Oppositional Defiant Disorder/Borderline Personality Dis.

Re: Oppositional Defiant Disorder/Borderline Personality Dis

littlek wrote:

Does any one have personal experience with Oppositional Defiant Disorder (ODD) and or Borderline Personality Disorder (BDP)? I have been cruising the web and it seems that everyone has the same info. It's helpful, clinical info. But, I would like more info on how the behaviors present at home and, in this case, at school.

Thanks.....

Er..yes.

But DSM IVR is pretty descriptive, I would have thought.

Can you give some context?

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dlowan, of course you've had personal experience with this! What is DSM IRV?

BPD has some obvious traits (to me) and some that are less than obvious. Less obvious to me are how the following look in the classroom:
- emptiness
- nondelusional paranoia
- impulse action patterns (they relay adult impulse actions like drug abuse)
- abandonment issues - this one doesn't seem to have them, but she may have detachment issues
- how does one feel both a sense of entitlement and worthlessness?

ODD is more obvious. But I find I have a hard time deciding what excessive and frequent mean when thinking about angry outbursts.

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littlek wrote:

dlowan, of course you've had personal experience with this! What is DSM IRV?

BPD has some obvious traits (to me) and some that are less than obvious. Less obvious to me are how the following look in the classroom:
- emptiness
- nondelusional paranoia
- impulse action patterns (they relay adult impulse actions like drug abuse)
- abandonment issues - this one doesn't seem to have them, but she may have detachment issues
- how does one feel both a sense of entitlement and worthlessness?

ODD is more obvious. But I find I have a hard time deciding what excessive and frequent mean when thinking about angry outbursts.

DSM IV R is the manual for diagnosis...but it sounds like you have had access to some stuff from there, or mebbe ICD 10? A lot of it sounds unfamiliar, it would help if I know where you got the criteria from, and exactly what they are.

For instance, "detachment issues" sounds very odd indeed!

" impulse action patterns"..huh? Sounds like they might to be trying to describe trauma based behaviour..but...

You teach little kids, don't you?

You shouldn't be even thinking of BPD for anyone younger than an adolescent. (Normally, such a diagnosis is not given until about 18...but you can certainly think of BPD traits before that).

Is the kid you are thinking of adolescent?

Here is a short version of DSM IV RT criteria

Borderline Personality Disorder (BPD) as: "a pervasive pattern of instability of interpersonal relationships, self-image and affects, as well as marked impulsivity, beginning by early adulthood and present in a variety of contexts."[3] BPD is classed on "Axis II", as an underlying pervasive or personality condition, rather than "Axis I" for more circumscribed mental disorders. A DSM diagnosis of BPD requires any five out of nine listed criteria to be present for a significant period of time. There are thus 256 different combinations of symptoms that could result in a diagnosis, of which 136 have been found in practice in one study.[4] The criteria are:[2]
Frantic efforts to avoid real or imagined abandonment such as lying, stealing, temper tantrums, etc. [Not including suicidal or self-mutilating behavior covered in Criterion 5]
A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
Identity disturbance: markedly and persistently unstable self-image or sense of self.
Impulsivity in at least two areas that are potentially self-damaging (e.g., promiscuous sex, eating disorders, binge eating, substance abuse, reckless driving, overspending, stealing). [Again, not including suicidal or self-mutilating behavior covered in Criterion 5]
Recurrent suicidal behavior, gestures, threats, or self-mutilating behavior.
Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).
Chronic feelings of emptiness, worthlessness.
Inappropriate anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
Transient, stress-related paranoid ideation or severe dissociative symptoms

With respect, you need to be very careful of labelling kids you are working with. The criteria don't replace lots of experience and training.

Can you tell me what you are wanting to get out of such an exercise?

Are you looking for ways to help/work with the kids?

Do you need it for some project?

ODD can reasonably be "diagnosed" in younger kids and it is a useful label to the extent that there is some good research now about what is and isn't helpful in helping them. It isn't an illness or anything, it is the result of factors like poor relationship and poor behaviour management, as far as we know. It is also a label often dumped on kids with a history of trauma...like ADHD is.

Eg..it is associated with avoidant attachment style.

It means they are naughty, more so than average.

It would help if you can copy what criteria you are using.

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I teach 9-10 year olds. I won't be labeling anyone. I'm just curious and avoiding writing lesson plans. Plus, the one is driving me a bit batty. I don't know how to handle her and I look to research to help me feel a bit more grounded.

I'm seeking at websites. The NIMH and the American Academy of Child & Adolescent Psychiatry. I think I'd have a hard time getting through a psych manual.

I came up with the term detachment issues. The one doesn't seem to be attached to anything. She wanders freely after school. Dangerously so. Ah. But, maybe she's avoiding being home alone after school.

Impulse action patterns is followed by a list including substance abuse, sexual deviance and manipulative suicide gestures. But, it is speaking to adolescent and adult behavior. Your quote looks familiar to some I saw out there.

Here's the behavior:
- impulsive outbursts in the form of very loud hicupping
- persistent and frequent disruptions in class. From the opposite side of the room calling out a teacher name 1-2 times per minute for 20 minutes (until removed from room)
- refusal to stop disrupting classmates. Removed classmates from area.
- refusal to come into the classroom
- refusal to leave classroom
- tried to staple body
- slammed head/hand in locker
- threatens suicide
- loudly laughs at others' quirks (including adults)
- caused bleeding so as to be excused from classroom (numerous times)
- slapped classmate
- refusal to stop whit-outing contents of desk
- stealing from classmates
- needs attention at all times, positive or negative
- refusal to do school work (does work 5-15 minutes per week on average)
- truancy

Also
- drawn like a moth to physically disabled students and pre-schoolers (positive reenforcement)
- bright
- math-oriented

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littlek wrote:

I teach 9-10 year olds. I won't be labeling anyone. I'm just curious and avoiding writing lesson plans. Plus, the one is driving me a bit batty. I don't know how to handle her and I look to research to help me feel a bit more grounded.

I'm seeking at websites. The NIMH and the American Academy of Child & Adolescent Psychiatry. I think I'd have a hard time getting through a psych manual.

I came up with the term detachment issues. The one doesn't seem to be attached to anything. She wanders freely after school. Dangerously so. Ah. But, maybe she's avoiding being home alone after school.

Impulse action patterns is followed by a list including substance abuse, sexual deviance and manipulative suicide gestures. But, it is speaking to adolescent and adult behavior. Your quote looks familiar to some I saw out there.

Here's the behavior:
- impulsive outbursts in the form of very loud hicupping
- persistent and frequent disruptions in class. From the opposite side of the room calling out a teacher name 1-2 times per minute for 20 minutes (until removed from room)
- refusal to stop disrupting classmates. Removed classmates from area.
- refusal to come into the classroom
- refusal to leave classroom
- tried to staple body
- slammed head/hand in locker
- threatens suicide
- loudly laughs at others' quirks (including adults)
- caused bleeding so as to be excused from classroom (numerous times)
- slapped classmate
- refusal to stop whit-outing contents of desk
- stealing from classmates
- needs attention at all times, positive or negative
- refusal to do school work (does work 5-15 minutes per week on average)
- truancy

Also
- drawn like a moth to physically disabled students and pre-schoolers (positive reenforcement)
- bright
- math-oriented

What do you know about the poor kid's background?

Sounds so far like trauma/attachment based problems...though I do have some Asperger's thoughts.

I do hope this kid/family are in touch with some assistance? GOOD assistance?

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Reading......

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Here's something you might be interested in>

The SMART Program

This is a training program for teachers, purchased by the Education Department in my state, to assist teachers to understand and work with kids who have experienced trauma.

It is a free online training program, which you just have to register to access, and it takes you through various modules on trauma and neglect, what it does to the brains and emotions of kids, and has ideas for working with them.

Each module only takes a few minutes, though the whole program would take a while, and it is good, in my view.

How frequent is the hiccoughing? (Really frequent outbursts like that, which appear involuntary, may mean that Tourette's needs to be ruled out........but kids like this have learned so many ways of seeking negative attention that it may well just be that.) Any tics?

Self harm at that age is scary...but kids seem to be getting into it at younger and younger ages.

What is your agreed plan for dealing with it?

Eg: Calmly sending child to school nurse, or whatever you have.

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Hi Boomer....

Her sister has Tourettes. I think she's probably already been assessed for the disease. We imagine she's learned it from her sis and that it's not her own. She has no tics. She doesn't do it when under stress, she does it when the class is behaving and she wants their attention. Several times a day.

Aspergers. She makes solid eye contact, snuggles up with classmates. But she does tend to alienate them (which is helping us teach them, unfortunately).

The school behavioralist said he'd develop a strategy, but hasn't. She will be evaluated for LDs for an education plan. But, the behavior contract will be separate. I think.

She's new to the school and her old school hasn't sent any of her records even though we've asked for them ("They're in the mail").

I'll check out the website, thanks!

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Deb, do I just make up an address to register under?

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littlek wrote:

Deb, do I just make up an address to register under?

If you like.

I have no reason to believe they will have a problem with you being American.

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We've come up with an agreed plan verbally, on the fly. Here's what we have:
- require output from her before teacher assists with scribing or explanations.
- ignore bad behavior as long as it isn't harming anyone.
- document everything.
- if she is disturbing classmates and refuses to move, remove other students.
- wait until she is "present" before engaging in discussion.
- simple language and limited options.
- consistency between what we do and what the office staff do.
- reward work with a favored activity (sitting with psych, hanging with a particular disabled child, spending time in pre-school).
- try to give her appropriate language for expressing her needs.

She had one good week - for her (it would have been unacceptable for any other student) and she was heavily rewarded. We praised her, we let her do preferred activities. We told her why we were happy, asked her if it felt good, etc.

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dlowan wrote:

littlek wrote:
Deb, do I just make up an address to register under?

If you like.

I have no reason to believe they will have a problem with you being American.

There are no American options in the drop-down menu. I'll see what I can do.

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littlek wrote:

dlowan wrote:
littlek wrote:
Deb, do I just make up an address to register under?

If you like.

I have no reason to believe they will have a problem with you being American.

There are no American options in the drop-down menu. I'll see what I can do.

Oh...just make up an OZ address, then! You may need to ensure your postcode goes with your chosen state/suburb is all.

littlek wrote:

We've come up with an agreed plan verbally, on the fly. Here's what we have:
- require output from her before teacher assists with scribing or explanations.
- ignore bad behavior as long as it isn't harming anyone.
- document everything.
- if she is disturbing classmates and refuses to move, remove other students.
- wait until she is "present" before engaging in discussion.
- simple language and limited options.
- consistency between what we do and what the office staff do.
- reward work with a favored activity (sitting with psych, hanging with a particular disabled child, spending time in pre-school).
- try to give her appropriate language for expressing her needs.

She had one good week - for her (it would have been unacceptable for any other student) and she was heavily rewarded. We praised her, we let her do preferred activities. We told her why we were happy, asked her if it felt good, etc.

I would add lots of empathy and reassurance to that.

Especially at transition times, which seem difficult for her...eg, give her warnings when she will soon need to leave the classroom. Maybe move close to her at such times, and engage her with chat and such as she transitions. Notice empathically that this is hard for her, and that you are there to help her. Try to do the same for coming into class.

I would try reassuring her that you will be over soon if she is calling out, and you WILL be over soon....notice that waiting is hard for her.

The choices thing is good....."either you stay quiet, or you are telling me that being in class is too much for you right now, and I will send you to the office until you are ready". If she has to leave, tell her you are sorry you need to send her out, and you look forward to her being ready to come back.

Couch everything in terms of helping her, and acknowledging her feelings and what she is trying to tell you with her behaviour, and when it is hard for her.

Empathy, empathy, empathy...even when you have none.

As you are rightly taking away negative attention, remember you have to up the positive until your pips squeak, or she'll be looking for the negative extra hard.

You can do this in a million little ways.....a smile, standing near her and noticing her work for a minute...start small with your demands for work (I know you know all this)..se needs to have lots and lots of pay offs at first if she is to change.

What IS positive for her? Is attention a positive?

Tell her what you are doing: "Oh, you have forgotten we ask for help with our work like this......(tell her how she is supposed to do it)...I will help as soon as you ask the right way.

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If I stand next to her she hangs on me, laughs loudly, plays with my earrings or necklace. I ask her to stop and she doesn't. I have to move away. If I sit with her and try to help her when she is not ready to engage in work, she does similar behavior. Believe me when I tell you we jump all over her when she is ready for work. At one point I had my hand on her harm while talking to her and she loudly declared to all that I was hurting her. I won't touch her again.

I feel like I can't be sympathetic, it feeds her frenzy. I am when I can get away with it. But I mostly don't let myself. I am full of praise and support when she is behaving better than usual. I am out of my league.

Oh, she does respond well when I tell her I am trying to help her be successful on her tests. When I speak of tests, grades, etc she responds - about half of the time. "I want to help you with this work. It's important. It is a review for your test and it will help you be successful." or "If you don't work, I can't help you. If you don't work, you will not be successful on the coming test." or "This spelling quiz is part of your grade, please sit up and write the words down." She does respond to these more often than other prompts I've tried.

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I started the modules, but seem to be a little stoopid on how to run that site. Will try tomorrow after I am better rested.

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littlek wrote:

If I stand next to her she hangs on me, laughs loudly, plays with my earrings or necklace. I ask her to stop and she doesn't. I have to move away. If I sit with her and try to help her when she is not ready to engage in work, she does similar behavior. Believe me when I tell you we jump all over her when she is ready for work. At one point I had my hand on her harm while talking to her and she loudly declared to all that I was hurting her. I won't touch her again.

I feel like I can't be sympathetic, it feeds her frenzy. I am when I can get away with it. But I mostly don't let myself. I am full of praise and support when she is behaving better than usual. I am out of my league.

Oh, she does respond well when I tell her I am trying to help her be successful on her tests. When I speak of tests, grades, etc she responds - about half of the time. "I want to help you with this work. It's important. It is a review for your test and it will help you be successful." or "If you don't work, I can't help you. If you don't work, you will not be successful on the coming test." or "This spelling quiz is part of your grade, please sit up and write the words down." She does respond to these more often than other prompts I've tried.

I would persist with empathy.

But of course, it is up to you.

It is just about being attuned to her emotional state, and noticing when she is distressed etc. Sounds as though she can only tolerate very low key empathy....

This is a real part of the process by which kids learn to regulate their feelings, which is something she clearly is really bad at.

What is your experience of empathy, (not sympathy btw), feeding her frenzy? What is her frenzy?

Her boundaries suck, don't they? That hanging off you sounds very attachment problem based.

Yes, any teacher is going to be out of their league with a kid like this.

They're tough, tough, tough!!!!

If I were working with her, there'd be lots of discussions/consults with you guys, plus the admin people, and the principal etc, and any behaviour management staff.

You kind of suss out over time how to respond to these kids.

Sounds as though you are already having quite a lot of success, though, which is damned good.

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littlek wrote:

I started the modules, but seem to be a little stoopid on how to run that site. Will try tomorrow after I am better rested.

Yeah...I have to double click and such to get it to work.

Also, you can stop it moving to the next page automatically...I am a fast reader, and it moves too fast for me!

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Her boundaries do suck. I will attempt a more hands-off, distant empathy. We try to be aware of what's happening at home, on weekends and after school. I'll try to see if there's consistent reactions to weekends spent with her father or mother, for example. I think I know two reasons why this week was so hard for her. Egads, it's sometimes hard to be empathetic with her.

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Littlek--

Having been in the trenches--as opposed to the command tent--having a tidy pigeonhole for a kid with bad behavior is worthless.

"Know the name and you will have the power" doesn't really work with disturbed, unhappy children.

You aren't equipped--or paid--to deal with severe mental disorders. Your job is to see that learning takes place in your classroom.

Rather than seeking a clinical title, you want to summon up a bit of super-human fortitude every single hour--every single minute--to deal with Little Miss Expressive Misery as though her disruptive techniques are brand-new and fascinating.

The fault, dear littlek, is neither in your stars nor in your self. This kid entered your class room with 9-10 years worth of accumulated baggage.
A non-professional would recognize her as a Little Horror. It is okay to feel she's a Little Horror. It is not okay to belt her physically or emotionally.

Do as much good as you can. Remember, if you refrain from belting her you're probably being kinder to her than most of the adults in her life have been.

You don't have to like her or understand her--all you have to do is cope with her disruptive behavior every single minute.

Hold your dominion.

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Oppositional Defiant Disorder/Borderline Personality Dis.

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