Oppositional Defiant Disorder (ODD) in Children

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

Consistent Pattern:

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.

Manipulative:

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.

Disobedient:

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:

• Often argue with adults
• Often lose his/her temper
• Is often angry and resentful
• Is often spiteful and vindictive
• Does he/she yell that they "hate you"
• Is he/she constantly in trouble at school
• Is often touchy or easily annoyed by others
• Does your child have extreme mood swings
• Often deliberately annoys people and is rude to adults
• Often blames others for his or her mistakes or misbehavior
• Is your he/she a little angel with others but a "monster" at home
• Does he/she constantly argue with you and always has to have the last say
• Does your child have trouble making friends and fitting in at school/pre-school
• His/her temper actively defies or refuses to comply with adults' requests or rules
• Is your child stealing, from home, school, etc. and constantly lying about where he/she obtained the items from

It's possible your child may have Oppositional Defiant Disorder (ODD). 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 not play "Let's Make a Deal" with the child, "If you clean your room, you can go to the movies tonight." Too many parents use this approach to get the child to do something and bargaining becomes a way of life. The parent is constantly caught in a struggle to make the deal. Instead, enforce predetermined consequences and apply intermittent reinforcement for good behavior. A reinforcer is anything that the child likes or desires. Examples of reinforcers can include praise, spending quality time together, or going to a movie to name a few. Once you have issued a rule or instruction, you shouldn't back down. The primary rule is that the child must obey the parent!
• Do NOT allow electronics to become a babysitter for your child. Parents often wonder how to take TV privileges from one child. If they have to shut off the TV, the other children will be punished. That's true. Do not shut the TV off because one child is restricted. That punishes everyone. Watch TV as usual. The child who is being punished should go in another room WITHOUT TV or games. That's the true punishment. If no one can watch TV because he/she cannot watch TV, you are giving your child control over the entire family. Who is being punished
• Don't allow the child to manipulate you, children with ODD are very cunning at getting their own way.

Do's:

• Limit the time children can watch television, play video games or listen to music. Sticking to these rules allows time for the children to think on their own and to use their creativity.
• Apply established consequences immediately, fairly and consistently. Be consistent and set down specific rules as changing the rules mid-stream can be confusing to the ODD child. Be sure that BOTH parents are on-board with the same rules.
• Only punish the child that deserves punishing. Think about how the punishment will affect you and the rest of the family. If you have a child who likes to control you or others in the family, choose his/her punishments carefully. Be sure that the punishment ONLY affects the child who misbehaved and not anyone else. Do not say, "We are not going until you clean your room." If you are going somewhere he wants to go, this threat may work. If he does not want to go, you have just given the child a lot of power. No one can go until the room is clean. You are giving this child control over the entire family! What do you do with a child who is not permitted to go somewhere with the rest of the family? Get a baby-sitter and then go and have a good time. Your child will learn that his misbehavior will not prevent the family from having fun.
• Do explain why you are punishing the child. Children need not only to understand what they did wrong but why it was wrong and what they should have done right. This also needs to be conveyed to them in a way that they will grasp. This allows the child to grow and not just stop the immediate behavior that is in front of you.

Paths an ODD Child Will Often Take When Growing Up

• There will be some children who outgrow this. About half of children who have ODD as preschoolers will have no psychiatric problems at all by age 8.
• ODD may turn into something else. About 5-10 % of preschoolers with ODD will eventually end up with ADHD and no signs of ODD at all. Other times ODD turns into conduct disorder (CD). This usually happens fairly early. That is, after a 3-4 years of ODD, if it hasn't turned into CD, it won't ever. After the age of 18, a conduct disorder may develop into anti-social personality disorder, which is related to psychopathy. Antisocial Personality Disorder (ASPD or APD) is defined by the American Psychiatric Association's Diagnostic and Statistical Manual as "...a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood." To be diagnosed, an individual must be age 18 or older, as well as have a documented history of a conduct disorder before the age of 15. People having antisocial personality disorder are sometimes referred to as "sociopaths" and "psychopaths."
• The child may continue to have ODD without anything else. However, by the time preschoolers with ODD are 8 years old, only 5% have ODD and nothing else.
• The child continues to have ODD but add on comorbid anxiety disorders, comorbid ADHD, or comorbid Depressive Disorders. By the time these children are in the end of elementary school, about 25% will have mood or anxiety problems which are disabling. That means that it is very important to watch for signs of mood disorder and anxiety as children with ODD grow older.

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:

• Argues often
• Frequently loses temper
• Is touchy or easily annoyed
• Is spiteful or seeks revenge
• Is angry and resentful of others
• Blames others for their own mistakes
• Performs actions deliberately to annoy others
• Actively refuses to comply with majority's requests or consensus-supported rules

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:

• www.yourfamilyclinic.com/ODD/ODD.html
• www.klis.com/chandler/pamphlet/oddcd/oddcdpamphlet.htm
• www.webmd.com/mental-health/oppositional-defiant-disorder
• www.aacap.org/cs/root/publication_store/your_child_oppositional_defiant_disorder

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