Oppositional defiant Disorder
Table of Contents
Oppositional defiant disorder (ODD) is a behavioral disorder that presents a pattern of defiance, disobedience, and hostility towards authority figures. It is in the group of disorders called disruptive behavioral disorders (DBD) because the adolescents and children who have it show disruptive behaviors. For the case of ODD, the children and adolescents are known to be stubborn, rebel often, and argue with the guardians and adults (Rowe et al., 2010). Also, they have a problem controlling temper and have anger outbursts. The case of ODD is different from normal adolescent hostility patterns because they display a constant/repetitive pattern of these aggressive and abusive behaviors all aimed towards authority figures in their lives (Sanders, Gooley, & Nicholson, 2000). Children who display these types of patterns require treatment because it is often accompanied by other serious mental health illnesses which can develop into conduct disorder (Schoorl et al., 2018). The ODD children also risk delinquency and substance abuse. While the cause of the disorder is not properly known, early interventions are advised to best deal with the condition and prevent its escalation. Learning about its risk factors also helps in its prevention.
Children argue and disagree with the author from time to time. The same symptoms can also happen to children that are upset, hungry, or tired. The behaviors also happen to adolescents when they are undergoing transitions, within a crisis or when under stress. Therefore, these exceptions make the diagnosis of the symptoms of ODD difficult. The criteria of the symptoms, therefore, follows that the children display the pattern of ongoing negativity, defiance, and hostility that is: (Hamilton & Armando, 2008)
- Lasts for at least six months
- Is constant
- Is excessive compared with usual behaviors of children their age
- The child is disruptive in all their environments i.e. Scholl, home church
- The behavior is directed to the authority figures in their life such as teachers, guardians, coaches, etc.
- Excessive arguments with adults
frequent temper tantrums
- Anger outbursts and resentment
- Refusing to comply with rules and requests
- Often annoyed by others
- Spiteful attitude and always seeking revenge
- Questions rules frequently
- Upsets and annoys others deliberately
- Blaming other people for their mistakes
It is important to note that with children with mood disorders such as bipolar and depression, they are not diagnosed with ODD. Typically, also, most children with ODD disorder do not exhibit delinquency. Recently, research has also covered evidence that the ODD disorder may show different symptoms in boys and girls (Utržan et al., 2018). Girls show their symptoms mostly in words rather than indirect ways such as actions. For example, girls would most likely lie and be uncooperative in the case when the boy would become angry and argue with the adult.
There is no specific medical test to determine the presence of ODD. However, a health care professional can diagnose the condition based on behaviors and symptoms through clinical experience. Physical examination and medical history form the basis of the primary analysis by the primary care physician (Sanders, Gooley, & Nicholson, 2000). The physician first looks out for any mental or physical health issues that may cause the symptoms and if they do not find any, they refer the patient to a child or adolescent psychiatrist to diagnose mental illness (Schoorl et al., 2018). The mental health professionals gather information from the child, parents, teachers, and children’s guardians. Getting more people to provide the information helps the doctor to better detect the patterns and effects of the behaviors. The diagnosis by the psychiatrist determines:
- If the symptoms and behaviors are severe
- If the behavior arises from stressors at home
- If the behaviors are directed towards peers or authority figures
- If the child reacts negatively to all adults or just a specific group
Just like with other mental health conditions, ODD is not easy to diagnose. Therefore there is a need for open communication from all the parties especially the child and the parents. When there is openness, the psychiatrist can determine the cause of the condition and understand which category of mental health conditions it fits into.
The prevalence of the condition is between 1% and 11% with an average of 3.3% in children and adolescents (Turner, Hu, Villa & Nock, 2018). The condition often appears in late pre-school. For the younger pre-adolescent ages, evidence shows that the condition is more present in the males than the females. The condition is however equally prevalent once the children are in adolescence because the condition becomes evident in girls after they reach puberty. ODD onset is gradual and is most evident after the age of 8yeras and not later than the early adolescence (Hamilton & Armando, 2008). Further, the conditions appear prevalently in families of low socio-economic backgrounds. The children who exhibit the symptoms early have a high likelihood of abuse from parents, school drop out, and crimes; they are also most likely to develop other mental health problems.
The main cause of ODD is not fully determined but it is thought to be caused by a combination of social, psychological, and biological factors.
Two theories best explain the cause of ODD in children
Developmental Theory – developmental theories work on explaining the changes that occur to the child as they grow up. They focus on the emotional, cognitive, and social growth. The theories, therefore, find the relation between children’s behaviors with their family relationships, temperaments, or age. The theories thus explain that as the child is growing, that is where the problem develops. In the case of the children with ODD, they may have had trouble leaning independence from their parents of people who are emotionally attached. Therefore they display these symptoms as behaviors as a result of the developmental problems. They, therefore, believe that the problem then extends beyond their younger ages.
Learning Theory -The learning theory explains the concepts through which children and people absorb the process and retain knowledge within their lifetime. The learning process is also explained to be affected by emotional, cognitive, and environmental conditions. The children’s world view is dependent on these factors and the absorption of new information and knowledge. Therefore, the learning theories explain that the children learn these negative attitudes that serve as ODD symptoms. The concepts are learned from the parents, teachers, coaches, and other people in authority (Turner, Hu, Villa & Nock, 2018). The children try to mirror these behaviors within their lives. The behaviors also increase their incidence as the parents continue to give negative reinforcement because the children get attention from the parents and other authority figures
The validity of the diagnosis of disruption based disorders has been questioned for a while; more so for the females. Research by Keenan et al. (2010) used a large community sample longitudinally from the ages of 7 to 15 years. They found out that many of the children who displayed the conduct disorder showed evidence for ODD. The research also proved the degree of severity of the behavior. Rowe ate all (2010) also proved the incidence of the disease among girls in the Great Smokey Mountain study; it however proved that it wasn’t a major risk factor for CD in girls as in the case of boys. Owe ate al, also proved that the age range of 9-21 was the major incidence age for CD and ODD.
Research by Kolko and Pardini (2010) followed a group of 177 children for 3 years. It proved that the irritability symptoms of ODD were as a result of post-treatment internalizing issues. The defiant facet was the one that predicted conduct disorder and thus the externalization problems. The result was also replicated by that of Rowe at all (2010), which had a larger sample size and a longer follow up period. They discovered that the symptoms of ODD were differentiated into two; irritability and headstrong symptoms (defying and arguing with adults).
Evidence suggests that ODD is treatable or regulated through psychotherapy (Utržan et al., 2018). The application of psychotherapy has shown improvement in the children’s responses and emotions. They can succeed in improving relationships, improve in school, and decrease susceptibility to other mental health-related issues. Some medications have also come out to help with the conditions but there is no specific one specializing with ODD. Antidepressants for example has helped children better manage their emotions. Self-help strategies applicable at home have also been proven to assist with the condition. When children improve their communication, social, and problem-solving skills, they show an improvement in their \behavior. The success of all these medication’s principles shows the evidence that the disease is real.
- Adolescents and children are more susceptible to the condition if they have:
- A parent with any form of mood disorder conditions such as bipolar or depression disorder
- A parent with a history of conduct disorder, Oppositional defiant disorder of Attention deficit or hyperactivity disorder
- A parent with a drug problem or drinking disorder
- Have an impairment in the brain section that deals with impulse control, reasoning or judgment
- Exposure to toxins
- A mother who smoked during pregnancy
- Poor nutrition
- Brain chemical imbalance
- Poor relationship with parents
- An absent or neglectful parent
- Problem creating social relationships
- Abusive relationships with adults and parents
- Neglect from guardians
- Uninvolved parents
- Inconsistent discipline
- Chaotic environment
- Family instability
- Lack of supervision
- Poor social-economic background
ODD can occur in children at the same time as other treatable mental health conditions. Some of the conditions that can coexist with ODD include: (Turner, Hu, Villa & Nock, 2018)
- Anxiety disorders
- Learning disorders
- Language disorder
- Mood disorders
Previous research in the study of ODD shows that some children display ODD symptoms as a management tactic for anxiety (Utržan et al., 2018). Anxiety disorders manifest themselves almost similar to ODD because they make the child respond to instability and uncertainty within the child’s school and home environment. Therefore this similarity increases the chances of the two conditions happening together. ADHD is the most common condition to coexist with ODD because both share the disruptive symptoms (Turner, Hu, Villa & Nock, 2018). However, in the case that a child or adolescent has both conditions, they have more negative behaviors, are more aggressive, and perform poorly in school than ODD alone.
ODD happens to also precursor CD which is a more serious condition that results in destructive and antisocial behavior. CD however appears when children are older than preschool. The children who have ODD and ADHD increase their susceptibility to CD which results in a mood disorder and antisocial characters later within their lives. Treatments exist that can deal with coexisting conditions and preserve the mental health of a child.
Research by Burke, Loeber, and, Birmaher B (2002) shows that ODD is preventable when the early intervention takes place. When a child is exposed to individual therapy and some social school-based programs, they can beat the condition before it gets too far. A head start program that begins in preschool has been proven to help children prevent delinquency and perform better in class. The head start program teaches students social skills, conflict resolution, communication skills, and anger management. It works even better when it targets children from lower social-economic situations. For the bigger children and adolescents, vocational training, psychotherapy and social skills training can work towards reducing the behavior (Turner, Hu, Villa & Nock, 2018). School-based programs that deal with bullying, social behavior, and improving peer friendships can help with the adolescent’s behaviors. The parent also requires training to develop nurturing abilities and setting up boundaries with their child; this way they can better handle the relationships with their child.
No specific treatment would fit it all on treating ODD and it thus requires an assortment of methods. Each child requires tailoring of the treatment plans to fit the personal needs and symptoms of the child. The best treatment will thus depend on the child’s age, the presence of coexisting problems, and the severity of conditions. Parents also need to participate in the treatment procedure as their goals and circumstances play a part in easing the healing process. In most cases, the treatment procedure lasts several months and thus those involved with the care of the child require being committed. The types of treatment include:
Medication – medication is also necessary for controlling more distressing behaviors (Schoorl et al., 2018). In the case of the presence of a coexisting condition, medication also deals with them. However, only medication cannot serve a solution to the problem.
Individual Cognitive behavioral therapy – this therapy works on the individual to help them cultivate coping mechanisms and positive behavior. They are taught anger management, problem-solving, and controlling emotions. The therapist also helps the individual to come up with positive alternative behaviors. The success of this therapy is most felt when the child is between 2-7 years when the social interactions are not hard to change (Turner, Hu, Villa & Nock, 2018). The procedure is more effective compared to other therapy forms
Family Therapy and parent Management Training programs – these types of therapy work on educating the family members more so the parents on ways of managing the child’s behavior. Techniques of positive reinforcement and discipline are important aspects taught within this form of therapy.
Parent-child interaction therapy – the therapy happens to mend the strained relationships between the parents and the child caused by the negative behaviors (Utržan et al., 2018). The parents listen to the therapist and interact with the child as they relate the parenting skills.
Group Therapy – Adolescents having the ODD can work together in group therapy to work out a better outcome. The method is effective because it helps an individual to be more aware of themselves based on what they listen about others with the same issues (Webster-Stratton & Reid, 2018).
Cognitive Problem-solving Skills Training – The children are involved in inappropriate behavior because they lack positive ways of reacting to stressful conditions. The program thus equips them with this information to substitute them with their negative ways of responding to life situations (Webster-Stratton & Reid, 2018). Thus, the children get a proper world view and learn the best responses.
Social skills program and school-based programs – The programs help the children to relate more positively and improve their school work (Webster-Stratton & Reid, 2018). They are more successful because they happen in the child’s natural environment; that is the school.
The treatment value depending on the age group of the child. Younger preschool children have therapies focusing on parent management training. School-age children work better with a combination of individual therapy, school-based intervention, and parent management training. Adolescents on the other hand work best with parent management training and group therapy. The problem-solving skills training is tailored depending on the age and the behaviors of the particular child. (Utržan et al., 2018)
- Parent management training is seen to be effective in all age groups. It helps parents to manage the way they handle their children, best discipline techniques, and appropriate supervision. It the best choice of treatment for many therapists. It is chosen because it embraces:
- Expanded positive child-rearing practices, for example, giving steady and steady management and order
- Decreased negative child-rearing practices, for example, the utilization of cruel discipline, what’s more, center around improper practices
- Consistent discipline for troublesome conduct
- Predictable, prompt parental reaction
Medication alone does not work to improve the condition of the ODD child. When it is used in combination with other remedies, it serves good purposes. It helps deal with certain excessive behaviors and other coexisting problems such as anxiety disorder, ADHD, and mood disorder. Treating these coexisting conditions lessens the behavioral symptoms of ODD.
Most treatment plans for youngsters and youths with ODD last a few months or more. For those with an increasingly extreme ODD or ODD that doesn’t react to treatment, treatment can last numerous years and may incorporate the situation in a treatment place (Utržan et al., 2018). A private treatment place just ought to be considered for families who can’t give treatment at home or school. In-home administrations are desirable over private positions and are frequently supported by state and neighborhood youngster government assistance offices.
Specialists concur that treatments are given in a one-time or brief style, such as training camps, strong but fair affection camps, or alarm strategies, are not viable for kids, what’s more, young people with ODD. These methodologies may accomplish more damage than good. Attempting to panic or coercively pressure kids and youths into acting may just strengthen forceful behavior. Kids react best to treatment that rewards positive conduct and instructs them abilities to oversee negative conduct.
For numerous youngsters, ODD improves after some time. Follow-up researchers have discovered that roughly 67 percent of kids determined to have ODD who gotten treatment will be side effect free for three years (Schoorl et al., 2018). Be that as it may, other studies additionally show that roughly 30 percent of youngsters who were determined to have ODD will proceed to create CD. Different examinations show that when the social side effects of ODD start in early life (preschool or prior), the kid or pre-adult will have less possibility of being side effect free further down the road (Utržan et al., 2018). Additionally, the danger of creating CD is three times more noteworthy for youngsters who were at first analyzed in preschool.
Furthermore, preschool youngsters with ODD are bound to have existing together conditions, for example, ADHD, nervousness issue, or state of mind issue (gloom or then again bipolar turmoil) further down the road. In all age gatherings, roughly 10 percent of kids and young people determined to have an ODD will in the end build up an all the more enduring character clutter, for example, reserved character issues.
Mary brings her child John, 7 years old, to the general expert. Mary says that she can’t deal with his conduct at home and that the teacher has said that he won’t adhere to directions in the class and is harassing his companions. The general practitioner asks how the kid behaved like a little child. He discovers that John would cry often and that it took Mary a long time to calm him. As a little child, if Mary attempted to expel something he needed, John would pitch fits enduring for as long as 30 minutes. As he grew, John would frequently kick his mom and decline to do what she inquired. Presently he argues with her consistently, even about little things. He battles day by day with his ten-year-old sister, Brenda, and consistently accuses her when things go wrong.
Mary reports that she felt deficient as a parent and became discouraged when John was around a year and a half old enough. Further addressing the home circumstance decided that John’s dad, Tom, regularly loses his temper and yells at his better half and kids. The family is encountering budgetary troubles and Tom is frequently unemployed.
John’s teacher thinks that John can do his homework yet is stubborn and won’t participate in tasks with different classmates. He escapes his seat normally and strolls around the room. He will regularly flick different kids on the arms and remove their pencils. He experiences issues making companions as he generally needs them to play his games, what’s more, he will shout at them if they don’t do what he wants.
At the point when the GP gets some information about school and home, John reveals to him that he hasn’t done anything incorrectly and that everybody singles out him and that he gets accused of everything. It’s John’s view that everybody needs him to carry on better and that they should simply disregard him.
For this situation, John meets the criteria for a diagnosis of ODD. He has a background marked by a troublesome demeanor, has been unfriendly toward his mom since he was a baby, what’s more, has experienced issues since entering the preschool framework meeting the teacher’s expectations for conduct and making companions
Hamilton, S. S., & Armando, J. (2008). Oppositional defiant disorder. American family physician, 78(7), 861-866.
Keenan, K., Wroblewski, K., Hipwell, A., Loeber, R., & Stouthamer-Loeber, M. (2010). Age of onset, symptom threshold, and expansion of the nosology of conduct disorder for girls. Journal of abnormal psychology, 119(4), 689.
Kolko, D. J., & Pardini, D. A. (2010). ODD dimensions, ADHD, and callous-unemotional traits as predictors of treatment response in children with disruptive behavior disorders. Journal of Abnormal Psychology, 119(4), 713.
Loeber, R., Burke, J. D., Lahey, B. B., Winters, A., & Zera, M. (2000). Oppositional defiant and conduct disorder: a review of the past 10 years, part I. Journal of the American Academy of Child & Adolescent Psychiatry, 39(12), 1468-1484.
Rowe, R., Costello, E. J., Angold, A., Copeland, W. E., & Maughan, B. (2010). Developmental pathways in oppositional defiant disorder and conduct disorder. Journal of abnormal psychology, 119(4), 726.
Rowe, R., Maughan, B., Pickles, A., Costello, E. J., & Angold, A. (2002). The relationship between DSM‐IV oppositional defiant disorder and conduct disorder: findings from the Great Smoky Mountains Study. Journal of Child Psychology and Psychiatry, 43(3), 365-373.
School, J., van Rijn, S., de Wied, M., Van Goozen, S., & Swaab, H. (2018). Boys with oppositional defiant disorder/conduct disorder show impaired adaptation during stress: An executive functioning study. Child Psychiatry & Human Development, 49(2), 298-307.
Turner, B. J., Hu, C., Villa, J. P., & Nock, M. K. (2018). Oppositional defiant disorder and conduct disorder.
Utržan, D. S., Piehler, T. F., Dishion, T. J., Lochman, J. E., & Matthys, W. (2018). The role of deviant peers in oppositional defiant disorder and conduct disorder. The Wiley handbook of disruptive and impulse-control disorders, 339.
Webster-Stratton, C., & Reid, M. J. (2018). The Incredible Years parents, teachers, and children training series: A multifaceted treatment approach for young children with conduct problems
Sanders, M. R., Gooley, S., & Nicholson, J. (2000). Early Intervention in Conduct Problems in Children. Clinical Approaches to Early Intervention in Child and Adolescent Mental Health, Volume 3. Australian Early Intervention Network for Mental Health in Young People, c/o CAMHS Southern, Flinders Medical Center, Bedford Park, South Australia 5042. For full text: http://auseinet. flinders. edu. au..