Oppositional Defiant Disorder

If a child/teen has ADHD, his or her impulsivity may become ‘below the belt’ and can misbehave or disobey authority. This doesn’t mean that he or she has a bad character. Chances are, he or she may have oppositional defiant disorder.

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What is oppositional defiant disorder?

Oppositional Defiant Disorder (ODD) is a condition in which a child displays an ongoing pattern of uncooperative, defiant, hostile, and annoying behavior toward people in authority. The child’s behavior often disrupts the child’s normal daily activities, including activities within the family and at school.[1] Frequently, children/teens with ODD have other conditions like depression, anxiety, and is commonly associated with ADHD.

What causes ODD?

The exact cause is unknown, but there are factors that contribute to ODD[2]:

Genetics. Chances are, ODD tends to run in families, particularly if there is a family history of ADHD, mood disorders, or substance abuse.

Prenatal and birth complications. If a mother abuses drugs, smoke, or drink alcohol, this heightens the risk of developing ODD.

Neurobiology. Injury or faulty development to certain parts of the brain may also cause ODD. Brain imaging studies have suggested that children with ODD may have subtle differences in the part of the brain responsible for reasoning, judgment and impulse control. Children with ODD are thought to have an overactive behavioral activation system (BAS), and underactive behavioral inhibition system (BIS). The BAS stimulates behavior in response to signals of reward or nonpunishment. The BIS produces anxiety and inhibits ongoing behavior in the presence of novel events, innate fear stimuli, and signals of nonreward or punishment.

Social-Cognitive. In one study, 40 percent of boys and 25 percent of girls with persistent conduct problems display significant social-cognitive impairments. Some of these deficits include immature forms of thinking (such as egocentrism), failure to use verbal mediators to regulate his or her behavior, and cognitive distortions, such as interpreting a neutral event as an intentional hostile act.[3]

Environment. Negative/insecure parenting can cause weak parental bonds to children that causes ODD. Low socioeconomic status is associated with poor parenting, specifically with inconsistent discipline and poor parental monitoring, which are then associated with an early onset of aggression and antisocial behaviors.[3]

What are the symptoms of ODD?

Symptoms of ODD may include[1]:

-Throwing repeated temper tantrums
-Excessively arguing with adults
-Actively refusing to comply with requests and rules
-Deliberately trying to annoy or upset others, or being easily annoyed by others
-Blaming others for your mistakes
-Having frequent outbursts of anger and resentment
-Being spiteful and seeking revenge
-Swearing or using obscene language
-Saying mean and hateful things when upset

Kids with ODD usually have low self-esteem, and coping is usually taking drugs or alcohol.

Complications of ODD

If not addressed, ODD can lead to conduct issues and has a high risk of becoming rebels or criminals in late adolescence and adulthood.

How is ODD diagnosed?

Early identification by a child psychiatrist is crucial especially if the symptoms follows the DSM-5 diagnosis of ODD[4]:

a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least six months as evidenced by at least four symptoms from any of the [defined] categories and exhibited during interaction with at least one individual who is not a sibling

This is usually done through psychological testing and referral to a child psychiatrist. Comorbities include ADHD, depression and/or anxiety.

How is ODD managed?

A combination of psychotherapy, social skills training, counselling for parents, and sometimes medication is used to manage ODD.

Parent Management Training Programs to help parents and others manage the child’s behavior. Individual Psychotherapy to develop more effective anger management. Family Psychotherapy to improve communication and mutual understanding. Cognitive Problem-Solving Skills Training and Therapies to assist with problem solving and decrease negativity. Social Skills Training to increase flexibility and improve social skills and frustration tolerance with peers.[5]

Medication 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.[5]

A child with ODD can be very difficult for parents. These parents need support and understanding. Parents can help their child with ODD in the following ways[5]:

-Always build on the positives, give the child praise and positive reinforcement when he shows flexibility or cooperation.
-Take a time-out or break if you are about to make the conflict with your child worse, not better. This is good modeling for your child. Support your child if he decides to take a time-out to prevent overreacting.
-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.
-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.

There is no cure for ODD, but with proper management, symptoms of ODD will diminish, and may even outgrow. Most of all, a loving and disciplined family is needed for every child to ensure normal growth.

References:
1. http://www.webmd.com/mental-health/oppositional-defiant-disorder
2. http://en.m.wikipedia.org/wiki/Oppositional_defiant_disorder
3. Mash EJ, Wolfe DA (2013). Abnormal Child Psychology (5th ed.). Belmont, CA: Wadsworth Cengage Learning. pp. 182–191.
4. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Diagnostic Criteria 313.81 (F91.3): American Psychiatric Association.
5. http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/Children_With_Oppositional_Defiant_Disorder_72.aspx

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