Oppositional Defiant Disorder

Don't tell me what to do!

Isn't it normal?

•As any parent knows, children and adolescents are oppositional from time to time. Frequently when when tired, hungry, stressed or upset children may argue, talk back, disobey, and defy parents, teachers, and other adults. •Oppositional behavior is often a normal part of development for two to three year olds and early adolescents. However, openly uncooperative and hostile behavior becomes a serious concern when it is so frequent and consistent that it stands out when compared with other children of the same age and developmental level and when it affects the child's social, family, and academic life.

Basic Info

•Oppositional defiant disorder is a psychiatric category listed in the Diagnostic and Statistical Manual of Mental Disorders. •It is described as an ongoing pattern of disobedient, hostile, and defiant behavior toward authority figures which goes beyond the bounds of normal childhood behavior.

Possible Causes

•There's no clear cause underpinning oppositional defiant disorder. Contributing causes may include:•The child's inherent temperament•The family's response to the child's style•A genetic component that when coupled with certain environmental conditions: lack of supervision, poor quality child care or family instability - increases the risk of ODD•A biochemical or neurological factor•The child's perception that he or she isn't getting enough of the parent's time and attention

DSM Criteria

•To meet DSM-IV-TR criteria, certain factors must be taken into account. •First, the defiance must interfere with the child's ability to function in school, home, or the community. •Second, the defiance cannot be the result of another disorder, such as the more serious Conduct disorder, depression, anxiety, or a sleep disorder such as DSPS. Third, the child's problem behaviors have been happening for at least six months.

Diagnostic Criteria

•If the child meets at least four of these criteria, and they are interfering with the child's ability to function, then he or she technically meets the definition of Oppositionally defiant.•A pattern of negativistic, hostile, and defiant behavior lasting at least 6 months, during which four (or more) of the following symptoms on the next page are present.

•Note: Consider a criterion met only if the behavior occurs more frequently than is typically observed in individuals of comparable age and developmental level.

Diagnostic Criteria cont.

•often loses temper•often argues with adults•often actively defies or refuses to comply with adults' requests or rules•often deliberately annoys people•often blames others for his or her mistakes or misbehavior•is often touchy or easily annoyed by others•is often angry and resentful•is often spiteful or vindictive

Diagnostic Criteria cont.

•The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.•The behaviors do not occur exclusively during the course of a Psychotic or Mood disorder.•Criteria are not met for Conduct Disorder, and, if the individual is age 18 years or older, criteria are not met for Antisocial personality disorder.

Prevalence

•The DSM-IV-TR cites a prevalence of 2-16%, "depending on the nature of the population sample and methods of ascertainment."•The Mayo Clinic Reports that up to 10% of teens may have ODD

Prognosis

•Childhood Oppositional Defiant Disorder is strongly associated with later developing Conduct disorder. Untreated, about 52% of children with ODD will continue to meet the DSM-IV criteria up to three years later and about half of those 52% will progress into Conduct Disorder.

Treatment•There are a variety of approaches to the treatment of Oppositional Defiant Disorder, including parent training programs, individual psychotherapy, family therapy, cognitive behavioral therapy, and social skills training.•According to the American Academy of Child and Adolescent Psychiatry, treatments for ODD are tailored specifically to the individual child, and different treatments are used for pre-schoolers and adolescents.•An approach developed by Russell Barkley uses a parent training model and begins by focusing on positive approaches to increase compliant behaviors. Only later in the program are methods introduced to extinguish negative or noncompliant behaviors.

•Risperidone is one medication that has been used by psychiatrists to treat this condition.

Controversy

•According to The American Journal of Psychiatry, there are several sources of controversy around the diagnosis of ODD. One concerns the fact that the DSM-IV criteria differ slightly from those of the World Health Organization's criteria, as outlined in the ICD-10. Diagnosis of ODD is further complicated by the high occurrence of comorbidity with other disorders such as ADHD, though a 2002 study provided additional support for the validity of ODD as an entity distinct from Conduct disorder.•In another study, the utility of the DSM-IV criteria to diagnose preschoolers has been questioned because the criteria were developed using school-age children and adolescents. The authors concluded that the criteria could be used effectively when developmental level was factored into assessment.

What's a parent to do?

•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 exercise and relaxation. Use respite care as needed.

Educational Production by

David Berglund2009