Oppositional defiant disorder

Overview

Oppositional defiant disorder (ODD) is defined as a pattern of disobedient, hostile, and defiant behavior toward authority figures. Sounds like every teenager I’ve ever met. Of course, every kid will have periods where they aren't going to follow directions given by an adult. It's a part of growing up and becoming an individual and many psychologists, like Erikson and Maslow, have argued that the testing of limits and rebellion against authority are how we develop our personalities independent of our parents. When the behaviors begin to interfere with a kids day to day functioning and personal relationships,

Symptoms

The Diagnostic and Statistical Manual of Mental Disorders lists the following symptoms for ODD

* Actively does not follow adults' requests

* Angry and resentful of others

* Frequently argues with adults

* Typically blames others for own mistakes

* Deliberately seeks to annoy or upset people

* Often loses temper

* Spiteful or seeks revenge

* Touchy or easily annoyed

To fit this diagnosis, the pattern must last for at least 6 months and must be more than normal childhood misbehavior, as compared to other kids in the same age group. The behavior must not occur only during psychotic episodes or mood disorders. Finally, the clinician must rule out conduct disorders and antisocial personality disorders. Even though the behavior may be observed in a variety of settings, it may be most extreme in the home or at school, which can lead to problems in diagnosis, as the parent, for instance, may not be observing the same behavior that the teacher does.

Causes

This disorder is more common in boys than in girls. Some studies have shown that it affects 20% of school-age children. However, most experts believe this figure is high due to changing definitions of normal childhood behavior, and possible racial, cultural, and gender biases. This behavior typically starts by age 8 and can carry on through adulthood. The cause of this disorder is unknown, and may be due to a combination of biology and parenting or environmental factors. Some studies have suggested that neurotransmitter imbalances may play a role, and medications can be effective in these situations. Another study has found a correlation among family members with a history of mental illness, especially mood disorders. Of course, it’s important to remember that this doesn’t mean that if your family has a history of illness, that your child will be diagnosed. It simply means that your child may be more at risk, and you’ll want to take preventative action early. And of course environmental factors are known to play a huge role in ODD. Children from dysfunctional homes, a family history of substance abuse as well as inconsistent parenting are all risk factors for children developing ODD.

Tests & diagnosis

The pattern of behaviors must be different from those of other children around the same age and developmental level. The behavior must lead to significant problems in school or social activities. While there are no lab tests that can be done, your doctor may order tests to rule out physical illness that may be causing the oppositional behavior. If nothing shows up, they may recommend evaluation by a mental health professional. In children and adolescents, depression and attention-deficit /hyperactivity disorder (ADHD) can cause similar behavior problems, and should be considered as possibilities.

Treatment

The best treatment for the child is talking with a mental health professional (psychotherapy). Individual psychotherapy can help develop effective anger management skills and teach appropriate communication.  Cognitive problem-solving skills training can assist with developing positive problem solving and aid in the decreased negativity.  Many therapists will teach social skills to increase flexibility in social and interpersonal communications, as well as frustration tolerance with peers. Family psychotherapy is an effective way to improve communication and mutual understanding at home. The parents should also learn how to manage the child's behavior.

Medication may be helpful if the behaviors occur as part of another condition (such as depression, childhood psychosis, or ADHD). It may be helpful in controlling some of the more distressing symptoms of ODD as well as the symptoms related to coexistent conditions such as ADHD, anxiety and mood disorders.

A child with ODD can be very difficult for parents.  These parents need support from friends and family.  Parents can help their child with ODD in the following ways:

  • Always build on the positives, give the child praise and positive reinforcement when he shows flexibility or cooperation. Our society especially is bad about recognizing and encouraging the good choices children make, focusing instead on the negative behaviors. Try balancing it out and thank your child for making good decisions.
  • Take a time-out or break if you are about to make the conflict with your child worse, not better.  Support your child if he decides to take a time-out to prevent overreacting. Sometimes a break in the day can help a child, and you, to get their emotions back in control.
  • Model the right behaviors for your child. Teach them, from an early age, the appropriate way to treat others and make sure that they see you following your own rules. When kids see that there’s one set of rules for them and another for everyone else, they are more likely to break the rules. In their minds, they often see it as leveling the playing field, making things fair.
  • Pick your battles.  Since the child with ODD has trouble avoiding power struggles, prioritize the things you want your child to do.  If you give your child a time-out in his room for misbehavior, don’t add time for arguing.  Say “your time will start when you go to your room.”
  • Set up reasonable, age appropriate limits with consequences that can be enforced consistently. The consistency is very important, your child should know what to expect for breaking a rule.
  • Maintain interests other than your child with ODD, so that managing your child doesn’t take all your time and energy.  Try to work with and obtain support from the other adults (teachers, coaches, and spouse) dealing with your child.
  • Manage your own stress with healthy life choices such as exercise and relaxation.  Use respite care and other breaks as needed. Remember that the higher your stress levels get, the harder it will be for you to effectively deal with your child.

Many children with ODD will respond to the positive parenting techniques.  Parents may ask their pediatrician or family physician to refer them to a child and adolescent psychiatrist or qualified mental health professional that can diagnose and treat ODD and any coexisting psychiatric condition.

Comments 2 comments

Julie A. Johnson profile image

Julie A. Johnson 6 years ago from Duluth, MN

Helpful advice -- consistency in parenting is key, and respit for parents is essential. Thanks. Julie


ptosis profile image

ptosis 6 years ago from Arizona

ODD, I always thought I was odd, strange, bizarre, weird and unusual!

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