Oppositional Defiant Disorder
Oppositional Defiant Disorder: What does it mean?
Oppositional defiant disorder (ODD) is a psychological disorder characterized by frequent and persistent behavioral patterns of anger, irritability, defiance, and vindictiveness, usually of a child to parents or those in authority. Well-behaved children could occasionally prove stubborn and difficult, but this differs from ODD because in the latter situation, the pattern is more regular, frequent, and occurs for a long period of time, usually a minimum of six months.
The behavioral pattern in oppositional defiant disorder has three components: defiant behavior, obstinate behavior, and vindictive behavior.
Defiant behavior is characterized by deliberately refusing to comply with rules or requests of those in authority and blaming other people for his or her mistakes.
An obstinate behavior refers to a pattern of deliberately annoying others and being unnecessarily resentful and a vindictive pattern of behavior is one characterized by been spiteful or vengeful.
These symptoms must be present in a child within the past 6 months to make a diagnosis of ODD.
Studies show that oppositional defiant disorder has a prevalence rate of 1-11% in the general population. The condition is more common in boys than in girls, before puberty. However, after puberty, it occurs in both boys and girls equally. Oppositional defiant disorder has an age of onset of 8 years.
What Causes Oppositional Defiant Disorder?
Although the exact cause of oppositional defiant disorder is not known, there are certain factors which may contribute to its development.
Genetics – A child’s personality type and temperament contributes significantly to the development of ODD. In addition, certain problems in a child’s brain chemistry and function, such as poor emotional control, high emotional reactivity, and poor stress tolerance may affect a child’s risk of oppositional defiant disorder.
Environmental Factors – Environmental factors such as neglectful or harsh parenting, inconsistent parental discipline, abuse, and excessively authoritarian parenting may contribute to a child’s risk of developing the disease.
Signs and Symptoms of Oppositional Defiant Disorder
A child with oppositional defiant disorder is often confused for a strong-willed child. However, the persistence of the symptoms, impairing a child’s relationship with parents and other authority figures and, in turn, daily functioning at home and school creates a need for therapy.
Signs of ODD manifest in preschool years, although it may develop later in some individuals. However, in almost all cases, symptoms begin to manifest by the early teen years. These symptoms include:
- Having frequent temper tantrums and aggressive outbursts.
- Being easily irritated and offended
- Being angry most of the time
- Arguing frequently with parents and other adults
- Disobeying requests or instructions given by an adult
- Always questioning rules and disobeying them
- Deliberately annoying others, including adults
- Blaming others for one’s mistakes or misbehaviors.
- Speaking aggressively and without considering the other’s feelings
- Seeking revenge for anything done wrong to them
What are the Diagnostic Criteria for Oppositional Defiant Disorder?
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) defines oppositional defiant disorder as a recurrent pattern of irritable/angry mood, argumentative/defiant behavior, or vindictiveness in an individual for a minimum of 6 months. An individual must have at least 4 of the following criteria to fulfill this diagnosis.
- Often loses temper
- Often touchy or easily annoyed
- Often angry and resentful
- Often argues with authority figures or with adults (if a child or adolescent)
- Often actively defies or refuses to comply with requests from authority figures
- Often deliberately annoys others
- Often blames others for his or her mistakes or poor behavior
- Has been spiteful or vindictive at least twice within the past 6 months
These symptoms are distinguishable from behaviors that are developmentally normal for children of different ages: for children younger than 5 years, these symptoms should occur on most days; for children 5 years or older, the symptoms should occur at least once per week.
Furthermore, these symptoms may occur at home, in the community, at school, with peers, or in all settings. Mild ODD is characterized by the presence of symptoms in only one setting, moderate ODD occurs with symptoms in at least two settings, while severe ODD is characterized by the presence of symptoms in three or more settings.
Oppositional Defiant Disorder and Other Conditions
The symptoms of oppositional defiant disorder closely overlap with several other disorders and it is essential to differentiate them clinically.
Oppositional Defiant Disorder vs. Conduct Disorder
Both oppositional defiant disorder and conduct disorder have several similarities. However, conduct disorder is an extreme psychological disorder characterized by the violation of others’ rights and societal norms. The symptoms of conduct disorder are typically more extreme than those of oppositional defiant disorder and include aggressive behavior toward people and animals, physical fights with others, physical cruelty to animals, deliberately destroying property, and using a weapon that could cause harm on self or others.
Oppositional Defiant Disorder vs. Intermittent Explosive Disorder
Both disorders have a number of similarities, however, while the symptoms of intermittent explosive disorder typically manifest in late adolescent years, the symptoms of oppositional defiant disorder manifests earlier, at the age of 8. Another key difference between both conditions is that symptoms of intermittent explosive disorder are not pre-meditated and usually occur within 30 minutes, after which the patient feels guilt and remorse. Typical symptoms of intermittent explosive disorder include short episodes of symptoms of aggression such as tremors, restlessness, rage, and racing thoughts, as well as aggressive outbursts characterized by temper tantrums, shouting, physical fights, destruction of property, heated arguments, and threats which are out of proportion to the inciting situation.
Attention-deficit hyperactivity disorder is a common comorbidity in patients with oppositional defiant disorder. Children with ADHD are particularly vulnerable to developing ADHD in the presence of environmental risk factors including harsh parenting and inconsistent punishment. Studies reveal that half of the children with ADHD have oppositional defiant disorder. Other conditions related to oppositional defiant disorder include antisocial personality disorder which is characterized by persistent rebellious behavior, lack of remorse, and gross social irresponsibility.
Oppositional Defiant Disorder in Adults/Children
Oppositional defiant disorder usually manifests at the age of 8 and is among the commonest mental health disorders in childhood. Although the symptoms may remit spontaneously as the child grows, about 50% of children with ODD may continue experiencing symptoms through adulthood. Some of these adults may go on to develop antisocial personality disorder.
Example Case of Oppositional Defiant Disorder
John, a 5-year-old boy is brought to the clinic by his parents on account of his temper tantrums at home and in school. The parents noted that John is always arguing with them when they give him an instruction, and he eventually refuses to carry out the tasks he is asked to do. They also noted that when they try to discipline him by removing his desert privilege, he becomes very aggressive, breaking his toys and tearing his school notes. The parents affirmed that they thought it was just a “childish” behavior, but he exhibits the same behavior in school and has resulted in poor performance and several bad reports from his teachers.
How to Deal with Oppositional Defiant Disorder
Oppositional defiant disorder is a complex disorder which is common among children. Symptoms may spontaneously remit over time or may progress into adulthood. Risk factors for oppositional defiant disorder to look out for include:
- Temperament – A child with a temperament which is characterized by difficulty control his or her emotions or being unable to endure stress or frustrating situations has a high risk of developing oppositional defiant disorder.
- Poor parenting – A child who experiences parental neglect, harsh parenting, or physical abuse from parents has a high risk of developing oppositional defiant disorder. In addition, a child who lives with a parent with mental health issues or substance abuse disorders is likely to develop oppositional abuse disorder. Positive parenting is, therefore, essential in improving behavior and preventing complications.
- Environmental factors – Oppositional defiant disorder can be exacerbated by inconsistent discipline from authority figures.
Oppositional and defiant behavior often begins with mild symptoms which may progress to causing serious complications which include:
- Poor school performance
- Poor social relationships and antisocial behavior
- Substance use disorder
- Suicidal tendency.
Oppositional Defiant Disorder Treatment
Children with ODD show significant improvement with early treatment, and this could restore the child’s self-esteem, positive attitude, and rebuild positive social relationships. Treatment for ODD includes the use of certain medicines, parental training, personal and family therapy, and parent-child interaction therapy.
Possible Medicines for ODD
Medicines are not often used in treating ODD, as the mainstay of treatment is therapy. However, children with co-occurring disorders such as ADHD may be treated with agents such as Ritalin, Dexmethylphenidate, and antidepressants including imipramine.
Home Remedies to Help ODD
In addition to clinical therapy instituted by your doctor, the following home strategies may help improve your child’s symptoms:
- Recognize and reward your child’s positive behaviors. The rewards should be specific and consistent.
- Model the desired behavior – Modeling appropriate social behavior which you desire in your child may help them improve their behavior and social relationships.
- Set clear boundaries – Behavioral patterns should be limited by clear boundaries and the consequences should be consistent so the desired behavior is reinforced.
- Spend time together – creating a consistent and regular schedule for spending time with your child may help in improving their behavior.
- Assign tasks – Give clear instructions for your child to carry out tasks which will not be done if the child does not do it.
Living with ODD
It may be challenging dealing with a child with ODD. Parents, tutors, and other adults who take care of such children need to be patient with them and work together to ensure the inappropriate behavioral pattern is eliminated.
- Parents and other family members may also seek the help of a therapist to learn coping strategies to help them overcome the emotional distress which comes with being a parent of a child with ODD.
- Build supportive relationships which would help you acquire coping strategies and help provide support for the child.
Insurance Coverage for ODD
Check your insurance plan benefits for coverage of mental or behavioral health services. You may inquire through your human resources unit for employer-sponsored health coverage for treatment of this condition or contact your health insurance company directly. Also, find out about out-of-pocket costs and deductibles you will pay to access the mental health services under your insurance plan.
How to Find a Therapist
After an initial evaluation, your primary care physician will refer your child to a psychiatrist or child psychologist for therapy. You may also ask friends and family for good therapists, or check through online resources and directory to find the right therapist for you.
What should I be looking for in a Licensed Mental Health Professional (LMHP)?
Qualities you should look for in an LMHP include:
- Good Communication Skills: An effective LMHP should be able to effectively communicate their expert ideas about your child’s symptoms effectively.
- Empathy: You do not want a counselor who would rush through medical facts without considering your emotional needs or the needs of your child. You need an LMHP that is considerate, patient, calm, and compassionate with you.
- Problem-Solving Skills: Your chosen LMHP must be knowledgeable enough to help you through to a satisfactory resolution of your child’s symptoms. While your child’s remission is not entirely up to your counselor, they must demonstrate ample ability to help manage your symptoms effectively.
- Good multicultural Relationship: Your counselor must be able to strike a strong patient-therapist relationship with you and your family irrespective of your racial, ethnic, or cultural differences. Therapy must be devoid of such prejudices which may hamper on the effectiveness of treatment.
Questions to ask for Potential Therapist
You should ask a potential therapist the following questions to help you gain more insight into your symptoms and the scope of your treatment options.
- What do you think is causing my child’s symptoms?
- How will the diagnosis be determined?
- Does my child have oppositional defiant disorder?
- Is the condition self-limiting or chronic?
- What factors contribute to the problem?
- Does my child require screening for other mental health disorders?
- What are the likely complications of this condition?
- What is the treatment approach you recommend?
- How long will therapy be for, if necessary?
- What medications will my child be on?
- What side effects should I expect from those drugs?
- Should I inform my child’s school teachers about the diagnosis?
- Are there effective strategies to use at home and school to improve my child’s behavior?
- Do you recommend family therapy?
- Are there any resources or websites you recommend?
Oppositional Defiant Disorder: Overview
Oppositional defiant disorder is a chronic psychological disorder characterized by at least 6 months duration of a child demonstrating angry and irritable mood, defiant behavior, and vindictiveness. Oppositional defiant behavior may remit spontaneously or require medications for comorbidities and sessions of family therapy, parent-child interaction therapy, and parental training.