- Oppositional Defiant Disorder (ODD)
Oppositional defiant disorder is a disorder in a child marked by defiance and disobedient behavior to authority figures. It is estimated that 2 in 16 of children have the oppositional defiant disorder, with it being common in boys than girls of a younger age. The symptoms of ODD are noticed when the child is around eight years old, including defiant behavior, vindictiveness, hostility towards peers, aggression and argumentative behavior, and an irritable mood. The cause of ODD is unclear but has been found to likely involve genetic and environmental factors or developmental problems or can be learned from another child. ODD can be distinguished from a typically disruptive behavior by noticing the severity of the behavior and how long it lasts. There are many risk factors associated with ODD, the hallmark being experiencing life stress and trauma.
- Clinical Presentation
- ODD Criteria
A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting
at least 6 months as evidenced by at least four symptoms from any of the following categories, and exhibited during interaction with at least one individual who is not a sibling.
- ODD Symptoms
- Angry/Irritable Mood
- Often loses temper.
- Is often touchy or easily annoyed.
- Is often angry and resentful.
- Argumentative/Defiant Behavior
- Often argues with authority figures or, for children and adolescents, with adults.
- Often actively defies or refuses to comply with requests from authority figures or
- Often deliberately annoys others.
- Often blames others for his or her mistakes or misbehavior.
- Has been spiteful or vindictive at least twice within the past 6 months.
Symptoms of ODD may include:
III. Prevalence/Incidence Rates
The prevalence of oppositional defiant disorder ranges from 1% to 11%, with an average
prevalence estimate of around 3.3%. The rate of oppositional defiant disorder may vary
depending on the age and gender of the child. The disorder appears to be somewhat more
prevalent in males than in females (1.4:1) prior to adolescence. This male predominance is
not consistently found in samples of adolescents or adults.
There is no clear-cut cause of ODD. However, most experts believe that a combination of biological, psychological, genetics, environmental, and social risk factors play a role in the development of the disorder.
- Theoretical Perspectives
- Developmental theory. This theory suggests that the problems start when children are toddlers. Children and teens with ODD may have had trouble learning to become independent from a parent or other main person to whom they were emotionally attached. Their behavior may be normal developmental issues that are lasting beyond the toddler years.
- Learning theory. This theory suggests that the negative symptoms of ODD are learned attitudes. They mirror the effects of negative reinforcement methods used by parents and others in power. The use of negative reinforcement increases the child’s ODD behaviors because these behaviors allow the child to get what he or she wants: attention and reaction from parents or others.
- Empirical Support
- Psychotherapy (Behavioral Parent Training)
- Self Help Strategies
- Biological Factors
Children and adolescents are more susceptible to developing ODD if they have:
- A parent with a history of attention-deficit/hyperactivity disorder (ADHD), ODD, or CD
- A parent with a mood disorder (such as depression or bipolar disorder)
- A parent who has a problem with drinking or substance abuse
- Impairment in the part of the brain responsible for reasoning, judgment, and impulse control
- A brain-chemical imbalance
- A mother who smoked during pregnancy
- Exposure to toxins
- Poor nutrition
- Psychological Factors
- A poor relationship with one or more parent
- A neglectful or absent parent
- Difficulty or inability to form social relationships or process social cues
- Social Factors
- Chaotic environment
- Lack of supervision
- Uninvolved parents
- Inconsistent discipline
- Family instability (such as divorce or frequent moves)
- Genetic Factors
- Environmental Factors
- Treatment Approaches/Outcomes
- Psycho-education is used to help the child and/or parent or caregiver understand how the child’s diagnosis, strategies to manage the child’s symptoms and behaviors, and treatment options.
- Social skills training is a proven treatment approach to improving peer relationships that pose difficulty with children with ODD, Children struggling with extreme emotional dysregulation may also benefit from dialectical behavior therapy (DBT). DBT is designed to identify and change negative thinking patterns to enforce positive behavioral changes.
- Parent-child interaction therapy is designed to focus on strained relationships that may be contributing to the behaviors. During parent-child interaction therapy allows family members to interact while listening to recommendations from the therapist behind a one-way mirror, so the individual will relate the parenting skills with the parent and not the therapist.
- Group therapy is proven to be very helpful treatment approach in ODD. Group therapy allows individuals to develop self-awareness by listening to others with similar issues.
- Individual Cognitive Behavioral Therapy teach individuals with ODD various techniques for reducing anger, controlling emotions, and solving problems. Individual Cognitive Behavioral Therapy can provide positive alternative behaviors to replace defiant ones. Individual Cognitive Behavioral Therapy works best when the child is between the ages of 2-7 and when family and social interactions aren’t difficult to change. Numerous research findings suggest that Individual Cognitive Behavioral Therapy leads to considerable improvement in functioning and quality of life. In many studies, Individual Cognitive Behavioral Therapy has been demonstrated to be as effective as, or more effective than, other forms of psychological therapy or psychiatric medications.
- Medication is helpful in managing symptoms of ODD. Although there is no FDA-approved medication for ODD. However, antipsychotic medications are frequently prescribed to help minimize symptoms and behaviors associated with ODD. Clinical experience has shown that the majority of individuals diagnosed with ODD show signs of improvement with a low dose of antipsychotic medications.
- Core Value-Respect
Different treatment approach is based and build on respect. During cognitive Behavioral therapy one session can be solely on treating others with respect.
VII. Case Example
Calen, a 7 year old male, has been exhibiting an increase in behavior over the past 7 months. Calen has been displaying anger, aggression and disruptive behaviors in the home and school settings. Calen’s anger has resulted in him throwing the remote control to his video game and breaking the arm on the chair. Calen will argue with his parents and teachers and become disrespectful by talking back to authority figures. Calen has difficulty following rules and will stay out past his curfew and refuse to do his chores when directed. Calen often disrupts the classroom setting by making weird noises and banging on the desk during instruction time. When confronted with his behaviors, Calen has difficulty accepting responsibility for his actions and will blame others. Calen’s sisters state that Calen is purposely annoying by standing in front of the television while they are watching their show and pulling their hair and running. Calen’s parents explained that Calen’s behaviors are causing significant impairment in the home and school settings.