INTRODUCTION:

Oppositional Defiant Disorder:

It is common for children and teenagers to display bouts of irritability, frustration, and disobedience over the course of their growth and development. For example, a 4 year old who throws a tantrum because she has to stop playing; a 13 year old who argues with her mother about going for a movie with friends. Some children and teens have such an inflexible and hostile nature and their behavior can be so uncooperative and defiant that they disrupt the functioning of whole households and classrooms, not to mention their own learning and well-being in relationships.

Definition:

Oppositional defiant disorder (ODD) is one of a group of behavioral disorders called disruptive behavior disorders (DBD). These disorders are called this because children who have these disorders tend to disrupt those around them.

According to the American Psychiatric Association, ODD is characterized by a chronic pattern of negativity, hostility, and non-compliant child behavior that is most often directed toward authority figures and has existed for at least 6 months. Evidence suggests that between 1 and 16% of children and adolescents have ODD.¹ However, there is not very much information on the prevalence of ODD in preschool children, and estimates cannot be made.²

Causes of ODD:

There is no clear-cut cause of ODD. However, most experts believe that a combination of biological, psychological, and social risk factors play a role in the development of the disorder.³

Biological Factors:

Children and adolescents are more susceptible to developing ODD if they have:

Ø A parent with a history of attention-deficit/ hyperactivity disorder (ADHD), ODD, or CD

Ø A parent with a mood disorder (such as depression or bipolar disorder)

Ø A parent who has a problem with drinking or substance abuse

Ø Impairment in the part of the brain responsible for reasoning, judgment, and impulse control

Ø A brain-chemical imbalance

Ø A mother who smoked during pregnancy

Ø Exposure to toxins

Ø Poor nutrition

Psychological Factors:

Ø A poor relationship with one or more parent

Ø A neglectful or absent parent

Ø A difficulty or inability to form social relationships or process social cues

Social Factors:

Ø Poverty

Ø Chaotic environment

Ø Abuse

Ø Neglect

Ø Lack of supervision

Ø Uninvolved parents

Ø Inconsistent discipline

Ø Family instability (such as divorce or frequent moves)

Signs and Symptoms:

Most children argue with parents and defy authority from time to time, especially when they are tired, hungry, or upset. Some of the behaviors associated with ODD also can arise in children who are undergoing a transition, who are under stress, or who are in the midst of a crisis. This makes the behavioral symptoms of ODD sometimes difficult for parents to distinguish from expectable stress-related behaviors.⁴ Children with ODD show an ongoing pattern of extreme negativity, hostility, and defiance that:

· Is constant

· Lasts at least 6 months

· Is excessive compared with what is usual for the child’s age

· Is disruptive to the family and the school

· Is usually directed toward an authority figure (parents, teachers, principal, coach)

The following behavioral symptoms are associated with ODD:

· Frequent temper tantrums

· Excessive arguments with adults

· Actively refusing to comply with requests and rules

· Often questioning rules

· Deliberately annoying and upsetting others

· Often touchy or annoyed by others

· Blaming others for their mistakes

· Frequent outbursts of anger and resentment

· Spiteful attitude and revenge seeking

It is not uncommon for children with Attention Deficit/Hyperactivity Disorder (AD/HD), depression, or anxiety to display symptoms of ODD.

Effect on Families & Relationships:

Parenting a child with ODD can be a tremendous challenge not only because he or she may seem so willing to defy adult authority, but also because intervention strategies that work with most children, such as time-outs, removal of privileges, and grounding, often do not work with ODD. Studies actually indicate that these children may not respond well to punishments. Other studies have found that children and teens with severe cases of ODD and/or aggression may feel threatened by situations where there are unclear messages, rules, or expectations, which can trigger hostile reactions. In addition, they often have poor frustration tolerance, which only makes it more difficult for them to get through situations where they feel uncomfortable, threatened, or where they may see little pay-off for their efforts. The result of these factors are children and teens who seem to be easily annoyed or angered, yet are difficult to soothe and calm. This pattern of behavior can leave many families feeling powerless, as if they have to “walk on eggshells” out of fear that one wrong move can cause a serious tantrum. It can also leave the child or teen feeling isolated, anxious, and unsure of herself as others anticipate her irritability and explosive behavior even before it occurs. They likely will be aware of any feelings of disappointment and resentment that other family members feel toward them due to their oppositional and defiant behavior. Unfortunately, it is not enough to help change the behavior.

Diagnostic tests:

While there is no single test that can diagnose ODD, a mental health professional can determine whether a child or adolescent has the disorder by assessing the child’s symptoms and behaviors and by using clinical experience to make a diagnosis.

Gathering Information:

A child and adolescent psychiatrist or a qualified mental health professional usually diagnoses ODD.A mental health professional will gather information from parents, teachers, and daycare providers as well as from the child.

The mental health professional will determine whether:

§ The behavior is severe

§ The conflicts are with peers or authority figures

§ The behavior is a result of stressful situations within the home

§ The child reacts negatively to all authority figures, or only his or her parents or guardians

Prevention of ODD:

There is research that shows that early-intervention and school-based programs along with individual therapy can help prevent ODD.³

Among preschoolers, the Head Start program has been shown to help children do well in school and prevent delinquency later in life. Head Start is a program of the United States Department of Health and Human Services (US-HHS) that provides education, health, and other services to low-income children and their families. Young children in this program learn social skills and how to resolve conflict and manage anger.⁵ A home visit to high-risk children also has been shown to help prevent ODD among preschoolers.⁶Among adolescents, psychotherapy (talk therapy), social-skills training, vocational training, and help with academics can help reduce disruptive behavior. In addition, school-based programs can be effective in stopping bullying, reducing antisocial behavior, and improving peer relationships.Parent-management training programs have proven effective in preventing ODD among all age groups. These programs teach parents how to develop a nurturing and secure relationship with their child and how to set boundaries for unacceptable behavior.³

Treatment:

There is no one-size-fits-all treatment for children and adolescents with ODD. The most effective treatment plans are tailored to the needs and behavioral symptoms of each child. Treatment decisions are typically based on a number of different things, including the child’s age, the severity of the behaviors, and whether the child has a coexisting mental health condition.⁷

Types of Treatment:

Treatment usually consists of a combination of:

§ Parent-Management Training Programs and Family Therapy to teach parents and other family members how to manage the child’s behavior. Parents, family members, and other caregivers are taught techniques in positive reinforcement and ways to discipline more effectively.

§ Cognitive Problem-Solving Skills Training to reduce inappropriate behaviors by teaching the child positive ways of responding to stressful situations. Children with ODD often only know of negative ways of interpreting and responding to real-life situations. Cognitive problem solving skills training teaches them how to see situations and respond appropriately.

§ Social-Skills Programs and School-Based Programs to teach children and adolescents how to relate more positively to peers and ways to improve their school work. These therapies are most successful when they are conducted in a natural environment, such as at the school or in a social group.

§ Medication may be necessary to help control some of the more distressing symptoms of ODD as well as the symptoms of coexisting conditions, such as ADHD, anxiety, and mood disorders. However, medication alone is not a treatment for ODD.

Intervention:

The key to successful interventions for ODD is parent involvement. It is critical that parents be firm and consistent not only with their discipline strategies, but also with the love and acceptance in their responses to the child. The most effective interventions are considered to be those that emphasize Parent Training, which provide a framework for understanding the nature of ODD in children and teens and help reinforce specific parenting skills, as well as teach creative strategies for managing ODD behavior. Parents who are not able to respond to ODD behavior in a manner that can calm and soothe the child only add fuel to the fire. It is a lot to ask of a parent who is constantly under attack from oppositional behavior to react calmly, and it probably seems impossible if you are feeling demoralized and exasperated. This is why it is often a good idea to seek the help of a mental health professional, such as a marriage and family therapist (MFT), who can not only help you learn strategies to confront this kind of extreme behavior, but also learn ways of coping with the stress of parenting in the face of such difficult circumstances.

Parent-Management Training:

Parent management training teaches parents positive ways to manage their child’s behavior, discipline techniques, and age-appropriate supervision. It is the treatment of choice to prevent disruptive childhood behavior for many mental health professionals.

This approach embraces the following principles:

v Increased positive parenting practices, such as providing supportive and consistent supervision and discipline

v Decreased negative parenting practices, such as the use of harsh punishment and focus on inappropriate behaviors

v Consistent punishment for disruptive behavior

v Predictable, immediate parental response

Prognosis:

Follow-up studies have found that approximately 67 percent of children diagnosed with ODD who received treatment will be symptom-free after three years. However, studies also show that approximately 30 percent of children who were diagnosed with ODD will go on to develop CD.⁵In all age groups, approximately 10 percent of children and adolescentsdiagnosed with ODD will eventually develop a more lasting personalitydisorder, such as antisocial personality disorder.⁸However, most children and adolescents will improve over time, especially ifthey receive treatment. Parents who suspect that their child has a behavioralproblem should have their child evaluated. For children who receive treatment,the outlook is very good.

CONCLUSION:

Oppositional defiant disorder (ODD) is a childhood behavioral problem characterized by constant disobedience and hostility. Children with ODD will struggle in school and in making and/or keeping friends. It appears a child with Oppositional defiant disorder thrives on deliberately annoying other people. They refuse to take responsibility, blaming others for their mistakes or misbehavior; they are easily annoyed and act with aggression toward peers and adults. They often have trouble academically. Parents with a child suffering from ODD should seek support and help from a professional familiar with this disorder as many times it is misdiagnosed, and left untreated ODD can, and most likely will, progress to the more serious Conduct disorder, substance abuse and severe delinquency. Children afflicted with ODD or Conduct disorder will most likely have trouble feeling empathy and may misread social queues or miss them altogether. He may misinterpret others behavior as hostile or aggressive leading him to act out in response to the aggression with aggression in return. Parents and children will benefit from parental training. Parents and siblings should have patience as the treatment will include the whole family. When one child is disruptive, the entire family feels the effects and everyone suffers the consequences to a degree. The upside to this “disorder” is that it is within a parent’s control to change their child’s behavior and their life.

REFERENCES:

1. Loeber R, Burke JD, Lahey BB, Winters A, Zera M (2000), Oppositional defiant and conduct disorder: a review of the past 10 years, part I. J Am Acad Child Adolesc Psychiatry 39:1468-1484.

2. American Psychiatric Association (1980), Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III). Washington, DC: American Psychiatric Press.

3. Burke JD, Loeber R, Birmaher B (2002), Oppositional defiant and conduct disorder: a review of the past 10 years, part II. J Am Acad Child Adolesc Psychiatry 41:1275-1293.

4. Skovgaard AM, Houmann T, Landorph SL, Christiansen E (2004), Assessment and classification of psychopathology in epidemiological research of children 0Y3 years of age: a review of the literature. Eur Child Adolesc Psychiatry 13:337-346.

5. Connor DF (2002), Aggression and Antisocial Behavior in Children and Adolescents: Research and Treatment. New York: The Guilford Press.

6. Eckenrode J, Ganzel B, Henderson CR, Smith E, Olds DL, Powers J, Cole R, Kitzman H, Sidora K (2000), Preventing child abuse and neglect with a program of nurse home visitation: the limiting effects of domestic violence. JAMA 284:1385-1391.

7. Kazdin AE (2005), Parent Management Training: Treatment for Oppositional, Aggressive, and Antisocial Behavior in Children and Adolescents. New York: Oxford University Press.

8. Rutter M, Giller H, Hagell A (1999), Antisocial behavior by young people. J Am Acad Child Adolesc Psychiatry 38:1320-1321.

Received on 18.06.2016 Modified on 10.07.2016

Int. J. Nur. Edu. and Research. 2016; 4(4): 493-496.

DOI: 10.5958/2454-2660.2016.00091.0