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Introduction
Oppositional defiant
disorder (ODD) is a psychiatric behavior disorder that is
characterized by aggressiveness and a tendency to
purposefully bother and irritate others. These behaviors
cause significant difficulties with family and friends and
at school or work.
Oppositional defiant
disorder is sometimes a precursor of conduct disorder.
Much of the literature tends to lump these two conditions
together. However, they seem to be distinct entities and,
although conduct disorder does have a genetic component,
ODD does not.
Description
Oppositional defiant
children show a consistent pattern of refusing to follow
commands or requests by adults. These children repeatedly
lose their temper, argue with adults, and refuse to comply
with rules and directions. They are easily annoyed and
blame others for their mistakes. Children with ODD show a
pattern of stubbornness and frequently test limits, even
in early childhood.
These children can be
manipulative and often induce discord in those around
them. Commonly they can incite parents and other family
members to fight with one and other rather than focus on
the child, who is the source of the problem.
Behavioral Symptoms
Common behaviors seen in
oppositional defiant disorder include:
- Losing one’s temper
- Arguing with adults
- Actively defying
requests
- Refusing to follow rules
- Deliberately annoying
other people
- Blaming others for one's
own mistakes or misbehavior
- Being touchy, easily
annoyed
- Being easily angered,
resentful, spiteful, or vindictive.
- Speaking harshly, or
unkind when upset
- Seeking revenge
- Having frequent temper
tantrums
Many parents report that
their ODD children were rigid and demanding from an early
age.
Normal children, especially
around the ages or 2 or 3 or during the teenage years
display most of these behaviors from time to time. When
children are tired, hungry, or upset, they may be defiant.
However, children with oppositional defiant disorder
display these behaviors more frequently and to the extent
that they and interfere with learning, school adjustment,
and, sometimes, with the child's social relationships.
Diagnosis
The diagnosis of ODD is not
always straight forward and needs to be made by a
psychiatrist or some other qualified mental health
professional after a comprehensive evaluation. The child
must be evaluated for other disorders as well since ODD
usually does not come alone. If the child has ADHD, mood
disorders, or anxiety disorders, these other problems must
be addressed before you can begin to work with the ODD.
If you feel your child may
have ODD, there is a quick screening test. Go to: http://addadhdadvances.com/ODDtest.html
Causes
What is the cause of ODD?
The real answer is that nobody knows. However, since as
scientist we hate to admit this, we have currently have
two theories.
The developmental theory
proposes that ODD is really a result of incomplete child
development. For some reason, these children never
complete the developmental tasks that normal children
learn to master during the toddler years.
The learning theory
suggests that ODD comes as a response to negative
interactions. The techniques used by parents and authority
figures on these children bring about the oppositional
defiant behavior.
ODD is the most common
psychiatric diagnosis in children and it usually persists
into adulthood. One would think a lot of research would be
done on this condition. That is not the case. While there
are hundreds of research studies on ADHD and childhood
mood disorders, there is very little research on ODD.
Co-morbidity
ODD is frequently goes
along with other disorders. 50-65% of ODD children also
have ADHD. 35% of these children develop some form of
affective disorder. 20% have some form of mood disorder,
such as depression or anxiety. 15% develop some form of
personality disorder. These children frequently have
learning disorders and academic difficulties.
If your child has ODD it is
important to know there are other co-existing problems.
These other problems usually must be addressed before you
can begin to help your child with ODD.
Prognosis
So what happens to these
children? There are four possible paths.
- Some will grow out of
it. Half of the preschoolers that are labeled ODD are
normal by the age of 8. However, in older ODD
children, 75% will still fulfill the diagnostic
criteria later in life.
- The ODD may turn into
something else. 5-10 % of preschoolers with ODD have
their diagnosis changed from ODD to ADHD. In some
children, the defiant behavior gets worse and these
children eventually are diagnosed with Conduct
Disorder. This progression usually happens fairly
early. If a child has ODD for 3-4 years and he hasn't
developed Conduct Disorder, then he won’t ever
develop it.
- The child may continue
to have ODD without any thing else. This is unusual.
By the time preschoolers with ODD are 8 years old,
only 5% have ODD and nothing else.
- The child develops other
disorders in addition to ODD. This is very common.
Treatment
Most of these children have
some other disorder along with their ODD. Treating this
other disorder is the key to proper ODD management. This
frequently means giving medication. Although this type of
medical intervention does not make the children
"normal", it can make a big difference. It often
allows other non-medical interventions to work much
better.
For example, if a child has
both ODD and ADHD, then giving the child Ritalin may have
a significant effect on his ODD, also. This positive
effect does not seem to be related to the severity of the
ADHD. That means even if the child has mild ADHD and could
do without Ritalin, if he is treated medically, you might
see an improvement in his ODD.
Once the other problems are
under control, the best treatment for ODD is parent
training. In a study published in 1998, eighty-two
research studies were evaluated were examined for
efficacy. Approaches focusing on parent training were the
most affective techniques.
The main point is that some
parent-training program is essential in addressing ODD.
This is not going to work for everyone, but it is the best
treatment that we have available for ODD.
Advice to Parents
That is with regard to your
child. If your child has ODD you need to take care of
yourself, also. No child needs a martyr as a parent.
Here are some of the things
you can do:
- Maintain interests other
than your child with ODD. You have to be a person.
- Try to work with and
obtain support from the other adults (teachers,
coaches, and spouse) dealing with your child.
- Take time to work on
your relationship with your spouse. Raising these
children is very difficult and can put a strain on the
best of marriages.
- Manage your own stress
with exercise and relaxation.
- Take frequent vacations.
This is a must.
Conclusion
It is tough to live with
children who have ODD. What is worse is that there does
not seem to be any cure. However, if you make sure that
your child has his other problems addressed and you
improve your parenting skills by enrolling in a parent
training program, you can do a great deal to improve your
child’s condition and your own.
Anthony Kane, MD
ADD ADHD Advances
http://addadhdadvances.com
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