8.26: Oppositional Defiant Disorder

Name: Stewie Griffin

Source: Family Guy (Television series, 1999 – Present)

Background Information
Stewie Griffin is a Caucasian male who is presumed to be one years old, although he may be four to five years old because in later episodes he attends preschool. Stewie is unemployed but shows a mastery level of physics and mechanical engineering. He has designed such things as mind control devices, weather control, fighter jets, and teleportation devices. Although there are not any known distinct physical illnesses, abnormalities, or disorders currently within Stewie Griffin, there are observable health concerns. The patient displays unprovoked hostility towards others, constant disobeying of parental rules, is extremely vengeful and vindictive, and easily loses his temper quite frequently. Stewie currently lives with his parents, Peter and Lois Griffin. Stewie’s father, Peter Griffin shows observable symptoms of mild mental retardation. This is evident when he took an IQ test in one of the episodes and scored a 70. It is also observed that Stewie’s parents exhibit a strong sense of control over his life, such as scheduling play dates for him to go on, toys he can/can not play with, and what/when, he can eat. Stewie exhibits strong introversion in social relationships. He does not have close relationships with anyone outside of his immediate family. This is due to the fact that Stewie sees his peers as obstacles in his path toward world domination. Because of this, he frequently kills off the lesser characters with tanks, guns, and other assorted weaponry. There have not been patterns of consistent alcohol usage by Stewie, but he has excessively used alcohol on occasion. This is particularly problematic, as any type of alcohol usage by a one year old can severely inhibit brain development. Stewie’s goal is to attain world domination by first killing his mother, who he fears will stand in his way. All of Stewie’s daily activities are designed to accomplish these two goals by creating weapons such as rocket launchers, engaging in violent criminal activities, carjacking, loan sharking, and forgery. Other weaknesses that Stewie displays are his stresses of infant life, such as teething and eating his vegetables.

Description of the Problem
Stewie Griffin currently displays a multitude of symptoms indicative of oppositional defiant disorder. He displays disobedient actions towards authority figures; however, Stewie believes that he is conducting himself in an appropriate manner for his own self-preservation. He also suffers from delusional behaviors such as having conversations with his stuffed teddy bear Rupert. He protects Rupert and will avenge any harm that comes Rupert’s way. Stewie deliberately annoys his peers by picking on them and continuously making rude remarks about their appearance or inabilities as a person. He also shows anger and resentfulness towards his mother because he feels that he is wrongly punished for activities he is supposed to carry out for the betterment of himself and world domination. As a result of this, he is also very spiteful and vindictive. For example, in one episodes Stewie loans Brian some money and they contractually agree that payment would be made on a certain date, but Brian does not repay on that date, so Stewie beats Brian with a bat daily until he receives payment. Stewie often uses a scapegoat for his own mistakes. When his attempts to kill his mother fail, he blames her for being unfair and bitchy.

Diagnosis
The diagnosis for Stewie Griffin that fits appropriately is Oppositional Defiant Disorder (313.81).
A. To be diagnosed with Oppositional Defiant Disorder a pattern of negativism, hostile, and defiant behavior lasting at least 6 months during which four (or more) of the following are present:
1. Often loses temper
2. Often argues with adults
3. Often actively defies complying with adults’ requests/rules
4. Often deliberately annoys people
5. Often blames others for his or her mistakes
6. Is often easily annoyed by others
7. Is often angry and resentful
8. Is often spiteful or vindictive

Stewie Griffin undoubtedly shows more than four symptoms of Oppositional Defiant Disorder, as described in the section “Description of the Problem.”

B.Consider a criterion met only if the behavior occurs more frequently than is typically observed in individuals of comparable age and developmental level.
Stewie possesses the ability to talk fluently at age one and interact with people at an intimate social level that is not yet observable in the one year old population. Typical one year olds rely heavily on parental care, where Stewie is significantly more independent than his peers (e.g. taking trips to San Francisco and Rhode Island).

C. The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.
Stewie is significantly impaired in social functioning because he does not develop and nurture his relationships, instead he sees his peers as obstacles towards his goal that he must defeat at all costs. Because of this, he does not have any significant social relationship with anyone outside his immediate family.

D. The behaviors do not occur exclusively during the course of a Psychotic or Mood Disorder.
Characteristics of oppositional defiant disorder can be observed in the patient in all settings and instances throughout his daily activities.

E.If the individual is age 18 years or older, criteria are not met for Antisocial Personality Disorder.
The patient is between the ages of 1-4 years old.

F. There is a recurrent pattern of negativistic, defiant, disobedient, and hostile behavior towards authority figures.
Stewie is in constant confliction with how he is going to succeed in killing his mother and attaining world domination.

G.Occurs outside of normal developmental levels and leads to impairment in functioning.
Stewies behavior is clearly outside of normal development for a one year old, and this leads to impairment in functioning such as developing strategies to kill his mother and take over the world (e.g. making weapons with the purpose of carrying out these goals).

Accuracy of Portrayal
The typical person watching Family Guy would be able to reach the conclusion that the character Stewie Griffin is abnormally developing compared to his average peer. A person with an Abnormal Psychology background would be able to further determine that Stewie showed all the symptoms for Oppositional Defiant Disorder. This is a cartoon character created to break the boundaries of normal development for babies, even to represent the general helplessness of an infant through the eyes of an adult. This show helps illustrate Oppositional Defiant Disorder by successfully creating a character that exemplifies every characteristic of the disorder, and not wavering from season to season. Although Stewie is not an accurate portrayal of the average one year old, he still can be related to children suffering from this disorder. Therefore, Stewie Griffin is an accurate illustration of someone with Oppositional Defiant Disorder.

Treatment
To treat Stewie Griffin, after a full medical examination, it would be best to teach him problem-solving skills as well as parent management training. Problem solving skills would help Stewie learn to solve problems in a logical and predictable manner. The downfall with this strategy is that is time consuming and on average requires 20 sessions. Another effective way to treat Oppositional Defiant Disorder is parent management training. This allows the parents to develop and implement structured management programs at home. This is designed to improve interactions between child and parent. Parents implementing this strategy should positively reinforce good behaviors. A secondary methodology of treating Oppositional Defiant Disorder is to medicate the child using Ritalin. Research has shown children treated with Ritalin who have Oppositional Defiant Disorder, 75% of the children no longer showed symptoms of ODD.

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Name: Walker Bobby and Texas Ranger “TR” Bobby

Source: Talladega Nights: The Ballad of Ricky Bobby (Movie, 2006)

Background Information
Walker and Texas Ranger Bobby are pre-pubescent males, with an estimated age of 11 and 7, respectively. Neither boy holds a job because of their young age. The Bobby brothers do not display any specific health issues. Walker and Texas Ranger live with both of their parents and their maternal grandfather, Chip. Their father, Ricky, is a famous racecar driver who displays some symptoms of Narcissistic personality disorder, claiming that he is “the best there is,” and that he “piss[es] excellence.” Their mother, Carley, does not show any observable symptoms of a mental disorder. However, she is very materialistic, markedly aggressive when provoked, and shows extreme devotion to her husband, at least until the promise of better prospect comes along (e.g., she leaves Ricky for Cal when Ricky can no longer race). In other words, their mother is a gold-digger. The family unit is still very much intact – they eat dinner together every night and attend all of Ricky’s races together. While the bonds between the family are obviously very strong, Walker and Texas Ranger display many types of defiant and hostile behaviors toward authority figures. Most likely due to their lack of shock and surprise, these behaviors are not typically directed towards their parents. Rather, the Bobby brothers act out to other close adults like both of their grandfathers, Chip and Reese, and their grandmother, Lucy. In fact, the boys’ mother and father seem to condone this behavior, claiming that they did not raise “sissies”. Walker and Texas Ranger were never portrayed as having done illicit drugs, although they did inquire about a comment that their grandfather Reese had made about possessing marijuana. Besides the problems that they have run into at school due to behavioral issues, the boys do not possess any real life difficulties. They do not have any deeply defined goals either as they are just kids looking to enjoy themselves while they can. Due to their inconsistent and overindulgent lifestyle, Walker and Texas Ranger’s coping skills are not very good. They handle less-than-perfect situations with immaturity and anger, often lashing out at whoever they believe will take it. Their weaknesses are handling new, unwanted situations (such as Sunday school) and being polite to adults.

Description of the Problem
Walker and Texas Ranger currently display a multitude of symptoms indicative of oppositional defiant disorder. They are consistently defiant and hostile, spouting out at whomever they believe deserves the criticism or hatred. These two display a constant need to argue and swear, especially to adults. They argue most often with their grandfathers, Chip and Reese, their grandmother, Lucy, and their teachers in school. There is nothing off limits for these boys. Their actions and criticisms are often unnecessary and cruel – usually just for the purpose of upsetting or annoying the adults around them.

Diagnosis
The diagnosis for the Bobby brothers that fits most appropriately is Oppositional Defiant Disorder (313.81). To be diagnosed with Oppositional Defiant Disorder the following criteria must be met:

1. A pattern of negativism, hostile, and defiant behavior lasting at least 6 months, during which four (or more) of the following are present:
   1. Often loses temper
   2. Often argues with adults
   3. Often actively defies or refuses to comply with adults’ requests or rules
   4. Often deliberately annoys people
   5. Often blames others for his or her mistakes or misbehavior
   6. Is often touchy or easily annoyed by others
   7. Is often angry or resentful
   8. Is often spiteful or vindictive

*Note – Consider a criterion met only if the behavior occurs more frequently than is typically observed in individuals of comparable age and developmental level.
Walker and Texas Ranger meet all criteria for oppositional defiant disorder except for number 5, blaming others for mistakes or misbehavior. They constantly insulted and swore at adults, threw Chip’s war medals off of a bridge to make him mad, argued with their teachers, and purposefully peed their pants and refused to take them off just to prove a point. These behaviors are more extreme than those of children at similar developmental levels. Where most children their age might only do these sorts of things once, Walker and Texas Ranger do them all of the time.

1. The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.

The boys do not know how to function in a social setting, repulsing most adults who come into contact with them. The boys do not seem to care what other people think of them. They say mean things, causing adults to react negatively, creating a viscious cycle of disobedience. Academic functioning, although mentioned briefly, is most likely effected. Texas Ranger, specifically, flaunted his bad behavior in the classroom.

1. The behaviors do not occur exclusively during the course of a Psychotic or Mood Disorder.

The characteristics previously described are displayed in many contexts over a lasting period of time. They are not a result of a psychotic or mood disorder.

1. Criteria are not met for Conduct Disorder, and, if the individual is age 18 years or older, criteria are not met for Antisocial Personality Disorder.

Walker and Texas Ranger are approximately 11 and 7 years old, respectively. They did not physically aggress towards others and did not commit any serious crimes.

1. Recurrent pattern of negativistic, defiant, disobedient, and hostile behavior towards authority figures.

The symptoms are constant – they do not vary from day to day. Their disobedience is only in response to authority figures.

1. Occurs outside of normal developmental levels and leads to impairment in functioning.

Most children their ages do not insult, swear, and act out this much. The quality of their interactions are severely inhibited and functioning is impaired.

Accuracy of Portrayal
The average person watching these boys would immediately recognize that there is a significant problem. Walker and Texas Ranger are on the extreme side of disobedience. Most parents would probably be able to relate the problems of these characters to those of their own children, only to a much lesser degree. They would learn that Oppositional Defiant Disorder is characterized by defiance, hostility, frequent outbursts of rage, swearing, and disobedience. The portrayal of this disorder is very accurate – the boys’ behavior was consistent throughout the movie and did not waiver. Their depiction, in particular, was very extreme as their behavior was observed both at home and in school. The inaccurate aspects of the boys’ portrayal would be their display of oppositional behaviors in unfamiliar territory, their lack of temper tantrums or clear frustration with difficult situations, and the ease and rapid pace of change in behavior once their grandmother decided it was time to start acting appropriately.

Treatment
In the movie, Walker and Texas Ranger’s grandmother, Lucy, took things into her own hands. She established what she called, “Granny Law,” and broke the boys like “wild horses” with community service, yoga, disposal of their weapons, and church attendance.

As a mental health professional, it would be best to first conduct a structured or semi-structured clinical interview to explore fully the family’s history, the symptoms that pertain to ODD, and the possible co-morbid problems that can occur as a result of the disorder. The first measure of treatment that should be implemented are Problem-Solving – Skills-Training programs, which involve teaching children how to solve problems in a logical and predictable manner. The only setback of this training is that it is extremely time-consuming, requiring an average of twenty sessions. Another possible treatment is called Parent Management Training. This training teaches parents how to effectively implement contingency management programs at home, allowing both parent and child to better enjoy their interactions by learning how to praise positive behaviors, establishing schedules and sticking to them, and maintaining effective timeouts. This greatly increases awareness in the child as to what is expected of them as well as what will happen if they misbehave.