Oppositional Defiant Disorder

It is not unusual for children, particularly those in their ‘terrible-twos’ through early-teens to defy authority every now and again. Children might express their defiance with arguing, talking back to parents and teachers, and disobeying adults.

If this behavior lasts longer than six months and is in a high amount, then it may mean that your child has a behavior disorder called oppositional defiant disorder.

What is Oppositional Defiant Disorder?

ODD is a condition where a child shows a continuous pattern of angry and irritable moods, defiant and argumentative behavior, and vindictive behavior to people in authority. The child’s behavior disrupts their normal daily activities, including those at school and at home with their family.

Most children and teens with ODD can also have other behavioral problems including ADD, mood disorders, learning disabilities and anxiety disorders.

What Are the Symptoms?

Symptoms include:
• Multiple temper tantrums
• Arguing with adults; mostly those with authority
• Purposefully refusing to follow rules and requests
• Actively trying to upset and annoy others, or getting annoyed with others
• Blaming others for their mistakes
• Seeking revenge, and acts of spite
• Using obscene language and swearing
• Expressing hateful and mean things when upset

In addition to these symptoms, children with ODD are easily frustrated, moody and tend to have a lower self-esteem than others. They may also abuse alcohol and drugs as teens and beyond.

What Causes Oppositional Defiance?

The cause of ODD is unknown, yet it is presumed to be a combination of genetic, environmental, and biological factors that contribute to the condition.

Genetics: Many children and teens with ODD have close family members that have mental illnesses, including mood disorders and personality disorders. This alludes to a vulnerability to develop ODD, and it may be inherited.

Environmental: Dysfunctional family life and a family history of mental illness coupled with substance abuse; and factors such as inconsistent discipline by parents can contribute to behavior disorder development.

Biological: Some studies believe that defects or injuries to certain parts of the brain can cause behavioral problems in children. ODD has also been linked to abnormal functioning of neurotransmitters or chemicals in the brain. If these chemicals do not function properly, then messages do not flow through the brain correctly.

Is Oppositional Defiant Disorder Common?

It is estimated that up to 16% of children and teens have ODD. ODD is more common in younger boys. In older children, it has an equal occurrence between boys and girls. It begins at age 8 typically.

How is Oppositional Defiant Disorder Diagnosed?

Similar to adults, mental illnesses in children are diagnosed through symptoms and signs that suggest an illness like ODD. If the symptoms are there, then the therapist and physician would being the evaluation with a complete medical history and physical exam. There are no lab tests that can diagnose ODD specifically, but one may use blood tests or neuro-imaging if there may be a medical reason for the behavior problems.

If the provider does not find a physical cause for the symptoms, they will refer the child to an adolescent psychiatrists or psychologist. These mental health professionals are specially trained to treat and diagnose the child. There is a specially designed assessment and interview to evaluate the child. The doctor will base their diagnosis on reports of the child’s symptoms and their observation of their behavior and attitude.

The provider will also rely on reports from the child’s parents, teachers, and other adults that interact with them. Children may have trouble explaining their problems and understanding their symptoms, so the adults in their lives act as a medium.

How is Oppositional Defiant Disorder Treated?

Treatment for ODD is based on a multitude of factors; child’s age, how severe the symptoms are, and their ability to participate in specific therapies. Treatment will usually consist of a combination of:

Psychotherapy: Psychotherapy is a type of counseling that is aimed at helping your child develop more effective problem solving and coping skills, also ways to control and express their anger. Cognitive behavioral therapy aims to reshape the child’s thinking and improve their behavior.

Family Therapy: Family therapy can also be used to help improve family interactions and communication with family members. Parent management training is a specialized therapy that teaches parents how to alter their child’s behavior in a positive way. Behavior management plans involve making contracts between the child and parent that identify the rewards for positive behavior and punishments for the negative behaviors.

Note: In some cases medication may be used to treat some symptoms associated with ODD. There is no medication that is scientifically made or approved formally to treat ODD, and drugs are sometimes used to treat other mental illnesses that could be present as well, such as ADHD or depression.

What is the Outlook for Children With Oppositional Defiant Disorder?

If your child shows the signs, it is important you seek help from a qualified mental health professional rather quickly. If children go without treatment, they may experience rejection from peers and classmates due to poor social skills, instigating and aggressive behavior. Also, a child with ODD has a higher chance of developing an even more serious behavioral disorder called conduct disorder.  If started early, treatment is very effective.

Can I Prevent My Child from Oppositional Defiant Disorder?

It may be possible to prevent ODD, but recognizing the symptoms and acting on them when they first appear can decrease the stress on the child and family, as well as prevent many of the problems that come with the illness. Family members can also learn which steps to take if the signs return. Providing a supportive, consistent, and nurturing home environment with a good balance of discipline and love can help reduce the symptoms and prevent the episodes of defiant behavior.

3 Guidelines to Follow

1. Recognize the symptoms before they progress. Catching the illness early can make a big difference in the therapy process. Recall that the symptoms are common in all children starting at age two, yet if they progress past six months duration, start paying closer attention.
2. Consult the right health professional. Give your child the best chance and get a head start on finding a good therapy plan.
3. Support and love your child. The illness, if diagnosed, does not make them any less or more your child. It can be frustrating at times, but try not to let it keep you from supporting your child. Remember it is not always the child’s fault, and they need your help to get well.

As always, if you have questions please email or call. If you think a friend, or your child is experiencing these symptoms, then please reach out.

To your mental health.

Noel

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