This is one of the DSM-5 disorders. It is an insistently repetitive display of anger and rebellious behavior in children. Children with this disorder are marked to be rebellious, disruptive, impulsiveness, argumentative or disobedient character, vindictiveness, have conduct disorder, irritable mood, and disordered pattern.
An oppositional defiant disorder is also referred to as “The naughty disorder”. They are usually not aggressive towards animals or people, and they do not destroy properties or show a pattern of deceit or theft. All children can be difficult or challenging at times, but it can only become an issue when your adolescent presents with a frequent and persistent pattern of anger, defiance, irritability, or vindictiveness.
Several studies have shown that about 45% to 84% of little children and adolescents are likely to disobey their parents. They may be impulsive and act aggressively. They have difficulty in regulating emotions. They can be easily frustrated and often angry. It is not uncommon to find children in their teens to be troublesome. They may display their defiance by arguing, talking back to their parents and adults, disobeying, and other annoying characters. When these behaviors occur frequently and persist for longer than six months in a child or an adolescent, such child can be marked as showing symptoms of an oppositional defiant disorder. It may advance in some children to become a more serious disorder known as Conduct Disorder.
Symptoms of Oppositional Defiant Disorder
It may be sometimes difficult to tell apart the difference between a stubborn, emotional, or strong-willed child from a child with an oppositional defiant disorder. Even the calmest and gentle child may exhibit some episodes of dramatic behavior. The oppositional defiant disorder usually starts during the pre-school years, childhood, or it may develop later in life before teen years. The symptoms related to ODD may cause impairment in the society, family and at work.
The criteria for ODD diagnosis include the following;
- The pattern of negativistic: this is a behavioral pattern in which a child exhibits a pattern of negative attitudes and passive resistance to demands. Children with oppositional defiant disorder have hostility issues and may have difficulty with self-expression and assertiveness. They may present with a negative attitude as a means of expressing their feelings, much more in an indirect way.
- Hostility: children with ODD are usually emotionally aggressive. They have a problem with showing love. They act in an unfriendly way and would usually be in their own shell than share love with friends.
- Defiant: defiant behavior is not uncommon in children with ODD. They would normally show a disposition to challenges. They are usually resistive and tend to cause rancour among their peers. Children and adolescents with the oppositional defiant disorder are often disobedient towards others. They actively refuse to comply with rules and regulations. They find it difficult to control their temper and heed to their parents calmly.
Temperamental: They usually have a problem with their temper. They tend to lose their temper and throw tantrums with adults. You will find them arguing with adults in most cases. They also have troubles controlling their temper. They just can’t keep calm.
- Annoying: Being annoying is a common characteristic of children with the oppositional defiant disorder. They are trouble for the peace of people and society. They tend to annoy people around them.
- Anger and Resentment: They tend to get upset and angry about the slightest offence. They get annoyed over the smallest thing and would normally show their anger in the most disordered way.
- Spiteful and vindictive: They would normally seek revenge when they are wronged or offended. They are spiteful and hateful. They take the slightest offence to heart.
- Throwing repeated tantrums
- Deliberately trying to annoy or upset others, or being irritable to others.
- Having frequent and consistent outbursts of anger and resentment
- Cursing or using swear language
- Uttering spiteful and hateful words when angry
The main factor that determines if a child has an oppositional defiant disorder or is just emotional or strong-willed is the frequency and re-occurrence of these symptoms. Check these symptoms across a comparable age to mark a child with the oppositional defiant disorder.
Aetiology of Oppositional Defiant Disorder
The definite cause of oppositional defiant disorder remains unknown but many studies have shown that there are contributing factors which may contribute to this condition. Contributing factors include Biological, Environmental, and Genetic factors.
Biological factors: studies have shown that some biological factors may be a contributing factor to ODD. Injuries or defects in certain areas of the brain may cause severe behavioural problems in children. Biological defects may arise from teratogenic substances ingested by the mother. Nicotine is a teratogenic substance that may cause ODD in a child. Nutritional deficiencies and developmental delay may also be a cause.
The oppositional defiant disorder has been linked to abnormal functions of some chemicals in the brain. These brain chemicals are known as neurotransmitters. They are responsible for several communications that happen within the brain. They help the nerve cells in the brain to interact and communicate efficiently. Neurotransmitters create a network or source of communication between the systems of the brain.
If the neurotransmitters in the brain are not working properly, the brain might not function properly, messages may be sent amiss and incorrectly which may lead to symptoms of the oppositional defiant disorder and other mental problems.
Genetic factors: Familial clustering indicates that oppositional defiant disorder may have some underlying genetic causes. There are visible hereditary connections as regards the cause of an oppositional defiant disorder. Studies have shown that a lot of children with this disorder probably have close family members with mental problems. These mental problems may include anxiety disorder, personality disorder, and mood disorder.
There is a high vulnerability for children with close family members with mental illnesses to have an oppositional defiant disorder. The genetic component of ODD suggests that it can be inherited.
Environmental Factor: there are several environmental factors that may come together to pose a risk of ODD on a child. Childhood trauma, poverty, parental psychopathology, maternal aggression, harsh punishment, inconsistent discipline, abuse, lack of supervision, neglect and others may lead to the development of ODD. Newer researches have shown that parental behavior or interaction with a child is a likely cause rather than a response to ODD. All of these factors come together to create an effect of oppositional defiant disorder in a child.
Diagnosis of Oppositional Defiant Disorder
ODD is a mental health condition and can be diagnosed through signs and symptoms exhibited by the patient. Evaluation of the symptoms is carried out on the patient to diagnose an oppositional defiant disorder. Just as mental illnesses are diagnosed by testing for signs and symptoms in adults, it is done the same way in oppositional defiant disorder.
The Doctor tests for the oppositional defiant disorder by placing the child (patient) on evaluation. He carries out a complete physical examination and checks for a complete medical history. There is usually no lab test required for ODD diagnosis, but doctors may use neuroimaging techniques or blood test to check for any underlying medical cause or background for the behavior the child is exhibiting. Other conditions related to oppositional defiant disorder are also checked for.
If after the physical assessment, the cause is yet to be established, there may be a need for a referral to an adolescent psychologist, psychiatrist, or mental health professionals who are trained and skilled at diagnosing and treating mental illnesses in children and teens. These sets of professionals have a special and formulated method in which they assess and evaluate a patient with mental illness. The psychiatrist bases the diagnosis on the reports gotten from the observation of the child’s symptoms, attitude, and behavior. The psychiatrist also makes his diagnosis based on reports from the child’s parents, other adults around the child, and teachers. Information from peers may not be important because children may have troubles explaining and understanding the symptoms.
Diagnostic criteria for oppositional defiant disorder requires a child to exhibit at least four symptoms of an oppositional defiant disorder. The child must have an irritable or angry mood, defiant or argumentative behavior, or vindictiveness.
Diagnostic symptoms for ODD are grouped to be dictated by mood, behaviors, and vindictiveness. The reason why these are the prevailing Diagnostic symptoms is that oppositional behaviors are a part of early childhood, they are behaviors you will find with many children and adolescents. The diagnosis follows the guidance of the DSM-5 on behaviors that are a complete departure from normal childhood development. DSM-5 regards temper outburst for pre-school age children has been common, but may need to be paid great attention to if it happens on most days and consistently. If other significant impairments like the child being asked to leave school are involved, then that may be a pointer to oppositional defiant disorder.
DSM-5 gives a number of settings to be another criterion for ODD diagnosis. The oppositional defiant disorder must present in a single setting to make a diagnosis. Severity may depend on the settings. A child with behavioral problems in school may be diagnosed to have ODD due to oppositional issues in his or her home. ODD usually cause impairments across multiple settings which is an indication of a more severe case. However, children who present with ODD in one setting may have a problem with current and future adjustments and may need further evaluation and treatment.
There is no questionnaire specially designed for diagnosing ODD, but there are many other tools that can aid diagnosis. Vanderbilt ADHD Diagnostic Parent Rating Scale and the Conners 3 scales which are often used to diagnose ADHD (attention-deficit / hyperactivity disorder) can also be used. These tools can be greatly helpful in identifying ODD. Affirmative answers to items such as “Angry or bitter” and “Actively disobeys to follow requests and rules ” has a high sensitivity for diagnosing an oppositional defiant disorder. The Child Behavior Checklist is another tool that helps to evaluate behavioral and emotional problems including ADHD, conduct disorder, depression, anxiety, phobias, and ODD.
Disorder DSM-5 Complications Or Patient Outlook
Children with ODD may have troubles at home with their siblings and parents. They may also have troubles in school and other social gatherings. They may experience rejection due to annoying and aggressive behaviors. Patients may find it hard to maintain a circle or keep friends. It may lead to antisocial behaviors, substance use disorder, poor school performance, impulse control problems, depression, and suicide.
Disorder DSM-5 Treatment
An oppositional defiant disorder can be treated based on factors including child’s age, patient’s ability to tolerate therapy, and severity of symptoms. Treatment of ODD is usually a combination of psychotherapy and medication.
Psychotherapy: This treatment plan aims at helping the child develop coping skills and healthy ways to express and control anger. There are several types of therapies that can be used. Cognitive-behavioural therapy helps to reshape the child’s behavior and thinking capability. Family therapy can help to improve and develop peaceful and healthy interactions between the child and the members of the family. Parent Management Training, PMT teaches parents on ways to build their child’s behavior. All these are an individualized treatment which has been said to be the most effective treatment plan for an oppositional defiant disorder.
The first line therapy for treatment in children with an oppositional defiant disorder is Behavioral parenting, in which the parents are actively involved in helping their child to develop a positive behavior. The goal of psychotherapy which involves the active intervention of parents is to prevent harsh treatments from the parents and focus more on positive ways to influence their child’s behavior.
Pharmacological treatment or Medication: There are no medications specifically designed for an oppositional defiant disorder. It is also not employed as the first line of treatment but there are drugs that may help to improve patient’s condition. These drugs help to treat irritability, impulsivity, and depression.
Atomoxetine (Strattera) may help to reduce symptoms of ODD. Anti-depressant drugs can also be used to suppress symptoms of depression from ODD.