Oppositional Defiant Disorder (ODD) Essay

Oppositional Defiant Disorder (ODD) Essay

Oppositional Defiant Disorder (ODD) Essay

Oppositional Defiant Disorder (ODD)

(Signs and Symptoms),

What is oppositional defiant disorder (ODD) in children?
Oppositional defiant disorder (ODD) is a type of behavior disorder. It is mostly diagnosed in childhood. Children with ODD are uncooperative, defiant, and hostile toward peers, parents, teachers, and other authority figures. They are more troubling to others than they are to themselves.Oppositional Defiant Disorder (ODD) Essay

What causes ODD in a child?
Experts don’t know what causes ODD. But there are 2 main theories for why it occurs:

Developmental theory. This theory suggests that the problems start when children are toddlers. Children and teens with ODD may have had trouble learning to become independent from a parent or other main person to whom they were emotionally attached. Their behavior may be normal developmental issues that are lasting beyond the toddler years.

Learning theory. This theory suggests that the negative symptoms of ODD are learned attitudes. They mirror the effects of negative reinforcement methods used by parents and others in power. The use of negative reinforcement increases the child’s ODD behaviors. That’s because these behaviors allow the child to get what he or she wants: attention and reaction from parents or others.

Which children are at risk for ODD?
ODD is more common in boys than in girls. Children with these mental health problems are also more likely to have ODD:

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Mood or anxiety disorders

Conduct disorder

Attention-deficit/hyperactivity disorder (ADHD)

What are the symptoms of ODD in a child?
Most symptoms seen in children and teens with ODD also happen at times in other children without it. This is very true for children around ages 2 or 3, or during the teen years. Many children tend to disobey, argue with parents, or defy authority. They may often behave this way when they are tired, hungry, or upset. But in children and teens with ODD, these symptoms happen more often. They also interfere with learning and school adjustment. And in some cases, they disrupt the child’s relationships with others.Oppositional Defiant Disorder (ODD) Essay

Symptoms of ODD may include:

Having frequent temper tantrums

Arguing a lot with adults

Refusing to do what an adult asks

Always questioning rules and refusing to follow rules

Doing things to annoy or upset others, including adults

Blaming others for the child’s own misbehaviors or mistakes

Being easily annoyed by others

Often having an angry attitude

Speaking harshly or unkindly

Seeking revenge or being vindictive

These symptoms may seem like other mental health problems. Make sure your child sees his or her healthcare provider for a diagnosis.

How is ODD diagnosed in a child?
If you see symptoms of ODD in your child or teen, get a diagnosis right away. Early treatment can often prevent future problems.Oppositional Defiant Disorder (ODD) Essay

Before a mental health referral is made, your child’s healthcare provider will want to rule out any other health problems. Once this is done, a child psychiatrist or qualified mental health expert can diagnose ODD. He or she will talk with you and your child’s teachers about your child’s behavior. He or she may also watch your child. In some cases, your child may need mental health testing.

How is ODD treated in a child?
Early treatment can often prevent future problems. Treatment will depend on your child’s symptoms, age, and health. It will also depend on how bad the ODD is.

Children with ODD may need to try different therapists and types of therapies before they find what works for them. Treatment may include:

Cognitive-behavioral therapy. A child learns to better solve problems and communicate. He or she also learns how to control impulses and anger.

Family therapy. This therapy helps make changes in the family. It improves communication skills and family interactions. Having a child with ODD can be very hard for parents. It can also cause problems for siblings. Parents and siblings need support and understanding.Oppositional Defiant Disorder (ODD) Essay

Peer group therapy. A child learns better social skills.

Medicines. These are not often used to treat ODD. But a child may need them for other symptoms or disorders, such as ADHD or anxiety disorders.

How can I help prevent ODD in my child?
Experts don’t know what causes ODD. But certain approaches can help prevent the disorder. Young children may be helped by early intervention programs. These can teach them social skills and how to deal with anger. For teens, talk therapy (psychotherapy), learning social skills, and getting help with schoolwork can all help reduce problem behaviors. School-based programs can also help to stop bullying and improve relationships among teens.

Parent-management training programs are also important. These programs teach parents how to manage their child’s behavior. Parents learn positive reinforcement methods, and also how to discipline their child.Oppositional Defiant Disorder (ODD) Essay

How can I help my child live with ODD?
Early treatment for your child can often prevent future problems. Here are things you can do to help:

Keep all appointments with your child’s healthcare provider.

Take part in family therapy as needed.

Talk with your child’s healthcare provider about other providers who will be included in your child’s care. Your child may get care from a team that may include counselors, therapists, social workers, psychologists, school psychologists, school counselors, and psychiatrists. Your child’s care team will depend on his or her needs and how serious the disorder is.

Tell others about your child’s conduct disorder. Work with your child’s healthcare provider and school to create a treatment plan.

If ODD greatly interferes with your child’s ability to succeed in school, he or she may be eligible for certain protections and reasonable accommodations under the Americans with Disabilities Act (ADA) or Section 504 of the Civil Rights Act. Talk with your your child’s teacher and school principal about how to get more information.

Reach out for support. Being in touch with other parents who have a child with ODD may be helpful. If you feel overwhelmed or stressed out, talk with your child’s healthcare provider. He or she may direct you to a support group for caregivers of children with ODD.Oppositional Defiant Disorder (ODD) Essay

When should I call my child’s healthcare provider?
Call your child’s healthcare provider right away if your child:

Feels extreme depression, fear, anxiety, or anger toward him or herself or others

Feels out of control

Hears voices that others don’t hear

Sees things that others don’t see

Can’t sleep or eat for 3 days in a row

Shows behavior that concerns friends, family, or teachers, and others express concern about this behavior and ask you to seek help

Call 911 if your child has suicidal thoughts, a suicide plan, and the means to carry out the plan.

Key points about ODD in children
Oppositional defiant disorder (ODD) is a type of behavior disorder. Children with ODD are uncooperative, defiant, and hostile toward peers, parents, teachers, and other authority figures.

Developmental problems may cause ODD. Or the behaviors may be learned.

A child with ODD may argue a lot with adults or refuse to do what they ask. He or she may also be unkind to others.Oppositional Defiant Disorder (ODD) Essay

A mental health expert often diagnoses ODD.

Therapy that helps the child get along better with others is the main treatment. Medicines may be needed for other problems, such as ADHD.

Next steps
Tips to help you get the most from a visit to your child’s healthcare provider:

Know the reason for the visit and what you want to happen.

Before your visit, write down questions you want answered.

At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.

Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.

Ask if your child’s condition can be treated in other ways.

Know why a test or procedure is recommended and what the results could mean.

Know what to expect if your child does not take the medicine or have the test or procedure.

If your child has a follow-up appointment, write down the date, time, and purpose for that visit.

Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.

Oppositional defiant disorder (ODD) is a childhood behavioural problem characterised by constant disobedience and hostility. Around one in 10 children under the age of 12 years are thought to have ODD, with boys outnumbering girls by two to one.Oppositional Defiant Disorder (ODD) Essay

ODD is one of a group of behavioural disorders known collectively as disruptive behaviour disorders, which include conduct disorder (CD) and attention deficit hyperactivity disorder (ADHD).

Early intervention and treatment is important, since children with untreated ODD may continue to be difficult and antisocial into their adult years. This can impact on their relationships, career prospects and quality of life. Some children with ODD will develop the more serious conduct disorder (CD), which is characterised by aggressive law-breaking and violent behaviours.
Characteristics of ODD
ODD behaviours usually surface when the child is at primary school, but the disorder can be found in children as young as three years of age.

A child with ODD may:
Become easily angered, annoyed or irritated
Have frequent temper tantrums
Argue frequently with adults, particularly the most familiar adults in their lives such as parents
Refuse to obey rules
Seem to deliberately try to annoy or aggravate others
Have low self-esteem
Have a low frustration threshold
Seek to blame others for any accidents or bad behaviour.
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Link to conduct disorder
Without intervention and treatment, some children with ODD progress to develop conduct disorder (CD), which is characterised by aggressive and delinquent behaviours including:Oppositional Defiant Disorder (ODD) Essay
Being sadistic or cruel to animals and people
Physically or sexually abusing others
Law-breaking behaviours such as deliberately lighting fires, vandalism or stealing.
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Family life and ODD
The cause of disruptive behaviour disorders is unknown, but the quality of the child’s family life seems to be an important factor in the development of ODD. Some studies have found that certain environmental factors in the family increase the risk of disruptive behaviour disorders. These include:
Poor parenting skills (inadequate supervision, harsh or inconsistent discipline, rejection)
Marital conflict
Domestic violence
Physical abuse
Sexual abuse
Substance misuse by parents or carers.
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Diagnosis of ODD
ODD is professionally diagnosed by a child psychologist, child psychiatrist or paediatrician specialising in behavioural disorders. Diagnosis involves detailed interviews with the child (if they are old enough), parents and teachers, and comparing the child’s behaviour with the checklist for ODD contained in the Diagnostic and Statistical Manual of Mental Disorders from the American Psychiatric Association.Oppositional Defiant Disorder (ODD) Essay
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Treatment of ODD
Treatment options for ODD may include:
Parental training – to help the parents better manage and interact with their child, including behavioural techniques that reinforce good behaviour and discourage bad behaviour. This is the primary form of treatment and the most effective. Social support is increased if the parents are trained in groups with other parents who have children with ODD
Functional family therapy – to teach all family members to communicate and problem-solve more effectively
Consistency of care – all carers of the child (including parents, grandparents, teachers, child care workers and so on) need to be consistent in the way they behave towards and manage the child.

Oppositional defiant disorder (ODD) is described in the
Diagnostic and Statistical Manual of Mental Disorders – 4th
edition (DSM-IV) and the International Classification of
Mental and Behavioural Disorders (ICD-10) as a ‘repetitive
and persistent pattern of opposition, defiant, disobedient and
disruptive behaviours towards authority figures persisting
for at least 6 months’.1,2 Oppositional defiant disorder does
not include the more aggressive aspects of conduct disorder
(CD) which is directed toward people, animals and property.1
Oppositional defiant disorder has a high co-occurrence with
attention deficit hyperactivity disorder (ADHD) and many
children with ODD go on to be diagnosed with CD. This
means that families are under high levels of stress, dealing
with several difficult behaviours.
Does this child have ODD?
Characteristics of ODD as described in the DSM-IV include:
• persistent stubbornness and refusal to comply with instructions or
unwillingness to compromise with adults or peers
• deliberate and persistent testing of the limits
• failing to accept responsibility for one’s own actions and blaming
others for one’s own mistakes
• deliberately annoying others
• frequently losing one’s temper.
It can be difficult to determine if a child qualifies for a diagnosis
of ODD as many of the behaviours required to meet this diagnosis
are not uncommon in the preschool child or adolescent. However,
if the child’s behaviours are consistently presented by the parent
as causing distress to the family system and are impacting on the
child’s social and educational functioning then further evaluation
is warranted.Oppositional Defiant Disorder (ODD) Essay
A preschool aged child will usually behave in this way at home
and with people they know well. Oppositional behaviours may not
be evident in other settings or during the medical examination, thus
Oppositional defiant disorder (ODD) is defined as a repetitive
and persistent pattern of opposition, defiant, disobedient and
disruptive behaviours toward authority figures persisting for at
least 6 months.
This article reviews the nature of ODD, its relationship to
attention deficit hyperactivity disorder and conduct disorder,
and considers the management options available to general
Many of the behaviours required to meet this diagnosis are
not uncommon in the preschool child or adolescent. However,
in children with ODD the behaviours are persistent, cause
significant distress to the family system, and impact on the
child’s social and educational functioning. Oppositional defiant
disorder usually presents in the preschool years, although it may
become evident during adolescence. There is strong evidence
that early intervention to increase positive factors in family
relationships and to increase both the parents’ and child’s skill
levels can assist in the prevention of more serious disorders and
mental health issues.Oppositional Defiant Disorder (ODD) Essay
Oppositional defiant
402 Reprinted from Australian Family Physician Vol. 37, No. 4, April 2008
making the practitioner reliant on reports from family members. As
the child develops and becomes involved in other environmental
settings such as school, adverse experiences with peers, teachers
or academic challenges can result in the child’s oppositional
behaviours becoming evident in that setting.3
Case study
Sandy brings her son Matt, 6 years of age, to the general
practitioner. Sandy says that she cannot manage his
behaviour at home and that the teacher has said that
he will not follow instructions in the classroom and is
bullying his friends at lunch time. The GP asks what
the boy was like as a baby and toddler. He learns that
Matt would cry easily and that it took Sandy a long
time to settle him. As a toddler if Sandy tried to remove
something he wanted, Matt would throw tantrums lasting
for at least half an hour. As he got older, Matt would often
kick his mother and refuse to do what she asked. Now he
argues with her every day, even about small things. He
fights daily with his 8 year old sister, Amy, and always
blames her when things get damaged.
Sandy reports that she felt inadequate as a parent and
became depressed when Matt was about 18 months of age.
Further questioning about the home situation determined
that Matt’s father, Barry, often loses his temper and shouts
at his wife and children. The family is experiencing financial
difficulties and Barry is often out of work.Oppositional Defiant Disorder (ODD) Essay
Matt’s teacher considers that Matt is able to do his
schoolwork but is stubborn and refuses to join in tasks with
the other children. He gets out of his seat regularly and
walks around the room. He will often flick the other children
on the arms and take away their pencils. He has difficulty
making friends as he always wants them to play his games
and will yell at them if they do not do what he wants.
When the GP asks Matt about school and home, Matt
tells him that he hasn’t done anything wrong and that
everyone picks on him and that he gets blamed for
everything. It’s Matt’s view that everyone wants him to
behave better and that they should just leave him alone.
In this case Matt meets the criteria for a diagnosis of
ODD. He has a history of a difficult temperament, has
been hostile toward his mother since he was a toddler,
and has had difficulties since entering the preschool
system meeting the teacher’s expectations for behaviour
and making friends.

Based on international research, Sanders, Gooley and Nicholson
reported that the prevalence of ODD in nonclinical samples ranges
from 6–10%.4
Similarly Angold and Costello concluded from a review
of prevalence rates that CD/ODD in the western world is a ‘gigantic
public health problem’ with 5–10% of children aged 8–16 years
having notable behavioural problems.5
The problem is also significant
in Australia with Al-Yaman, Bryant and Sargeant reporting that in
1999–2000 for children aged 1–14 years, ODD occurred among the
most frequent specific diagnoses accounting for hospitalisation
for mental health problems and behavioural disorders.Oppositional Defiant Disorder (ODD) Essay
The most
frequent diagnoses were activity and attention disorders (17%),
oppositional defiant disorder (16%) and anorexia nervosa (6%).
Oppositional symptoms are more common in preschool boys
than girls, with the behaviours in girls becoming more evident after
puberty. The onset of ODD is usually gradual and becomes evident
before 8 years of age and no later than early adolescence.1,4
Children with early onset ODD and CD are at an increased risk
of abuse by their parents and school drop out, and may go on to
commit serious crimes or have long term involvement in the mental
health system.3,7
Barkley et al reported that 65% of children diagnosed with ADHD
have a co-occurring diagnosis of ODD.8
Practitioners may experience
difficulty in determining which features of a child’s presentation are
due to ODD or aspects of ADHD. For example, the child’s apparent
failure to respond to parental directions may be due to oppositional
behaviour but could also be due to a lack of concentration because
of ADHD symptoms. Learning disorders and communication disorders
are also common in children with ODD1,3 and may result in the child
appearing to be oppositional when in fact they simply do not have
the cognitive abilities to understand the adult’s instructions.
Research has shown that early onset of ODD is a strong predictor
of the development of CD, making early intervention desirable.
Sanders et al reported that 20–60% of children with ODD have a
co-occurring diagnosis of CD.Oppositional Defiant Disorder (ODD) Essay
What causes ODD?
There is no single factor indicated by the research evidence as
the cause of ODD. It appears that a cluster of factors in the child’s
characteristics, parental interactions, and environmental factors
contribute to its development.3,4
Developmental factors include:
• a history of the child having a difficult temperament
• being difficult to soothe as a baby
• having high motor activity, and
• a propensity toward extreme emotional reactions.
If there have been periods of different care givers, a history of harsh
and inconsistent or neglectful parenting, the child may also develop
ODD traits. Oppositional defiant disorder appears to be more common
when there is serious conflict between the parents and the presence
of a history in one or both parents of mental health problems such as
depression, ADHD, ODD or antisocial personality disorder.
Two pathways to the development of ODD are summarised by
Sanders et al and Webster-Stratton and Reid.3,4 These are:
• the early onset pathway in which the behaviours develop before
preschool and may continue into adolescence. These children may
display a greater range of oppositional behaviours across a range
of settings. Without intervention the outlook for many of these
children is not good and they may develop conduct problems in
adolescence or an antisocial personality disorder in adulthood
Reprinted from Australian Family Physician Vol. 37, No. 5, May 2008 403
theme Oppositional defiant disorder  Oppositional Defiant Disorder (ODD) Essay
until the child and the systems around him develop the skills to
cope with the oppositional behaviours.
If there is a comorbid diagnosis of ADHD, the use of stimulant
medication to treat these symptoms may show some improvement
in ODD symptoms.4,11,12 Improvements in overall behaviour have also
been seen in short term controlled trials of atomoxetine (Strattera) and
clonidine (Catapress) in children with ODD and ADHD. The long term
efficacy and side effects of these medications in the management
of ODD has not been assessed. The complexity of comorbidities and
the need for thorough assessment generally require multidisciplinary
management and there is no indication for pharmacological
intervention on its own. The most important treatment strategy is to
assist families with psychosocial interventions to deal with the many
behavioural challenges from their child.
The characteristics and behaviours that define ODD causes stress
on the family and the school system in which the child is involved.
Oppositional defiant disorder usually presents in the preschool
years, although it may become evident during adolescence. There is
strong evidence that early intervention to increase positive factors
in family relationships and to increase both the parents’ and child’s
skill levels can assist in the prevention of more serious disorders
and mental health issues. The GP can assist the family to deal with
these issues by being empathic to their concerns and by directing
them to parenting and family counselling services. Oppositional Defiant Disorder (ODD) Essay