What is Oppositional Defiant Disorder?

Oppositional Defiant Disorder? (O.D.D.)

All children are oppositional from time to time, particularly when tired, hungry, stressed or upset. They 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.

Oppositional Defiant Disorder is a persistent pattern of angry and irritable mood along with vindictive behavior. DSM-V now includes three symptom clusters; an angry or irritable mood, touchy or easily annoyed by others, and resentful. It is characterized by a persistent pattern of negative, defiant, disobedient and hostile behavior towards authority figures that seriously interferes with the child’s day to day functioning. This behavior typically starts by age 8, but it may start as early as the preschool years. Up to 16 % of school-age children and adolescents are believed to have O.D.D. The disorder is more common in boys than in girls and is one of the most common reasons for referrals to mental health services for children and adolescents.

The exact cause of oppositional defiant disorder is not known however the term disorder may be misleading because it is thought that oppositional defiant disorder is a learned behavior or a combination of a child’s environment and their inherited characteristics which may include:

·         Ineffective, Inconsistent and/or harsh discipline

·         Lack of supervision, neglect or abuse

·         Developmental delays in the ability to process their thoughts and feelings

Signs and symptoms

The child must consistently exhibit signs and symptoms for at least six months, behaviors must be different from those of other children around the same age and developmental level and present at least 4 symptoms to meet the DSM-IV-TR diagnosis for oppositional defiant disorder. Common features of oppositional defiant disorder include:

·         Frequent temper tantrums or angry outbursts

·         Excessive arguing with adults

·         Often questioning rules

·         Active defiance and refusal to comply with adult requests and rules

·         Deliberate attempts to annoy or upset people

·         Blaming others for their mistakes or misbehavior

·         Often being touchy or easily annoyed by others

·         Mean and hateful talking when upset

·         Spiteful attitude and prefer taking revenge rather than calm resolutions

·         Excessive, often persistent anger and resentment

·         Disregard for authority

·         Parents often observe more rigid and irritable behaviors than in siblings.

·         Often have problems with school and friendships as a direct result of the behavior 

·         Behaviors cause considerable distress for the family

·         Put themselves in harmful situations

·         Interferes significantly with school or social activities.

The symptoms of oppositional defiant disorder may be difficult to distinguish from those of other behavioral or mental health problems. In addition, oppositional defiant disorder can be greatly amplified by other disorders and may be difficult to improve without treating the coexisting disorder. In children and adolescents, the following conditions can cause similar behavior problems:

·         Anxiety disorders

·         Attention-deficit /hyperactivity disorder (ADHD)

·         Bipolar disorder

·         Depression

·         Learning disorders

·         Substance abuse disorders

Successful treatment of the often-coexisting conditions will improve the effectiveness of treatment for oppositional defiant disorder. In some cases, the symptoms of oppositional defiant disorder disappear entirely. However if it is left untreated and becomes severe, with the child or adolescent showing a lack of empathy for the rights of others, oppositional defiant disorder can, and likely will, progress to more serious diagnosis of Conduct disorder, substance abuse, severe delinquency or Antisocial Personality Disorder in adult life, a severe disorder that is difficult to overcome and is associated with criminal behaviors and incarceration. A child diagnosed with oppositional defiant disorder is not automatically going to develop conduct disorder but it is important to seek treatment as early in the child's life as possible to treat the disorder before it progresses.

If the disorder does progress, the child will likely start violating more serious rules like running away from home or skipping school and progressing to more aggressive behavior toward people, property or animals. They may initiate bullying, fighting, or animal cruelty, or become disrespectful of others’ property by stealing, causing damage, vandalism and even arson.

What causes oppositional defiant disorder?

The cause of oppositional defiant disorder is not known however there are two main theories are used to explain the development of O.D.D. Developmental theory suggests children and adolescents who develop it may have had difficulty learning to separate and become independent from the parent or guardian that they were emotionally attached to. The bad behavior and emotional responses of oppositional defiant disorder are seen as normal developmental issues that were not resolved during the child’s early years. On the other hand Learning theory suggests that the negative features of O.D.D are learned attitudes reflecting the effects of reinforcing negative behaviors whether unintentionally or willingly used by parents or other authority figures.

No single factor causes oppositional defiant disorder but rather is a complex problem involving a many influences, circumstances and genetic components that can play a role in the development of oppositional defiant disorder such as:

·         The family's response to the child's personality style

·         The child's perception that he or she isn't getting enough of the parent's time and attention

·         Children of alcoholic parents or parents in trouble with the law have a higher chance of developing ODD (suggests the development of ODD may be influenced by the behavior of parents)

·         Having a parent with a mood or substance abuse disorder

·         Child being abused or neglected

·         Harsh or inconsistent discipline

·         Lack of supervision

·         Poor relationship with one or both parents

·         Family instability such as occurs with divorce, multiple moves, or changing schools or child care providers frequently

·         A family history of behavioral disorders which may include ADHD, oppositional defiant disorder or conduct problems

·         Financial problems in the family

·         Exposure to violence

·         Substance abuse in the child or adolescent

·         Having had an unusually hard time separating from parents when younger

·         Did not resolve their normal development issues leading to later behavioral problems

·         Developed unusually strong levels of negativity and pessimism because of excessive punishment or other forms of negative reinforcement

·         Acting out to obtain extra attention, time or sympathy and compassion from a parent/caregiver

·         A parent too often and too easily giving in to the child’s demands

·         The mother’s exposure to harmful agents while pregnant

·         Significant stress or a lack of predictable structure in the home or community environment

·         Biological causes relating to chemical imbalances or dysfunction in the particular parts of the brain.

·         A child’s temperament being particularly moody or displaying a dominant behavior

·         Environmental causes play a strong role, including dysfunctional family relationships or inappropriate parenting

·         Living in harsh surroundings or stresses such as poverty

Treatment

If your child is showing possible symptoms of ODD, it's important to seek professional help as soon as possible. The most effective way of treating disruptive behavior disorders is behavioral therapy which focuses on how to prevent problem thoughts or behaviors from being reinforced and to try new behaviors. Therapists may also work with parents to discontinue ways in which they are unintentionally reinforcing unwanted behaviors.

Researchers have found that the use of positive reinforcement and praise for appropriate behaviors are two key elements in effective interventions. If the majority of interactions with the child are focused around correcting their negative behaviors, a cycle of negative interactions is created, where the child expects attention after misbehaving. Positive reinforcement and praise builds the child's self-esteem and serves to strengthen the bond between a child and their caregiver.

Self-care for parents
Dealing with a child with oppositional defiant disorder can be overwhelming but here are some things to keep in mind:

·         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.

·         Recognize and praise your child's positive behaviors.

·         Model the behavior you want your child to have.

·         Pick your battles. Avoid power struggles.

·         Set limits and enforce consistent reasonable consequences.

·         Set up a routine. Develop a consistent daily schedule for your child.

·         Build in time together. Develop a consistent weekly schedule that involves parents and child being together.

·         Work with your spouse or others in your household to assure consistent and appropriate discipline procedures.

·         It is important to set your child up for success with tasks that are relatively easy to achieve and gradually blend in more important and challenging expectations.