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Oppositional defiant disorder

Oppositional defiant disorder

Definition

Oppositional defiant disorder (ODD) is a disorder found primarily in children and adolescents. It is characterized by negative, disobedient, or defiant behavior that is worse than the normal "testing" behavior most children display from time to time. Most children go through periods of being difficult, particularly during the period from 18 months to three years, and later during adolescence. These difficult periods are part of the normal developmental process of gaining a stronger sense of individuality and separating from parents. ODD, however, is defiant behavior that lasts longer and is more severe than normal individuation behavior, but is not so extreme that it involves violation of social rules or the rights of others.

The mental health professional's handbook, Diagnostic and Statistical Manual of Mental Disorders , fourth edition, text revision (DSM-IV-TR ), classifies ODD as a disruptive behavior disorder.

Description

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.

In addition, the child with ODD often starts arguments and will not give up. Winning the argument seems to be very important to a child with this disorder. Even if the youth knows that he or she will lose a privilege or otherwise be punished for continuing the tantrum or argument, he or she is unable to stop. Attempting to reason with such a child often backfires because the child perceives rational discussion as a continuation of the argument.

Most children with ODD, however, do not perceive themselves as being argumentative or difficult. It is usual for such children to blame all their problems on others. Such children can also be perfectionists and have a strong sense of justice regarding violations of what they consider correct behavior. They are impatient and intolerant of others. They are more likely to argue verbally with other children than to get into physical fights.

Older children or adolescents with ODD may try to provoke others by being deliberately annoying or critical. For example, a teenager may criticize an adult's way or speaking or dressing. This oppositional behavior is usually directed at an authority figure such as a parent, coach, or teacher. Youths diagnosed with ODD, however, can also be bullies who use their language skills to taunt and abuse other children.

Causes and symptoms

Causes

ODD has been called a problem of families, not of individuals. It occurs in families in which some or all of the following factors are present:

  • Limits set by parents are too harsh or too lax, or an inconsistent mix of both.
  • Family life lacks clear structure; rules, limits, and discipline are uncertain or inconsistently applied.
  • At least one parent models oppositional behavior in his or her own interactions with others. For example, mother or father may get into frequent disputes with neighbors, store clerks, other family members, etc., in front of the child.
  • At least one parent is emotionally or physically unavailable to the child due to emotional problems of the parent (such as depression), separation or divorce, or work hours.

The defiant behavior may be an attempt by the child to feel safe or gain control. It may also represent an attempt to get attention from an unresponsive parent.

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.

Symptoms

According to DSM-IV-TR, a diagnosis of ODD may be given to children who meet the following criteria, provided that the behavior occurs more frequently than usual compared to children of the same age and developmental level.

A pattern of negativistic, hostile, and defiant behavior lasting at least six months, during which four (or more) of the following are present. The child:

  • often loses his or her temper
  • frequently argues with adults
  • often disregards adults' requests or rules
  • deliberately tries to provoke people
  • frequently blames others for his or her mistakes or misbehavior
  • is often easily irritated by others
  • is often angry and resentful
  • is often spiteful

In order to make the diagnosis of oppositional defiant disorder, the behavioral disturbances must cause significant impairment in the child's social, academic or occupational functioning, and the behaviors must not occur exclusively during the course of a psychotic or mood disorder. In addition, the child must not meet criteria for conduct disorder , which is a more serious behavioral disorder. If the youth is 18 years or older, he or she must not meet criteria for antisocial personality disorder .

Demographics

Oppositional defiant disorder is thought to occur in about 6% of all children in the United States. It is more common in families of lower socioeconomic status. In one study, 8% of children from low-income families were diagnosed with ODD. The disorder is often apparent by the time a child is about six years old. Boys tend to be diagnosed with this disorder more often than girls in the preteen years, but it is equally common in males and females by adolescence.

It is estimated that about one-third of children who have attention-deficit/hyperactivity disorder (ADHD) also have ODD. Children who have ODD are also often diagnosed with anxiety or depression.

Diagnosis

Oppositional defiant disorder is diagnosed when the child's difficult behavior lasts longer than six months. There is no standard test for diagnosing ODD. A full medical checkup may be done to make sure that there is no medical problem causing the child's behavior. The medical examination is followed by a psychological evaluation of the child, which involves an interview with a mental health professional. The mental health professional may also interview the child's parents and teachers. Psychological tests are sometimes given to the child to rule out other disorders.

Evaluation for ODD includes ruling out a more disruptive behavioral disorder known as conduct disorder (CD). CD is similar to ODD but also includes physical aggression toward others, such as fighting or deliberately trying to hurt another person. Children with CD also frequently break laws or violate the rights of others, for example by stealing. They tend to be more covert than children with ODD, lying and keeping some of their unacceptable behavior secret.

The diagnosis of ODD may specify its degree of severity as mild, moderate, or severe.

Treatments

Treatment of ODD focuses on both the child and on the parents. The goals of treatment include helping the child to feel protected and safe and to teach him or her appropriate behavior. Parents may need to learn how to set appropriate limits with a child and how to deal with a child who acts out. They may also need to learn how to teach and reinforce desired behavior.

Parents may also need help with problems that may be distancing them from the child. Such problems can include alcoholism or drug dependency, depression, or financial difficulties. In some cases, legal or economic assistance may be necessary. For example, a single mother may need legal help to obtain child support from the child's father so that she won't need to work two jobs, and can stay at home in the evenings with the child.

Behavioral therapy is usually effective in treating ODD. Behavioral therapy focuses on changing specific behaviors, not on analyzing the history of the behaviors or the very early years of the child's life. The theory behind behavioral therapy is that a person can learn a different set of behaviors to replace those that are causing problems. As the person obtains better results from the new behavior, he or she will want to continue that behavior instead of reverting to the old one. To give an example, the child's parents may be asked to identify behaviors that usually start an argument. They are then shown ways to stop or change those behaviors in order to prevent arguments.

Contingency management techniques may be included in behavioral therapy. The child and the parents may be helped to draw up contracts that identify unwanted behaviors and spell out consequences. For example, the child may lose a privilege or part of his or her allowance every time he or she throws a temper tantrum. These contracts can include steps or stagesfor example, lowering the punishment if the child begins an argument but manages to stop arguing within a set period of time. The same contract may also specify rewards for desired behavior. For example, if the child has gone for a full week without acting out, he or she may get to choose which movie the family sees that weekend. These contracts may be shared with the child's teachers.

The parents are encouraged to acknowledge good or nonproblematic behavior as much as possible. Attention or praise from the parent when the child is behaving well can reinforce his or her sense that the parent is aware of the child even when he or she is not acting out.

Cognitive therapy may be helpful for older children, adolescents, and parents. In cognitive therapy, the person is guided to greater awareness of problematic thoughts and feelings in certain situations. The therapist can then suggest a way of thinking about the problem that would lead to behaviors that are more likely to bring the person what they want or need. For example, a girl may be helped to see that much of her anger derives from feeling that no one cares about her, but that her angry behavior is the source of her problem because it pushes people away.

Although psychotherapy is the cornerstone of treatment for ODD, medicine may also be helpful in some cases. Children who have concurrent ADHD may need medical treatment to control their impulsivity and extend their attention span. Children who are anxious or depressed may also be helped by appropriate medications.

Prognosis

Treatment for ODD is usually a long-term commitment. It may take a year or more of treatment to see noticeable improvement. It is important for families to continue with treatment even if immediate results are not apparent.

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.

Prevention

Prevention of ODD begins with good parenting. If at all possible, families and the caregivers they encounter should be on the lookout for any problem that may prevent parents from giving children the structure and attention they need.

Early identification of ODD and ADHD is necessary to obtain help for the child and family as soon as possible. The earlier ODD is identified and treated, the more likely it is that the child will be able to develop healthy patterns of relating to others.

Resources

BOOKS

Hales, R. E., S. C. Yudofsky, J. A. Talbott, eds. Textbook of Psychiatry. 3rd ed. Washington DC: American Psychiatric Press, 1999.

Sadock, B. J., and V. A. Sadock. Kaplan & Sadock's Comprehensive Textbook of Psychology, 7th ed. Philadelphia: Lippincott Williams and Wilkins, 1999.

PERIODICALS

Loeber, Rolf. "Oppositional defiant and conduct disorder: a review of the past 10 years, part I." Journal of the American Academy of Child and Adolescent Psychiatry Dec. 2000.

ORGANIZATIONS

American Academy of Child and Adolescent Psychiatry. 3615 Wisconsin Avenue, NW, Washington, DC 20016-3007.(202) 966-7300. Fax: (202) 966-2891. <www.aacap.org>.

Jody Bower, M.S.W.

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Oppositional Defiant Disorder

Oppositional defiant disorder

Definition

Oppositional defiant disorder (ODD) is a childhood mental disorder characterized by a pattern of angry, antagonistic, hostile, negative, irritable, and/or vindictive behavior lasting at least six months and occurring more frequently than is typically observed for the child's age and developmental stage. Children diagnosed with ODD do not meet the clinical diagnostic criteria for conduct disorder .

Description

Oppositional defiant disorder (ODD), a relatively new clinical classification, involves an ongoing pattern of antagonistic, defiant, and hostile behavior toward parents and other authority figures. Children and adolescents with ODD often have frequent temper tantrums , blame others for their misbehavior, argue excessively with adults, actively refuse to comply with adult rules and requests, deliberately defy adults and attempt to annoy or upset them, and are easily annoyed by others.

Demographics

Before puberty , ODD is more common in boys than girls; however, after puberty ODD occurrence rates are about equal in boys and girls. The disorder typically begins by the age of eight. According to the American Academy of Child and Adolescent Psychiatry, approximately 5 to 15 percent of all school-aged children have ODD.

Causes and symptoms

Although the specific causes of ODD are unknown, genetics and environment are thought to play a role in its development. As of 2004 several theories about the causes of oppositional defiant disorder are being investigated. ODD may be related to the following:

  • the child's temperament and the family's response to that temperament
  • an inherited predisposition to the disorder in certain families
  • a neurological cause, such as a head injury
  • a chemical imbalance in the brain (especially with the brain chemical serotonin)

ODD appears to be more common in families in which at least one parent has a history of a mood disorder, conduct disorder, attention deficit hyperactivity disorder (ADHD), antisocial personality disorder , or a substance abuse-related disorder. Children with one parent who is alcoholic or who has been in trouble with the law are almost three times more likely to have ODD. Additionally, some studies suggest that mothers with a depressive disorder are more likely to have children that develop ODD. ODD can also occur in conjunction with other conditions such as ADHD, learning disabilities, anxiety disorders, and mood disorders . About 50 percent to 65 percent of children with ADHD also have ODD.

Symptoms of ODD include a pattern of negative, hostile, and defiant behavior lasting at least six months. During this time four or more of the following must be present for a child to be diagnosed with ODD:

  • often loses his/her 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/her mistakes or misbehavior
  • is often touchy or easily annoyed by others
  • is often angry and resentful
  • is often spiteful or vindictive
  • misbehaves frequently
  • swears or uses obscene language
  • has a low opinion of him/herself

Additional problems may be present, including the following:

  • learning problems
  • a depressed mood
  • hyperactivity (although ADHD must be ruled out)
  • substance abuse or dependence
  • dramatic and erratic behavior

When to call the doctor

Parents of children and adolescents who exhibit symptoms of ODD should see a physician as soon as possible. Usually, a referral to a psychologist, psychiatrist, or therapist will be given.

Diagnosis

ODD is diagnosed by psychological and psychiatric evaluations; interviews with family members, teachers, and caregivers; and observation and interviews with the child or adolescent. Diagnosis is based on clinical criteria defined in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision C (DSM-IV-TR).

ODD often has characteristics in common with other psychological disorders and often occurs in conjunction with other conditions, such as ADHD or mood disorders. Therefore, diagnosis of ODD usually depends on exclusion of other disorders. A diagnosis of ODD is not made if the symptoms occur exclusively in psychotic or mood disorders, or if the child meets clinical criteria for conduct disorder, or, if the adolescent is 18 years old or older and meets clinical criteria for antisocial personality disorder. Children and adolescents with ODD do not exhibit the more serious aggressive behaviors or physical cruelty that is common in other disorders.

Treatment

Treatment of ODD usually involves medication, and group, individual, and/or family therapy . Of these, individual therapy is the most common. The goal of therapy is to help provide a consistent daily schedule, support, rules, discipline , and limits, as well as to help train patients to get along with others by modifying behaviors. Therapy can occur in residential or day treatment facilities, in a medical setting, or on an outpatient basis. Therapy can instruct patients on how to effectively deal with ODD and help them learn how to do the following:

  • use self time-outs
  • identify what increases anxiety
  • talk about feelings instead of acting on them
  • find and use ways to calm themselves
  • frequently remind themselves of their goals
  • get involved in tasks and physical activities that provide a healthy outlet for energy
  • learn how to talk with others
  • develop a predictable, consistent, daily schedule of activity
  • develop ways to obtain pleasure and feel good
  • learn how to get along with other people
  • find ways to limit stimulation
  • learn to admit mistakes in a matter-of-fact way

Therapy can also involve the parents. Parent management training focuses on teaching parents specific and more effective techniques for handling the child's opposition and defiance. Research has shown that parent management training is more effective than family therapy.

Stimulant medication is used only when ODD cooccurs with ADHD. Occasionally, children and adolescents with ODD may also have depression or anxiety disorders, and treatment with antidepressants and anti-anxiety medications can help alleviate some symptoms of ODD.

Prognosis

The prognosis for ODD varies. In some children, ODD evolves into a conduct disorder or a mood disorder. ODD, if left untreated, has approximately an 80 percent chance of turning into conduct disorder as a child ages. Later in life, ODD can develop into passive-aggressive personality disorder or antisocial personality disorder. ODD can cause significant social, academic, and/or occupational impairment. Generally, with treatment and long-term participation in therapy, adjustment in social settings and in the workplace can be made in adulthood.

Prevention

As of 2004, ODD could not be prevented.

Parental concerns

Children and adolescents with ODD usually have difficulties in school and at home. In some cases, ODD can result in expulsion from school. Parents should investigate alternative school settings that may be able to provide counseling and group therapy integrated with academics. Assistance is available through county social or mental health services, educational consultants, and local school counselors. Family therapy may help alleviate stressful family situations and help other family members understand the disorder.

Television viewing and video/computer games can contribute to ODD behaviors. For children with ADHD or ODD, the American Academy of Pediatrics recommends limiting use of television and video/computer games to no more than two hours per day, monitoring children's use of television and computers, and viewing family-oriented television programs with their children.

Parents may find it helpful to track their child's moods and behaviors and to help children learn to track their own moods and behaviors to help identify possible stresses and causative factors.

Parents should actively participate in their child's therapy and learn positive parenting techniques that can help ODD behaviors. When parents are too restrictive, children and adolescents with ODD can rebel, and power struggles can frequently occur. Therapists specializing in ODD can help families become more effective in handling ODD behaviors in order to avoid such rebellion. The American Academy of Child and Adolescent Psychiatry recommends the following for parents with children who have ODD:

  • Choose battles by setting priorities regarding child's behavior.
  • Set reasonable, age-appropriate limits with consistently enforceable consequences.
  • Work with teachers, coaches, and other family members for support in dealing with the child with ODD.
  • Use positive reinforcement praise when the child displays desired behaviors.
  • Take time to manage stress by exercising and/or relaxing away from the child.

KEY TERMS

Alternative school An educational setting designed to accommodate educational, behavioral, and/or medical needs of children and adolescents that cannot be adequately addressed in a traditional school environment.

Antisocial personality disorder A disorder characterized by a behavior pattern that disregards for the rights of others. People with this disorder often deceive and manipulate, or their behavior might include aggression to people or animals or property destruction, for example. This disorder has also been called sociopathy.

Attention deficit hyperactivity disorder (ADHD) A condition in which a person (usually a child) has an unusually high activity level and a short attention span. People with the disorder may act impulsively and may have learning and behavioral problems.

Conduct disorder A behavioral and emotional disorder of childhood and adolescence. Children with a conduct disorder act inappropriately, infringe on the rights of others, and violate societal norms.

Resources

BOOKS

Sutton, James D. What Parents Need to Know about ODD: Upto-Date Insights and Ideas for Managing Oppositional Defiant Disorder and Other Defiant Behavior. Pleasanton, TX: Friendly Oaks Publications, 2003.

PERIODICALS

Barrickman, L. "Disruptive Behavioral Disorders." Pediatric Clinics of North America 50 (2003):100517.

Greene R. W., et al. "Psychiatric Comorbidity, Family Dysfunction, and Social Impairment in Referred Youth with Oppositional Defiant Disorder." American Journal of Psychiatry 159 (July 2002): 121424.

ORGANIZATIONS

American Academy of Child and Adolescent Psychiatry. Web site: <www.aacap.org>.

American Psychiatric Association. 1000 Wilson Boulevard, Suite 1825, Arlington, VA 222093901. Web site: <www.psych.org/>.

WEB SITES

Tynan, W. Douglas. "Oppositional Defiant Disorder." eMedicine, November 2, 2003. Available online at <www.emedicine.com/ped/topic2791.htm> (accessed November 21, 2004).

Wood, D. "What is Oppositional Defiant Disorder (ODD)?" Available online at <www.mental-health-matters.com/disorders/dis_details.php?disID=67> (accessed November 21, 2004).

Jennifer E. Sisk, M.A.

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Oppositional Defiant Disorder

Oppositional Defiant Disorder

Definition

Oppositional defiant disorder (ODD) is defined by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), as a recurring pattern of negative, hostile, disobedient, and defiant behavior in a child or adolescent, lasting for at least six months without serious violation of the basic rights of others. The incidence of ODD in the American population varies somewhat according to the sample studied; DSM-IV gives the rate as between 2-16% while the American Academy of Child and Adolescent Psychiatry (AACAP) gives a figure of 5%-15%, and a researcher at a children's hospital gives a rate of 6-10%.

Description

In order to meet DSM-IV criteria for ODD, the behavior disturbances must cause clinically significant problems in social, school, or work functioning. The course of oppositional defiant disorder varies among patients. In males, the disorder is more common among those who had problem temperaments or high motor activity in the preschool years. During the school years, patients may have low self-esteem, changing moods, and a low frustration tolerance. Patients may swear and use alcohol, tobacco, or illicit drugs at an early age. There are frequent conflicts with parents, teachers, and peers.

Children with this disorder show their negative and defiant behaviors by being persistently stubborn and resisting directions. They may be unwilling to compromise, give in, or negotiate with adults. Patients may deliberately or persistently test limits, ignore orders, argue, and fail to accept blame for misdeeds. Hostility is directed at adults or peers and is shown by verbal aggression or deliberately annoying others.

Causes and symptoms

Oppositional defiant disorder is more common in boys than girls before puberty ; the disorder typically begins by age eight. After puberty the male:female ratio is about 1:1. Although the specific causes of the disorder are unknown, parents who are overly concerned with power and control may cause an eruption to occur. Symptoms often appear at home, but over time may appear in other settings as well. Usually the disorder occurs gradually over months or years. Several theories about the causes of oppositional defiant disorder are being investigated. Oppositional defiant disorder may be related to:

  • the child's temperament and the family's response to that temperament
  • an inherited predisposition to the disorder in some families
  • marital discord or violence between husband and wife
  • frequent or multiple geographical moves
  • a neurological cause, like a head injury
  • a chemical imbalance in the brain (especially with the brain chemical serotonin)

Oppositional defiant disorder appears to be more common in families where at least one parent has a history of a mood disorder, conduct disorder, attention deficit/hyperactivity disorder, antisocial personality disorder, or a substance-related disorder. Additionally, some studies suggest that mothers with a depressive disorder are more likely to have children with oppositional behavior. However, it is unclear to what extent the mother's depression results from or causes oppositional behavior in children.

Symptoms include a pattern of negative, hostile, and defiant behavior lasting at least six months. During this time four or more specific behaviors must be present. These behaviors include the child who:

  • often loses his/her 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/her mistakes or misbehavior
  • is often touchy or easily annoyed by others
  • is often angry and resentful
  • is often spiteful or vindictive
  • misbehaves
  • swears or uses obscene language
  • has a low opinion of him/herself

The diagnosis of oppositional defiant disorder is not made if the symptoms occur exclusively in psychotic or mood disorders. Criteria are not met for conduct disorder, and, if the child is 18 years old or older, criteria are not met for antisocial personality disorder. In other words, a child with oppositional defiant disorder does not show serious aggressive behaviors or exhibit the physical cruelty that is common in other disorders.

Additional problems may be present, including:

  • learning problems
  • a depressed mood
  • hyperactivity (although attention deficit/hyperactivity disorder must be ruled out)
  • substance abuse or dependence
  • dramatic and erratic behavior

The patient with oppositional defiant disorder is moody, easily frustrated, and may abuse drugs.

Diagnosis

While psychological testing may be needed, the doctor must examine and talk with the child, talk with the parents, and review the medical history. Diagnosis is complicated because oppositional defiant disorder rarely travels alone. Children with attention/deficit hyperactive disorder will also have oppositional defiant disorder 50% of the time. Children with depression/anxiety will have oppositional defiant disorder 10-29% of the time. Because all of the features of this disorder are usually present in conduct disorder, oppositional defiant disorder is not diagnosed if the criteria are met for conduct disorder.

A diagnosis of oppositional defiant disorder should be considered only if the behaviors occur more frequently and have more serious consequences than is typically observed in other children of a similar developmental stage. Further, the behavior must lead to significant impairment in social, school, or work functioning.

As of 2004 a new evaluation scale known as the Oppositional Defiant Behavior Inventory (ODBI) has been developed as an aid to diagnosis. The ODBI appears to meet accepted standards of reliability and validity.

Treatment

Treatment of oppositional defiant disorder usually consists of group, individual and/or family therapy, and education. Of these, individual therapy is the most common. Therapy can provide a consistent daily schedule, support, consistent rules, discipline, and limits. It can also help train patients to get along with others and modify behaviors. Therapy can occur in residential, day treatment, or medical settings. Additionally, having a healthy role model as an example is important for the patient.

Parent management training focuses on teaching the parents specific and more effective techniques for handling the child's opposition and defiance. Research has shown that parent management training is more effective than family therapy. One variation of parent management training known as Parent-Child Interaction Therapy (PCIT) appears to be helpful over the long term; a group of Australian researchers reported in 2004 that families who were given a course of PCIT maintained their gains two years after the program ended.

As of the early 2000s, elementary school teachers are being trained to deal more effectively with classroom disruptions caused by children with ODD. The long-term effectiveness of these interventions, however, will require further study.

Whether involved in therapy or working on this disorder at home, the patient must work with his or her parents' guidance to make the fullest possible recovery. According to the New York Hospital/ Cornell Medical Center, the patients must:

  • use self timeouts
  • identify what increases anxiety
  • talk about feelings instead of acting on them
  • find and use ways to calm themselves
  • frequently remind themselves of their goals
  • get involved in tasks and physical activities that provide a healthy outlet for energy
  • learn how to talk with others
  • develop a predictable, consistent, daily schedule of activity
  • develop ways to obtain pleasure and feel good
  • learn how to get along with other people
  • find ways to limit stimulation
  • learn to admit mistakes in a matter-of-fact way

Stimulant medication is used only when oppositional defiant disorder coexists with attention deficit/hyperactivity disorder. Currently, no research is currently available on the use of other psychiatric medications in the treatment of oppositional defiant disorder.

KEY TERMS

Attention deficit/hyperactivity disorder A persistent pattern of inattention, hyperactivity and/or impulsiveness; the pattern is more frequent and severe than is typically observed in people at a similar level of development.

Conduct disorder A repetitive and persistent pattern of behavior in which the basic rights of others are violated or major age-appropriate rules of society are broken.

Prognosis

The outcome varies. In some children the disorder evolves into a conduct disorder or a mood disorder. Later in life, oppositional defiant disorder can develop into passive aggressive personality disorder or antisocial personality disorder. Some children respond well to treatment and some do not. Generally, with treatment, reasonable adjustment in social settings and in the workplace can be made in adulthood.

Resources

BOOKS

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed., revised. Washington, D.C.: American Psychiatric Association, 2000.

PERIODICALS

Harada, Y., K. Saitoh, J. Iida, et al. "The Reliability and Validity of the Oppositional Defiant Behavior Inventory." European Child and Adolescent Psychiatry 13 (June 2004): 185-190.

Nixon, R. D., L. Sweeney, D. B. Erickson, and S. W. Touyz. "Parent-Child Interaction Therapy: One- and Two-Year Follow-Up of Standard and Abbreviated Treatments for Oppositional Preschoolers." Journal of Abnormal Child Psychology 32 (June 2004): 263-271.

Tynan, W. Douglas, PhD. "Oppositional Defiant Disorder." eMedicine November 2, 2003. http://www.emedicine.com/ped/topic2791.htm.

van Leer, P. A., B. O. Muthen, R. M. van der Sar, and A. A. Crijnen. "Preventing Disruptive Behavior in Elementary Schoolchildren: Impact of a Universal Classroom-Based Intervention." Journal of Consulting and Clinical Psychology 72 (June 2004): 467-478.

ORGANIZATIONS

American Academy of Child and Adolescent Psychiatry (AACAP). 3615 Wisconsin Avenue, NW, Washington, DC 20016-3007. (202) 966-7300. Fax: (202) 966-2891. http://www.aacap.org.

American Psychiatric Association. 1400 K Street, NW, Washington, DC 20005. http://www.psych.org.

Families Anonymous. Westchester County, Westchester, NY. (212) 354-8525.

OTHER

American Academy of Child and Adolescent Psychiatry (AACAP). Children with Oppositional Defiant Disorder. AACAP Facts for Families #72. Washington, DC: AACAP, 2000.

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Oppositional Defiant Disorder

Oppositional Defiant Disorder

What Is Oppositional Defiant Disorder?

What Causes Oppositional Defiant Disorder?

How Is Oppositional Defiant Disorder Treated?

A child whose behavior is overly hostile, negative, and puposefully disobedient much of the time for a period of more than 6 months may have oppositional* (op-po-ZI-shun-al) defiant* (dee-FY-ent) disorder.

* Oppositional
(op-po-ZI-shun-al) is an attitude of going against something or refusing in a combative way,
* defiant
(dee-FY-ent) is an attitude of challenging the rules in a hostile way or of being disobedient on purpose.

KEYWORDS

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Conduct disorder

Defiant behavior

Disruptive behavior

Oppositional behavior

What Is Oppositional Defiant Disorder?

Oppositional defiant disorder (ODD) is a type of disruptive behavior problem in children. Children with ODD often lose their temper, act stubborn and willful, argue, and refuse to follow rules, and may annoy others on purpose. Some oppositional behavior is quite common and normal in children. Examples of oppositional behavior are refusing to follow rules, directions, or requests given by adults in charge. While all children may act in these ways occasionally, ODD is diagnosed in those children who act in these ways frequently and whose oppositional behavior seriously interferes with their ability to get along with others in school, on the playground, or at home. ODD can start as early as the preschool years and can be diagnosed in children and adolescents of any age whose defiant behavior is the cause of problems at home, in school, or with peers. Children with ODD have at least 5 of the following problem behaviors to a greater degree than expected for their age for at least 6 months:

  • become easily annoyed
  • lose temper often
  • feel and act angry and resentful
  • argue with adults
  • refuse to do what adults request
  • actively defy the rules of behavior at home or in the classroom
  • blame others for mistakes
  • deliberately annoy others.

Children with ODD are often set in their ways (inflexible) and stubborn. They may have other problems as well, such as hyperactivity*, anxiety*, or depression. ODD is sometimes an early sign of another behavioral disorder called conduct disorder. Some, but not all, children with ODD go on to show signs of conduct disorder when they are older. While there are some similarities between ODD and conduct disorder, children and adolescents with ODD do not demonstrate the physical aggression or property destruction that is typical of those with conduct disorder.

* hyperactivity
(hy-per-ak-TI-vitee) is overly active behavior, which makes it hard for a person to sit still.
* anxiety
(ang-ZY-i-tee) is a troubling feeling, a sense of dread, fear of the future, or distress over a possible threat to a persons physical or mental well-being.

What Causes Oppositional Defiant Disorder?

There is no single cause of ODD. Some experts believe that certain children may develop oppositional problems because they are less adaptable and overly sensitive by nature. For example, there seem to be some children who find it especially hard to handle frustration and who become easily upset even by minor things. When they are frustrated, such children have extreme difficulty coping and adapting. They may act very stubborn, defiant, and inflexible. Some children are more irritable and touchy by nature. They may be particularly upset by the way certain clothing feels or by tastes or smells, and they may act even more cranky, oppositional, and defiant when they are tired or hungry.

Family environment also can contribute to oppositional defiant disorder. In families where there is much conflict, harsh discipline, aggressive behavior, or inconsistent rules for behavior, children are more likely to develop oppositional defiant disorder because they are learning to relate to others in hostile, argumentative ways.

How Is Oppositional Defiant Disorder Treated?

Children with oppositional defiant disorder may work with a mental health expert. Often children with ODD are referred by their parents or by school personnel because their behavior is so difficult to manage. Treatment involves helping the child learn to handle frustration, develop more cooperative forms of behavior, and acquire more skills for solving problems and adapting to situations. Parents may be coached to make clear and simple rules for the childs behavior, to reward the childs positive behavior patterns, and to enforce consequences for the oppositional ones. When oppositional defiant disorder is treated early, more serious problems with conduct disorder may be prevented.

See also

Conduct Disorder

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"Oppositional Defiant Disorder." Complete Human Diseases and Conditions. . Encyclopedia.com. 23 Sep. 2017 <http://www.encyclopedia.com>.

"Oppositional Defiant Disorder." Complete Human Diseases and Conditions. . Encyclopedia.com. (September 23, 2017). http://www.encyclopedia.com/medicine/encyclopedias-almanacs-transcripts-and-maps/oppositional-defiant-disorder-0

"Oppositional Defiant Disorder." Complete Human Diseases and Conditions. . Retrieved September 23, 2017 from Encyclopedia.com: http://www.encyclopedia.com/medicine/encyclopedias-almanacs-transcripts-and-maps/oppositional-defiant-disorder-0