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Oppositional Defiant Disorder (ODD) in Children Today

Outline: A child with Oppositional Defiant Disorder (ODD) argues with adults parents teachers, has to have last say, does not listen or obey rules.

Main Digest

Children with ODD show a pattern of stubbornness, aversion to authority, and frequently test parents, teachers limits, even in early childhood...

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 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.

Children who have ODD are often disobedient. They are easily angered and may seem to be angry much of the time. Very young children with the disorder will throw temper tantrums that last for 30 minutes or longer, over seemingly trivial matters.

Do You Know a Child Who...

It's possible your child may have Oppositional Defiant Disorder (ODD).

So, What is Oppositional Defiant Disorder?

Oppositional Defiant Disorder (ODD) is defined as a childhood disorder characterized by negative, defiant, disobedient and often hostile behavior toward adults and authority figures primarily. In order to be diagnosed, the behaviors must occur for at least a period of 6 months. Treatment of ODD involves therapy, training to help build positive family interactions and skills to manage behaviors, and possibly medications to treat related mental health conditions.

ODD is the most common psychiatric problem today in children. Estimates suggest that 2%-16% of children and teens have Oppositional Defiant Disorder. In younger children it is more common in boys than girls, but as they grow older, the rate is the same in males and females. Children with ODD consistently dawdle and procrastinate. They claim to forget or fail to hear and, as a result, are often referred for hearing evaluations, only to be found to have normal hearing. The issue is not obeying what was heard rather than a problem with not hearing.

There may be a genetic factor involved in ODD; the disorder often seems to run in families. This pattern may, however, reflect behavior learned from previous generations rather than the effects of a gene or genes for the disorder. For example; if an older child in the family continually overrides their parents parental authority by attempting to control and manipulate how family members younger than themselves act and behave, it's possible this older child also suffers from ODD and has "passed down" their "mannerisms" to the younger children. This older child is of the mistaken belief that she/he is the head of the family as she/he has already manipulated their parents to gain control, and now wishes to exert her/his authority on their younger siblings who, in turn, will grow up thinking this is "normal" behavior and act accordingly.

Is There a Difference Between ODD and ADHD?

ODD is characterized by aggressiveness, but not impulsiveness. In ODD people annoy you purposefully, While it is usually not so purposeful in ADHD. ODD signs and symptoms are much more difficult to live with than ADHD. Children with ODD can sit still. If a child is diagnosed with ADHD, about 30-40% of the time the child will also have ODD. ODD plus Depression/Anxiety is the other common combination with ODD. If you look at children with ODD, probably 15-20% will have problems with their mood and even more are anxious.

My child has been diagnosed with ODD. We are losing friends because of his/her behavior in public and at home, no one can stand him/her. Is this common

Unfortunately, it is quite common. In comparison to ADHD alone, children and adolescents with ODD plus ADHD or just ODD are much more difficult to be with. The destructiveness and disagreeableness are purposeful. They like to see you get mad. Every request can end up as a power struggle. Lying becomes a way of life, and getting a reaction out of others is the chief hobby. Perhaps hardest of all to bear, they rarely are truly sorry and often believe nothing is their fault. After a huge blow up, the child with ODD is often calm and collected. It is the parents who look as they are going to lose it, not the child. This is understandable. The parents have probably just been tricked, bullied, lied to or have witnessed temper tantrums which know no limits.

When an argument occurs, the focus of the parent(s) is usually on resolution of the dispute. For the oppositional child the focus is not on the outcome of the argument, but on "winning" the argument. Winning does not necessarily mean the outcome of the argument leads to desired objects or activities. For the oppositional child winning means that he/she is able to demonstrate his/her power. Power can be demonstrated in a number of ways. For example, power can be demonstrated if the child is able to make the parent angry, cause an argument between mother and father, delay going to an appointment, or simply increase tension within the household. The point to remember is that the oppositional child is not interested in resolution or logical/rational solutions. The oppositional child's focus is on "winning" as defined above. Parents on the other hand, find themselves frustrated and confused because they can't understand "what is going on in his head" (as one mother put it). By controlling the household through the regular application of aversives, the oppositional child gains power. BOTH parents must agree, be involved and committed to making the necessary changes involved in dealing with the oppositional child.

Do's and Don'ts When Dealing with a Child with ODD

The best way to treat a child with ODD in and out of the classroom include behavior management techniques, using a consistent approach to discipline and following through with positive reinforcement of appropriate behaviors.

Dont's:

Do's:

Paths an ODD Child Will Often Take When Growing Up

Medication is only recommended when the symptoms of ODD occur with other conditions, such as ADHD, obsessive compulsive disorder (OCD), or anxiety disorder. When stimulants are used to treat attention deficit/hyperactivity disorders, they also appear to lessen oppositional symptoms in the child. There is no medication specifically for treating symptoms of ODD where there is no other emotional disorder.

If ODD is not treated or if treatment is abandoned, the child has a higher likelihood of developing conduct disorder. The risk of developing conduct disorder is lower in children who are only mildly defiant. It is higher in children who are more defiant and in children who also have ADHD. In adults, conduct disorder is called antisocial personality disorder, or ASD.

Children who have untreated ODD are also at risk for developing passive-aggressive behaviors as adults. Persons with passive-aggressive characteristics tend to see themselves as victims and blame others for their problems.

Miscellaneous Facts

Oppositional Defiant Disorder (ODD) has an estimated lifetime prevalence of 10.2% (11.2% for males, 9.2% for females), and was first defined in the DSM-III (1980). The cause of ODD is unknown, but it is believed that a combination of biological, psychological, and environmental factors may contribute to the condition.

The fourth revision of the Diagnostic and Statistical Manual (DSM-IV-TR) (now replaced by DSM-5) stated that the child must exhibit four out of the eight signs and symptoms to meet the diagnostic threshold for oppositional defiant disorder. Furthermore, they must be perpetuated for longer than six months and must be considered beyond normal child behavior to fit the diagnosis.

Signs and symptoms were:

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.

As many as 40 percent of boys and 25 percent of girls with persistent conduct problems display significant social-cognitive impairments.

For a child or adolescent to qualify for a diagnosis of ODD, behaviors must cause considerable distress for the family or interfere significantly with academic or social functioning. Interference might take the form of preventing the child or adolescent from learning at school or making friends, or placing him or her in harmful situations. These behaviors must also persist for at least six months. Effects of ODD can be greatly amplified by other disorders in comorbidity such as ADHD.

Approaches to the treatment of ODD include parent management training, individual psychotherapy, family therapy, cognitive behavioral therapy, and social skills training.

A diagnosis of ODD cannot be given if the child presents with conduct disorder. A diagnosis of ODD is also no longer applicable if the individual is diagnosed with Reactive Attachment Disorder (RAD).

References

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