Oppositional Defiant Disorder

Understanding Difficult or Defiant Children: What is Oppositional Defiant Disorder?

From the “terrible twos” through to the “rebellious teens,” any parent will attest that dealing with the many emotional and intellectual changes every child goes through before reaching adulthood is very difficult. Most parents I have counseled take some solace in the knowledge that these changes are most often “stages” that will likely pass.

However, some children’s emotional or behavioral challenges are the result of a deeper-seated problem or disorder. One difficult and often overlooked condition is called oppositional defiant disorder, or ODD. Estimates vary, but some researchers suggest that as many as 16 percent of children and adolescents, mostly boys, suffer with ODD, as do those who live and work around them.

  • What Is Oppositional Defiant Disorder?

ODD is described as a nightmare by most parents. It is a behavioral disorder characterized by the repeated display of negative, angry, defiant behavior. But there’s a slightly positive twist. Compared with children with other behavioral disorders, children with ODD don’t normally directly violate the rights of others. They appear to know the difference between right and wrong, which keeps them from looking like sociopaths, and many are remorseful if and when they do something that is seriously wrong. These are all good signs because it shows us that there is a core empathic value structure on which to build within these children,

  • How Normal Is Defiance?

Some defiant behavior in children is normal, according to Dr. Claudio Toppelberg, a child psychiatrist and researcher at Harvard Medical School and Boston’s Children’s Hospital. “Similar to aggressive behavior, oppositional and defiant behavior is common in the first years of life and decreases subsequently in most children,” Dr. Toppelberg explains. “Children who suffer from ODD, however, tend to display negative behavior much more often, for longer periods of time and with greater intensity than is typical in other children of a similar age."

  • Common Symptoms of Oppositional Defiant Disorder

Symptoms of ODD usually become apparent around age 8 (but I have witnessed these symptoms showing up in much younger children in recent years, children as young as 3 or 4) and they often occur gradually over a number of months. Generally, they include a high amount of hostile, defiant behavior, which lasts for at least six months. A child with the typical symptoms of ODD often:

• argues a great deal with siblings and adults
• easily loses his or her temper

• refuses to listen or follow adults’ requests or rules
• deliberately annoys others
• is easily annoyed by siblings, friends, or adults
• behaves in angry and resentful ways
• can be spiteful or vindictive
• consistently blames others for his or her mistakes
• displays very little tolerance for others
• feels entitled to get their way, and what they want, when they want it

  • What Causes ODD?

There are several theories regarding the cause of ODD, but the exact cause is not known. Researchers believe that the disorder may be related to:

• A child’s temperament and the family’s response to it

• A child’s social skills (or lack of)

• A child’s confidence about communicating using language

• How parents discipline (punish) and understand (or make excuses for) the child

• The way a child’s body adjusts to arousal and stimulation

• Having parents who are overly concerned with power and control

• Disrupted childcare – involving, for example, multiple caregivers

• An inherited disposition to the disorder, possibly both environmental as well as genetic

• Neurological damage (such as a head injury)

• Prenatal and perinatal factors.

  • Parental Reaction and Interaction

How parents react to and approach the problem of ODD is as important, or more important, than the treatment.

When a child has ODD without other disorders, it tends to be a relatively benign disorder that many children overcome, but when other disorders – such as ADHD – coincide with ODD, treatment and prognosis become more complex.

It is important for parents not to get alarmed unnecessarily, not to blame themselves or the child, but to do all they can to gain the tools and knowledge to help them combat and eliminate this harmful and destructive disorder.

  • Diagnosing the Disorder

Symptoms of ODD tend to mirror common childhood and adolescent behavior, differing primarily in frequency and degree. Because of this fact, recognizing and diagnosing the disorder has its challenges. In addition, similar symptoms resulting from other disorders can make the diagnosis more complex. For these reasons, if you are concerned that your child might be suffering from ODD, it is important to have your child evaluated by a child psychiatrist, child psychologist or other qualified professional.

“To diagnose ODD, the disruptive behavioral pattern has to be significantly more intense, prolonged and frequent, and cause considerably more dysfunction whencompared to children of similar age and developmental level. Determining whether the behaviors are significantly different from what would usually be expected in a child at that age can be quite complex and shows how the developmental expertise of a child psychiatrist or child psychologist may be necessary to make an accurate diagnosis and effective recommendations.”
                                                                                                                                 
Dr. Claudio Toppelberg

  • If a doctor suspects ODD, he or she will first:

• Examine the child thoroughly
• Talk with the child and with their parents.
• Review the child’s and the family’s history.
• Obtain information about the child’s functioning in school.
• Look for signs of other disorders in the child. (ODD may be accompanied by one or more other psychological disorders, further increasing the difficulty of diagnosis).

  • A diagnosis of ODD will not be made unless:

• The child displays at least four of the typical behaviors of the disorder.
• These behaviors occur more frequently and have more serious consequences than is typical in children of a similar age.
• The behavior symptoms lead to significant problems in the child’s school, work or social life.

  • Prevention and Treatment

Since the exact cause of ODD is not known, specific measures to prevent the disorder are not known. However, a number of treatments for ODD are often helpful. These treatments come in the form of one or more types of psychological counseling or therapy (which are needed to address the multiple factors mentioned earlier). This counseling or therapy can be in a group, individual or family setting. The types of counseling or therapy used include:

Parent training to help parents better address the child’s behavior in an age-appropriate manner.

• Family therapy
to build and strengthen the family’s communication skills.

• Social skills training
to help the child increase his or her flexibility and improve his or her ability to deal with and tolerate frustration with peers.

• Cognitive-behavior therapy
to aid the child, and the family, in problem-solving skills and to decrease negativity.

• Child therapy to help the child develop ways to better modulate their negative and angry feelings and to develop a better understanding of what prompts the child to act the way he or she does.

  • Resource

American Academy of Child and Adolescent Psychiatry–  202-966-7300; www.aacap.org    – The academy’s “Facts for Families” series features two items relevant to families interested in ODD. Check out www.aacap.org/publications/factsfam/72.htm and www.aacap.org/publications/factsfam/discplin.htm

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