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07.13.06 (2 years ago)
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Oppositional defiant disorder (ODD) is a psychiatric behavior disorder that is characterized by aggressiveness and a tendency to purposefully bother and irritate others. These behaviors cause significant difficulties with family and friends and at school or work.
Description
Oppositional defiant children show a consistent pattern of refusing to follow commands or requests by adults. These children repeatedly lose their temper, argue with adults, and refuse to comply with rules and directions. They are easily annoyed and blame others for their mistakes. Children with ODD show a pattern of stubbornness and frequently test limits, even in early childhood.
These children can be manipulative and often induce discord in those around them. Commonly they turn attention away from themselves by inciting parents and other family members to fight with one and other
Behavioral Symptoms
Normal children occasionally have episodes of defiant behavior, particularly during ages of transition such as 2 to 3 or the teenage years where the child uses defiance in an attempt to assert himself. Children who are tired, hungry, or upset may be defiant. Oppositional defiant behavior is a matter of degree and frequency. Children with Oppositional Defiant Disorder display difficult behavior to the extent that it can interfere with learning, school adjustment, and, sometimes, with the child's social relationships
Common behaviors seen in Oppositional Defiant Disorder include:
1.Losing one’s temper
2.Arguing with adults
3.Actively defying requests
4.Refusing to follow rules
5.Deliberately annoying other people
6.Blaming others for one's own mistakes or misbehavior
7.Being touchy, easily annoyed
8.Being easily angered, resentful, spiteful, or vindictive.
9.Speaking harshly, or unkind when upset
10.Seeking revenge
11.Having frequent temper tantrums
Many parents report that their ODD children were rigid and demanding from an early age.
Diagnosis
The diagnosis of ODD is not always straight forward and needs to be made by a psychiatrist or some other qualified mental health professional after a comprehensive evaluation.
If you feel your child may have ODD, there is a quick ODD Screening Test
1.Loses temper at least twice a week
2.Argues with adults at least twice a week
3.Actively defies or refuses to comply with adults' requests or rules at least twice a week
4.Deliberately annoys people at least four times a week
5.Blaims others for his or her mistakes or misbehavior at least once during the last three months
6.Is touchy or easily annoyed by others at least twice a week
7.Is angry and resentful at least four times per week
8. Acts spiteful or vindictive at least once during the last three months
[ four out of eight is positive .]
Causes It is not clear what causes Oppositional Defiant Disorder. There are currently two theories.
The developmental theory suggests that ODD is really a result of incomplete development. For some reason, ODD children never complete the developmental tasks that normal children master during the toddler years. They get stuck in the 2-3 year old defiant stage and never really grow out of it.
The learning theory suggests thatOppositional Defiant Disorder comes as a response to negative interactions. The techniques used by parents and authority figures on these children bring about the oppositional defiant behavior.
Co-morbidity
Oppositional Defiant Disorder usually does not occur alone.
1.50-65% of ODD children also have ADD ADHD
2.35% of these children develop some form of affective disorder
3.20% have some form of mood disorder, such as Bipolar Disorder or anxiety
4.15% develop some form of personality disorder
5.Many of these children have learning disorders
Any child with Oppositional Defiant Disorder must be evaluated for other disorders as well. If your child has ODD it is imperative to find out what are the co-existing problems. This is the key to treating the condition, as we shall soon discuss.
Prognosis
So what happens to these children? There are four possible paths.
1.Some will grow out of it. Half of the preschoolers that are labeled ODD are normal by the age of 8. However, in older ODD children, 75% will still fulfill the diagnostic criteria later in life.
2.The ODD may turn into something else. 5-10 % of preschoolers with ODD have their diagnosis changed from ODD to ADHD. In some children, the defiant behavior gets worse and these children eventually are diagnosed with Conduct Disorder. This progression usually happens fairly early. If a child has ODD for 3-4 years and he hasn't developed Conduct Disorder, then he won’t ever develop it.
3.The child may continue to have ODD without any thing else. This is unusual. By the time preschoolers with ODD are 8 years old, only 5% have ODD and nothing else.
4.The child develops other disorders in addition to ODD. This is very common.
Treatment
Medical Intervention
There have been some recent studies that have examined the effects of certain medications on Oppositional Defiant Disorder. All the research is preliminary and just suggests that certain treatments may help.
One study examined the use of Ritalin to treat children with both ADHD and ODD. This study found that 90% of the children treated with Ritalin no longer had the ODD by the end of the study. The researchers skewed the results a bit because a number of children were dropped from the study because they wouldn't comply with the treatment regimen. Still if these children are included as treatment failures the study still showed a 75% success rate.
There have been two studies examining the effect of Strattera on children with both ADHD and ODD. One study showed that Strattera helped with ODD, one study showed it did not help
There was a large Canadian study that showed that Risperdal helped with aggressive behavior in children with below normal intelligence. It did not matter if the child had ADHD or not.
There was study showing that 80% of children with explosive behavior improved when given the mood stabilizer, divalproex.
There was another pilot study examining the use of Omega-3 oils and vitamin E in ODD children. Both helped the ODD behavior to some degree. Psychological Intervention
Parent management training(PMT) is still viewed as the main treatment for Oppositional Defiant Disorder.
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