Is your child ODD? Oppositional Defiant Disorder - Could it progress to Conduct Disorder?

You may notice that your child has become more argumentative; especially with adults. He could become hostile and obstructive towards you and other adults. You will probably have taken note that he is a lot more touchy than normal. There could be problems at school with him acting out towards the teachers; although sometimes the behaviour is not exhibited in school, only at home and generally not in public places. It is not known why this is.

ODD or Oppositional Defiant Disorder which is its full title, is a personality disorder which normally becomes evident around the age of 8 years or so. Sometimes it can be later but generally it shows itself before the early teens. The main characteristic of the disorder is as one might expect defiance; especially to adults and people who are perceived to be in authority.

In order to warrant a diagnosis of Oppositional Defiant Disorder or ODD the behaviour must have been present for at least six months

Types of Trauma which can cause ODD

• Abandonment by a parent or parents
• Bullying
• Constant family conflict and disruption
• Loss of a sibling or parent
• Physical trauma e.g. head injury
• Neglect
• Abuse

Other Possible Causes

Serotonin imbalance in the brain has been also cited as a cause for some behavioural disorders.

Also, children who come from families with few or no social skills are frequently affected by behavioural disorders.

Maternal drug and/or alcohol abuse is thought to be a factor for increased odds of a child developing behavioural disorders but in some cases there is no evident cause.

Apologies for previously referring to the child as he; this is due to the fact that prior to puberty more boys are affected than girls. After puberty both sexes are fairly equally affected.

Boys are often affected with ADHD more than girls so it may be that if your boy has ADHD he could also be affected by ODD. In later adolescent years CD (Conduct Disorder) could develop if help is not sought.

Girls are more often affected after puberty which might suggest that hormones are involved in the development of Oppositional Defiant Disorder.

Children with ODD have often suffered some kind of trauma in their early life.

For a diagnosis to be made the child must have been exhibiting defiant, hostile and negativistic behaviour for at least six months. The behaviours must not be part of a depressive illness or psychotic episode. He/she must be showing at least 4 of the behaviours below on a more regular basis than any other child of the same age and level of development:

• Refusal to follow rules
• Verbal hostility
• Inability to control temper
• Easily annoyed
• Blaming others for everything even though it isn’t their fault
• Stubbornness and inflexibility
• Vindictive and Malicious behaviour
• Argumentativeness; especially with adults
• Behaviour which is deliberately annoying

In order to outgrow or be cured of a behavioural disorder the child or young adult would have to have reached the realisation that his or her behaviour is a problem and want to change it.

In general, behavioural disorders cannot be cured. They are a lifelong affliction and as such can only ever be improved. Hopefully though, at some point, with the correct treatment, the disorder can be less problematic and may not meet the full criteria for diagnosis as Oppositional Defiant Disorder.

To date there is no single treatment for this disorder. The treatment plan will almost certainly include individual, parenting and family therapy which will be age appropriate. Parents will probably be taught techniques for disciplining the child, setting rules, forming regular routines and structures. Children will be taught problem solving and emotional coping skills to enable them to have better relationships with their peers. Efforts will be made to identify the cause of the disorder and talking and other therapies may be used to come to terms with the trauma experienced.

Medication offers some respite from the symptoms and other co-existing conditions such as depression and anxiety. There are a few medications that can decrease oppositional and disruptive behaviour; notably, Risperdal, Abilify and Tenex. Sometimes drugs for ADHD are used; as mentioned earlier ADHD often goes hand in hand with ODD so Ritalin or Dexedrine may be used for these children or adolescents. If anxiety and/or depression are present Prozac or Citalopram may be prescribed.

Often a child with a dual diagnosis of ADHD and ODD can be at greater risk of developing depressive illness. These youngsters sometimes practise self-medication with drugs or alcohol which makes the disorder worse. If untreated, the diagnosis can change to that of a more serious behavioural disorder known as Conduct Disorder or CD. It is not a foregone conclusion that this will happen but it is a risk.

Conclusion

Do not ignore behavioural problems in children and adolescents. Always seek medical advice as with the correct treatment and ongoing therapy; progression to more serious kinds of disorder can if not be prevented - at least be managed to make them less problematic.

© Susan Bailey 2013 All Rights Reserved