treatment of the individual in the home setting, and some of these methods

can be transformed to the treatment of children diagnosed with ODD in schools.


Treatment in Schools.

While parent training may be an important part of the treatment of students with ODD,

schools still need strategies to work with students with the ODD diagnosis. Two plausible

treatment methods that could be integrated to work with students with ODD in the school setting

are Choice Theory and operative conditioning. These two treatment methods work towards

predicting and modify behavior of the individuals.

Choice Theory

Choice Theory was developed for the school setting and provides a framework to

working with students about choices even after they are made. Cameron (2009) examined the

basic foundations of Choice Theory, which was created by William Glasser. Glasser (1988)

created Choice Theory and used Reality Therapy as a way to work with individuals on analyzing

their choices and behaviors in relation to five basic needs. There is an examination process of

choices being made by the individual before and after choices occur. Cameron expressed the

importance that Glasser put on the five basic needs as the driving force for an individual in their

life and how the choices the individual makes influence these needs. These basic needs fulfill

what Glasser referred to as the quality world. Mason and Duba (2009) also supported Glasser’s

Choice Theory when working with students on how to meet their individual needs. The

relationship piece of Choice Theory and Reality Therapy is also a major focus and something to

utilize when working with children who are diagnosed with ODD.

The basic needs.

Cameron (2009) researched the five basic needs of Choice Theory. These needs include:

survival, love and belonging, power, freedom and fun. These five basic needs coincide with one

another in and individual’s life in order for them to fulfill those needs in their quality world.


Glasser (1988) examined how individuals make choices to fulfill each of these basic needs and

rationalize their choices in their mind. Mason and Duba (2009) also discussed the motivation for

these needs to be meet by an individual. As these five basic needs are defined, they can all apply

to some of the behavior concerns that are symptoms of ODD. Taylor (2001) wrote about the

change from defiance to cooperation. He noted some of the basic needs in his book as driving

forces for children who are diagnosed with ODD. Power was discussed thoroughly as a need

that children who are diagnosed with ODD thrive to have by any means.

Rapport (2007) defined the basic need of power as the ability to feel important along with

being respected and recognized by those in an individual’s quality world. The basic need of

power ties directly in with ODD as children who are diagnosed with ODD have issues with

authority. According to Cameron (2009), the helplessness that goes along with the lack of this

basic need could drive individuals to have a loss of control. This loss of control ties into the

earlier research, which stated how individuals who are diagnosed with ODD could then make

decisions leading to negative consequences (Fahim et al., 2011). The basic need of freedom

relates to the basic need of power and how much control and individual has on their own life.

Cameron suggests that the ability to make a choice is the basic need of freedom. This is directly

connected with the need of power. When an individual has the ability to choose or make choices

over the individual’s life, the need of freedom is met which can also lead to meeting the basic

need of power or having control in one’s life. Rapport also pointed out how freedom can lead to

major choices in one’s life. He stated how the choices in one’s life could either conform to

norms or create new ones. When working with children diagnosed with ODD, these needs have

to be carefully looked at and not judged.


Survival is another basic need covered in Choice Theory that can apply to children

diagnosed with ODD.

Rapport (2007) defined the basic need of survival as the most primitive need. This is the

basic need for food, shelter, and clothing, and the need to live everyday and have security of your

life. Taylor (2001) described survival as the autonomy of everyday life for the child diagnosed

with ODD. He noted how important autonomy was for the child to survive through the basic

needs that must be met. He portrayed a four-legged table that stressed importance of having the

routine of and self-confidence. The routine and support in a child’s life come for the author

figures. These same authority figures are able to empower the child to make decisions over their

life while supporting and caring about them. Taylor then described how the basic need of

survival was met through the authority figures on one’s life, and how they are also utilized to

meet the basic need of love and belonging.

Love and belonging also fall into this primitive category of the basic needs (Rapport,

2007). Taylor (2001) discussed how important it is for parents of children with ODD to show

unconditional positive-regard when showing how much they love and care for their children. He

suggests that showing love allows the child to gain a sense of importance or self worth, which is

necessary for children who are diagnosed with ODD. Glasser (1988) felt the need for love and

belonging was the most primary need. Mason and Duba (2009) noted love and belonging was

the hardest need to have fulfilled due to the involvement of another individual. The authors

pointed out how school counselors can create opportunities for those individuals to discuss the

basic need and prepare them to make life choices in the future. The fulfillment of love and

belonging is a difficult one to meet or to replicate.


As these four basic needs are met, there is a fifth basic need of fun. Rapport (2007)

examined the basic need of fun as more than just the ability to laugh and learn, but as to the

extent and individual desires to feel that way. Cameron (2009) also pointed out how many

individuals do not take time to meet this basic need of fun, and it is often overshadowed by the

quest to meet other needs, and therefore not met. Taylor (2001) discussed how fun could be

developed through a relationship between children diagnosed with ODD and authority figures.

Authority figures are the primary targets of children diagnosed with ODD; therefore, involving

both authority and children in fun activities could lead towards building positive relationships for

the future. In relation to counseling, Cameron pointed out the positive effects that humor can

have with an individual over a long period of time. Cultivating positive relationships in

counseling through humor would also be beneficial. It is important to note, that the most

important aspect of the counseling work with individuals utilizing Choice Theory is the

relationship.

Relationship.

Mason and Duba (2009) discussed the importance of the therapeutic relationship when

utilizing Choice Theory with individuals in counseling. The client must have a sense of trust and

understanding with the individual with whom they are working in order to share and identify the

choices, they are making in their lives. Cameron (2009) identified the concept of total behavior

in relation to Choice Theory. The concept of total behavior involves looking at an individual’s

behavior one instance at a time. This concept focuses on one area of the individual’s life and

allows the counselor to help the individual resolve one conflict at a time and then relate it back to

their individual basic needs. Once one area has been resolved, the counselor and student can then

move forward to other areas.


Similarly, when working with children diagnosed with ODD, it is important to

understand what each individual concern is, rather than looking at every concern at once. One

individual concern that Cameron (2009) pointed out is control. As stated earlier, the concept of

control is important with children who are diagnosed with ODD, and helping them understand

they can only control their own actions and no one else’s is paramount. Taylor (2001) also

discussed control as an underlying issue for individuals who are diagnoses with ODD. The

striving need for power and control in the individual’s life can cause them to lash out at those

who are viewed as adults. Taylor pointed out how these authority figures can be seen in a very

negative light as someone who is looking to take away from the individual’s life. In relation to

control, Taylor discussed how the individual must have an understanding of what they can and

cannot control. This is a fundamental piece towards helping the individual gain a sense of hope.

Mason and Duba (2009) also identified how important the instillation of hope is in the

therapeutic relationship. The instillation of hope is geared towards creating a positive

relationship with the individual and instilling the idea that things will get better. The counselor

can work on improving the overall well being and providing a positive outlook on the future for

the child diagnosed with ODD. The main purpose is to find out what is important to the child

and what do they want to do with their life. This may be difficult for someone who is diagnosed

with ODD, but the idea of hope and the relationship with the counselor can begin the early

foundation towards this movement. When a child diagnosed with ODD meets with a counselor

the first time, that counselor is now a part of the child’s quality world. The individuals that make

up the child’s quality world have a direct effect on the fulfillment of their basic needs.

Quality World.


Mason and Duba (2009) stated the importance of the quality world and how information

from the beginning of one’s life makes up their quality world. Specifically, the quality world is

made up of people, information, beliefs, and relationships along with the basic needs. They noted

the importance of people in the quality world and when working with children diagnosed with

ODD, this is important to highlight. They examined how the counselor or person working with

the individual must represent someone positive in their life and someone who can help the

individual in order for that person to be a part of the person’s quality world. Cameron (2009)

also pointed out how the counselor’s ability to be part of the individual’s quality world can

greatly improve the rate of success with that individual. When the child who is diagnosed with

ODD allows the counselor or teacher to be a part of the individual’s quality world, the work can

then begin on analyzing the choices the person is making and how the individual’s life is being

affected.

Treatment with Choice Theory and Reality Therapy.

Choice Theory is the theoretical framework by which Reality Therapy is utilized (Mason

& Duba, 2009). They discussed how Reality Therapy could be utilized in the school as a way to

work with children to analyze the choices they are making. They also examined how important

it is for the counselor to not judge the children about their choices, but support them through the

events in the person’s life. The counselor’s main objective is to identify what basic needs are

getting met and not getting met through the client’s choices. In the implementation portion of

this paper, this will be identified more closely when working with children who are diagnosed

with ODD. When analyzing the choices of an individual, the operant conditioning model can be

utilized as a way to identify positive and negative consequences and then provide positive and

negative reinforcement for the choices that the individual is making.


Operant Conditioning

B.F. Skinner (1969) coined the term operant conditioning and used it as a way to examine

the environment and behavior. Skinner also developed the term operant behavior. Operant

behavior is behavior controlled by consequences and reinforcement. Reinforcement is a main

part of operant conditioning, and can be used to predict behavior (Staddon & Cerutti, 2003).

Staddon and Cerutti also pointed out how choice is involved in operant conditioning. They refer

to how an individual makes a choice between multiple responses. They looked at why the choice

was made and what the alternatives were for the individual to make the choice. The authors also

identified reinforcement as modifiers in choice. Reinforcement is one the main components to

operant conditioning (Skinner). These reinforcements can be positive and negative and differ

from punishment. Positive reinforcement is the addition of a pleasurable stimulus to continue the

behavior. Negative reinforcement is an increase or sustained behavior with the negative

condition (consequence) of the behavior being stopped or avoided. Punishment causes the

behavior to cease temporarily while the stimulus is removed (Shields & Gredler, 2003). The

definitions are often confused with one another and will be separated in order to clearly present

behavior management techniques for children diagnosed with ODD.

Reinforcement versus Punishment.

Shields and Gredler (2003) studied Skinner’s operant conditioning and identified ways to

teach it to others. The importance of reinforcement relates to how an individual can perceive it.

Shields and Gredler noted that positive reinforcement is often perceived as a reward.

Additionally, negative reinforcement is similar to a punishment for a negative behavior, and the

two terms could not be distinguished. They looked to develop a study for individuals to identify

positive and negative reinforcement along with distinguishing punishment as well.


Shields and Gredler (2003) used Skinner’s model to define positive reinforcement as a

way to stimulate a continued response. This would mean making the individual continually act a

certain way without a negative stimulus. They noted how desire is not a characteristic of

positive reinforcement, rather some individuals do not desire the positive stimuli but simply

continue the behavior because it is what is supposed to be done.

The authors continued to define negative reinforcement and how it is different from

punishment. Shields and Gredler (2003) noted how negative reinforcement and punishment are

often times viewed as the same thing. They wanted to separate the two terms and show their

differences. The authors suggested the negative emotional response that comes with punishment

as a reason that the terms are viewed as the same. Negative reinforcement, however, is when a

behavior is strengthened by removal of a negative stimulus. An example of negative

reinforcement would be if a teacher were to tell students that the they will have a quiz at the end

of the week (negative stimulus), but cancels the quiz (removal) if all homework gets turned in on

time; thereby increasing (or reinforcing) the likelihood that homework gets done. This would

entail having a negative reinforcement for the individual for every instance that the person

exhibited a said behavior. There is still a stimulus when negative reinforcement occurs.

On the other hand, punishment is the removal of the stimuli leading to instances of the

behavior decreasing. An example of punishment would be detention in schools. Detention is

used as a way to stop a specific behavior from a student. If the student exhibits the same types of

behavior after detention, they will receive another. This is a cycle of a form of punishment

geared towards stopping specific behaviors. Shields and Gredler (2003) examined how

punishment evoked the negative emotional response from the individual. To distinguish negative

reinforcement from punishment, the behavior occurs and the stimulus remains in negative


reinforcement. With punishment, the stimulus is removed for the behavior to cease. Punishment

includes consequences for behavior in order for a behavior to stop. The number of occurrences

can affect the modification process of a said behavior as Shields and Gredler point on.

Additionally, Staddon and Cerutti (2003) examined the number of occurrences over a period of

time and how that would affect the individual and the modification process.

Length of Reinforcement.

Staddon and Cerutti (2003) identified the key components to operant conditioning and

modifying behavior of an individual. They noted how operant behavior is aimed towards

repetition of a behavior and how time can have an impact on the reinforcement. The pattern of

behavior is aimed to be predictable (or repeated) and offers “reasons” for the behavior to

continue. These “reasons” are the positive reinforcers that increase the likelihood of the

behavior. The authors identified how sustainability of behavior can be increased with positive

reinforcement. This is a modification technique for the behavior to continue over a period of time

in which the individual is conditioned to behave in a certain manner. Staddon and Cerutti

discussed how the behavior could also be modified with a given response with negative

reinforcement. This is aimed towards the opportunity to give the individual an inherent

understanding of the choices they make. Taylor (2001) discussed the idea of continual behavior

monitoring with children diagnosed with ODD. He focused on prevention of behaviors through a

series of rules and guidelines for the child. These include sufficient nutrition, efficient sleep,

supervision, and “need-meeting” activities. This model expresses the need for consistency and

autonomy for the child diagnosed with ODD.

Choice in Operant Conditioning.


Staddon and Cerutti (2003) identified the importance of choice in relation to operant

conditioning. They discussed how choice is difficult to directly observe. The individual makes a

choice, and then there is a consequence following the individual’s choice. It is difficult to go

inside the person’s head and understand how the choice is made. With operant conditioning,

Staddon and Cerutti pointed out how the consequences can influence their choices, but it is not

the defining reason to explain choice. Choices are made through executive functioning and could

be related to deficits in the brain (Fahim et al., 2011).

The brain and operant conditioning.

Rapanelli, Frick, and Zanutto (2011) examined the brain in relation to operant

conditioning and how choices were being made in relation to behavior. Rapanelli et al. (2011)

researched the prefrontal cortex in relation to operant learning. They looked at learning a task,

the environment, and voluntary exercise. Their research was focused on animals, and used the

results to explain the functioning that goes with operant conditioning. They noted the

importance of operant learning for directed behaviors. The explained how the cells of the medial

prefrontal cortex (mPFC) and hippocampus (HIPP) were produced and how cells were created

through this experience. As stated earlier, children who are diagnosed with ODD have shown

areas of concern in the mPFC. Fahim et al. (2011) discussed the neurological concerns with brain

functioning of children diagnosed with ODD. When working with a child diagnosed with ODD,

the counselor must address these neurological concerns. This would involve identifying any

cognitive delays that the individual has. Additionally, the counselor would work with the

individual on the thought making process and what causes the individual to make specific

behaviors. The counselor must have an idea of how the child’s brain functions in relation to

choice. The counselor can then come up with a plan to improve the child’s decision-making


process. The decision making process of a child diagnosed with ODD is impaired, and those who

work with them must be prepared to offer proper alternatives in order to see positive results.

Fusing the models of Choice Theory and operant conditioning, appropriate and positive behavior

management can utilize techniques for children who are diagnosed with ODD.


Integrated Case Study

In order to provide an illustration of the methods of Choice Theory and operant

conditioning when working with a child diagnosed with ODD, a case study has been created.

This case study involves Baxter, an eight year old student, and Karin, his school counselor at the

elementary school.

Due to behavioral issues in the classroom, Baxter’s third grade teacher referred him to

Karin, the school counselor. Baxter has a history of behavioral issues in the classroom, at home,

and on the school bus. Baxter has recently failed to meet the expectations of the class and does

not comply with the rules of his teacher. Baxter’s parents both work full time to provide for him

and his two sisters, who are ages six and four. They have both reported instances of Baxter not

complying with household rules and arguing with them constantly. Baxter also exhibits

inappropriate behaviors on the bus to school. He has been seen running up and down the aisle

of the bus and not listening to the driver or aide. Baxter has been suspended from using the bus

for a period of one week due to a recent complaint where he began screaming at the bus driver

and would not sit down while they were at an intersection. Baxter’s mother has to drive him to

school for the week and misses an hour of work to do so.

Karin has been a school counselor for 8 years. She has a theoretical background in

cognitive behavioral techniques along with play therapy. She has met with Baxter in the past for

behavioral issues and also emotional aspects of his life. Karin has recently been studying the

effects of operant conditioning along with the methods of Choice Theory when working with

children diagnosed with ODD and decides to utilize them with Baxter. Karin has developed a

plan to work with Baxter, his teacher, and his parents on outlining a plan for positive behavior

management techniques utilizing Choice Theory and operant conditioning.


Karin set up her meeting with Baxter in her office, as Baxter enjoys playing with some of

the toys from the sand tray. Karin has a rapport built with Baxter due to her individual and group

counseling work with him. She has utilized play therapy and other behavioral modifications in

the past as ways to help Baxter with short-term effects. Karin recently studied the effects of the

brain in children diagnosed with ODD. When approaching Baxter’s case, she wanted to identify

the issues related the neurological deficits that ODD may bring about. When utilizing Choice

Theory and operant conditioning, both sides of the discussion can be covered.

Cognition of choice is a major piece to Choice Theory while also focusing on choices

that were made in the past. Karin will help Baxter identify choices he has made recently and try

to better understand why he made those choices. With Baxter being eight years old, his rationale

may be difficult to understand, but one of the essential pieces of Choice Theory is to not judge

the client for the choices they have made. It is better to give the student various perspectives on

the consequences (Glasser, 1988). After going through the consequences, Baxter can pick one,

which can be reinforced with operant conditioning. The process of continually repeating

behaviors with positive stimulus will be important for Baxter to see how his choices after what

happens to him.

Karin understands that Baxter sometimes “acts out” by exhibiting behaviors such as

arguing, annoying, and defiance because it is fun for him. Operant conditioning offers a model

of reinforcement for positive behaviors over negative. The stimulus of fun is still there,

however, determining which is more fun in Baxter’s eyes will be important to the success of his

goal attainment. Karin will utilize positive and negative reinforcement with Baxter’s teacher and

parents while emphasizing a decrease in punishment for negative behaviors. Karin has the


opportunity to meet with Baxter twice a week for twenty-five minutes in order to work on these

presenting concerns.

The initial sessions with Baxter were challenging for Karin because Baxter wanted to

play with the sand tray. Karin focused on setting clear boundaries for when he could play with

the sand tray. Karin also kept the rules to a minimum in order to keep the sessions fair in the eyes

of Baxter (Taylor, 2001). Karin also focused on creating a deal for Baxter (Taylor). She

discussed what she wanted from him including listening, sharing, following rules. In return,

Baxter would then receive five minutes of playtime at the end of the session to use the toys in the

sand tray. This works on both levels of Choice Theory and operant conditioning. Karin is

supporting Baxter’s need for fun by giving him the opportunity to play with the sand tray. Karin

is also empowering Baxter to have control over his behavior in order to achieve a goal he wants

(i.e., playing in the sand tray). These small behavior changes are methods of operant

conditioning by continually positively reinforcing behaviors for the client resulting in a stimulus

of what the person wants. This model then needs to be carried over to the classroom and home

setting.

In both the classroom and home setting, Karin needs to help the teacher and parents

identify things that Baxter strives to do. She wants to focus on positive stimuli for him to seek

and then attain through measurable behavioral goals. When working with Baxter, Karin knows

he will not change overnight, but more importantly, neither will the parents or the teacher. In

both cases, the teacher and parents have other kids they need to be aware of as well as Baxter.

The teacher has twenty-three children in her classroom. There are several students who

have behavioral issues as well as others with learning disabilities, but the teacher has identified

Baxter as the student that has had the most interruptions to the class. The techniques for working


with children diagnosed with ODD can be used for most children; however, more focus is

needed on consistency for those with the diagnosis of ODD. Karin works with the teacher on

being consistent and not engaging in power struggles. Baxter continually tries to enter in power

struggles with adults in order to annoy and not follow the adult’s directions. He has stated that

this is fun for him, and he enjoys doing it. The relationship between Baxter and his teacher must

be built upon the goal of finding fun. Some specific instances of relationship building activities

that meet his need for fun include games and one-on-one time. This will be difficult to attain due

to the size of the class, but can be approached if only for moments throughout the day. The

teacher has to look for opportunities to spend quality time with Baxter in order to build up their

relationship (Taylor, 2001). Along with this relationship, there will be a need to find instances of

what Baxter likes to do in order to set up a plan for him to achieve time doing those activities.

At school, Baxter enjoys recess. He enjoys running around and playing ball with other

kids. He also enjoys playing with Legos™. One of the major issues this year has been the

absence of playtime in the third grade classroom as compared to the second grade classroom.

Baxter has noted feeling that the teacher does not want him to play. Thus from the outset, this

relationship already has a negative connotation. Baxter does not feel like class is fun, he does

not feel like he has freedom to do what he wants to do, and he also feels like the teacher does not

let him make decisions about any of these issues. Therefore, the basic needs of fun, freedom, and

power are not being met. There are constructs that do not allow Baxter to simply do whatever he

would like to do, and that has been difficult for Karin to help him to understand. She has used

models and pictures to help him cognitively approach where he can do certain activities and

where he cannot. These are pictures of his classroom with children doing certain activities. With

his executive functioning being of concern, these pictures can be utilized to help him identify


where certain behaviors are to be exhibited. His teacher has been trained on how to let Baxter

know he is not doing what is supposed to be done through offering to help him when needed.

She also charts behavioral concerns when she notices them in relation to his ability to achieve his

goals. There is an inherent relationship with Baxter and his teacher, much like his parents.

Baxter views all three as authority figures with whom he has a problem. All of these

relationships are essential to Baxter’s positive development at the school and also in the home

setting.

With both of Baxter’s parents working full time, there is concern about his home life and

his needs being met. His parents both return home at 5:30pm weekly and pick up the children

from daycare. They have both noted constant struggles to get Baxter to leave day care if he is

engaged in an activity, which results in yelling between the parents and Baxter. Karin wants to

work with the parents on the importance of not yelling at Baxter, and working with him on

appropriate ways to transition from place to place (Taylor, 2001). Karin also works on

transitions at school between classes, meeting with her, lunch, recess, and other instances that

occur. Baxter has exhibited an inability to move from activity to activity without behavioral

issues with the adults supervising him. Parent training is going to be a major focus of this

intervention in order to achieve consistency at the school and at home (Larsson et al., 2008).

Setting up a positive reinforcement for smooth transitions may be a way to help him, while

helping his parents and day care providers. In terms of behavioral goals at home, Karin continues

to work with Baxter’s parents on activities that Baxter wants to do and how he can earn time

doing them.

One of the interventions Karin puts into place is the idea of a fun checklist (Taylor,

2001). This represents a list of activities and a routine for Baxter to have while he is at home.


When Baxter is able to complete the routine that has not only chores but also free time included,

there is a positive stimulus for him. This chart is a way for Baxter to stay focused and meet his

basic needs while engaging in behaviors on a consistent basis. Karin has worked with the

parents on ways for this list to incorporate more familial activities in it as well so that it can

include development of positive relationships with his sisters. The opportunity for the

relationships at home to be built concurrently with improving Baxter’s behavior will be pivotal

to the results of the intervention. Karin and the caregivers will need to include measurable

indicators so that Baxter will have clear-cut ways to show how his behavior is affecting others,

and how these relationships have improved over time both at school and at home. As Karin

continues to work with Baxter, she focuses on the choices he is making and how they are

affecting him in his eight year old quality world.

Baxter’s quality world is important to understand when using Choice Theory. With

Baxter’s diagnosis of ODD, some members of his quality world have negative connotations,

primarily the adults. Karin is also viewed in this way as someone who is an adult authority,

which has effects on their relationship. Karin has consistently worked on empowering Baxter

and giving him choices through their time together to build the relationship. The choice piece of

this intervention is essential. With evidence-based research showing that there are brain deficits

in children who are diagnosed with ODD, Karin can avoid taking Baxter’s behavior personally,

and can work toward looking back at choices, why they were made, and how Baxter can

approach them in the future (Hobson et al., 2011; Fahim et al., 2011).

Baxter does not have the ability to rationally think about each choice he is making when

he is acting out against adults. He has stated that he feels “angry and really mad” at the adult and

just wants to run away. Karin has gone through some scenarios that take away the basic needs of


Baxter and how he would react. She found that in all cases he would act out and threaten the

person of authority. Karin then worked on what behaviors he could have done differently in the

situation. She sets up her sessions with Baxter in a consistent format: check in, discussing

behavior reports from the week, scenario with choices, options to behave in a different way,

scenario work, and if he earns it, time to play in the sand tray. Over a period of six weeks, there

has been improvement at school and during the sessions with Baxter; however, the home

situation behaviors initially improved but have since fallen back. Karin has another meeting

scheduled with the parents to refocus on the house expectations for Baxter and to work on an

improved routine, consistency and an activity chart for him to follow with reinforcers for

positive behavior.


Limitations

There are multiple limitations to consider when utilizing Choice Theory in conjunction

with operant conditioning with children with ODD. The primary limitation is that no research

has been conducted on using the methods together for students with ODD. Our understanding of

the neurology of children with ODD and their brain functioning is in its infancy. Current

research is just starting to find a correlation between ODD and executive brain functioning

deficits, but more research is needed. In addition, further research is needed to determine how

ODD affects cognitive ability to identify choices and understand consequences. Additionally, the

use of operant conditioning has to be appropriate for the level of the child in order to predict and

modify their behaviors over a period of time in a developmentally appropriate way. Therefore,

more research on the brain and utilization of these techniques with children who are diagnosed

with ODD is necessary.


Conclusion

Classroom behaviors such as annoying others, losing one’s temper, and defiance towards

adults can create poor learning environments. These defiant behaviors have been found to

originate from a neurological concern with issues in the prefrontal cortex as recorded through

MRI imaging (Fahim et al. 2011). Students diagnosed with ODD have functioning difficulties in

schools. Additionally, school staff members having difficulty responding to the student’s

individual needs and behaviors when associated with ODD. As the DSM IV-TR (2000) stated,

children diagnosed with ODD have a pattern of behavior that defies adult authority. Two

interventions that have been suggested in this paper are Choice Theory and operant conditioning.

These two methods of behavioral intervention have the ability to counteract neurological effects

of ODD. The purpose is not to change a child diagnosed with ODD overnight, rather to modify

and predict their behavior over a period of time. With Choice Theory and operant conditioning,

there is a value system that can be established with the child to cause their behavior to be more

positive. These two methods take into account the cognitive functioning of the child and how

they perceive the world in relation to the choices they make. Further research can be done on the

use of Choice Theory and operant conditioning to accommodate one another in order to find the

most positive and appropriate ways to recognize positive behavior interventions while taking into

account the cognition over the choices being made in the individual’s life.


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