Oppositional Defiant Disorder

Defiance and opposition: are they usual?

Throwing tantrums, displaying oppositional behavior and disobeying authority figures are some behaviors that most children display as they go through their developmental stages. Now as adults, you may reflect and remember instances when you had exhibited such behaviors.

When do we then worry if our child’s behavior may be indicative of something more?

Oppositional Defiant Disorder (ODD) is described as a continuing pattern of defiant, uncooperative, hostile and annoying behaviors towards people in authority. These behaviors typically develop at around eight years of age. Though some behaviors may have been observed at younger ages. Behaviors displayed are beyond what is typical or usual of their age and last longer than six months.

Symptoms

1) Angry and Irritable mood

• loses temper easily

• frequent outbursts of anger/resentment

• touchy and easily annoyed by others

• angry and disrespectful

2) Argumentative or Defiant behaviours

• excessively argues with adults

• actively refuses to comply with rules or regulations

• blames others for own mistakes

• deliberately upsets or annoys others

3) Vindictiveness

• being spiteful or revenge seeking

• says mean and hateful things when angry or upset

Classification

• Mild: behaviors occur in one setting (i.e., home or school)

• Moderate: behaviors occur in two settings

• Severe: behaviors occur in three settings

Causes or Risk Factors

As with many other disorders, a direct cause has not been found for ODD. It is noted that in younger age groups, there are higher number of boys diagnosed while this numbers even out in older age groups. This gender difference could be due to the varied ways in which the behaviors are displayed between the genders.

In addition, children with ODD may also be diagnosed with other disorders such as ADHD, learning disorders, mood disorders and anxiety disorders.

1) Biological factors: differences in brain areas and imbalance of neurotransmitters have been found in individuals with ODD

2) Genetic factors: higher chances of an individual being diagnosed with ODD when there is a family history of ODD, substance use or other mental disorders

3) Environmental factors: Individuals with ODD have higher likelihood of being from a chaotic family background or where there was inconsistent parenting

4) Individual factors: having a temperament where the individual has difficulty regulating emotions could be a contributing factor

Diagnosis and Treatment

A trained psychologist or psychiatrist would be able to diagnose and treat an individual with ODD. Diagnosis can consist of tests involving the individuals and reports from others around them (i.e., parents, teachers). Individuals with ODD may have difficulty recognizing their behavioral problems or how it affects others and them.

Interventions for ODD may involve CBT and Social Skills training with the individual and parent training. CBT aims to help individual identify and change thought patterns that lead to behavior and to work on strategies that work on improving ODD-related problems. Social Skills training aids the individual in learning to interact more positively and effectively with peers and works on being flexible with their thinking. Parent training is also an essential part of therapy as it helps parents work on their relationship with their child by focusing on parenting techniques. It would also help them work on other stressors that may be affecting both parties and exacerbating current behavioral issues.

Seeking help is important

Having poor social skills increases chances of a child facing rejection by peers or classmates. This may lead to them behaving aggressively or engaging in annoying behaviors. Eventually, it becomes a cycle which they are trapped in. Other than developing antisocial behaviors, individuals with ODD may also struggle with their academics, engage in substance use and have difficulty controlling impulses. Without treatment at the appropriate time, some children with ODD may eventually develop conduct disorder.