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Title: Oppositional Defiant Disorder
Author: Anthony Kane, MD
Website: http://addadhdadvances.com
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Oppositional Defiant Disorder
by Anthony Kane, MD
Introduction
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.
Oppositional defiant disorder is sometimes a precursor of conduct
disorder. Much of the literature tends to lump these two
conditions together. However, they seem to be distinct entities
and, although conduct disorder does have a genetic component, ODD
does not.
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 can incite parents and other
family members to fight with one and other rather than focus on
the child, who is the source of the problem.
Behavioral Symptoms
Common behaviors seen in oppositional defiant disorder include:
Losing one’s temper
Arguing with adults
Actively defying requests
Refusing to follow rules
Deliberately annoying other people
Blaming others for one's own mistakes or misbehavior
Being touchy, easily annoyed
Being easily angered, resentful, spiteful, or vindictive.
Speaking harshly, or unkind when upset
Seeking revenge
Having frequent temper tantrums
Many parents report that their ODD children were rigid and
demanding from an early age.
Normal children, especially around the ages or 2 or 3 or during
the teenage years display most of these behaviors from time to
time. When children are tired, hungry, or upset, they may be
defiant. However, children with oppositional defiant disorder
display these behaviors more frequently and to the extent that
they and interfere with learning, school adjustment, and,
sometimes, with the child's social relationships.
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. The child
must be evaluated for other disorders as well since ODD usually
does not come alone. If the child has ADHD, mood disorders, or
anxiety disorders, these other problems must be addressed before
you can begin to work with the ODD.
If you feel your child may have ODD, there is a quick screening
test. Go to:
http://addadhdadvances.com/ODDtest.html
Causes
What is the cause of ODD? The real answer is that nobody knows.
However, since as scientist we hate to admit this, we have
currently two theories.
The developmental theory proposes that ODD is really a result
of incomplete child development. For some reason, these
children never complete the developmental tasks that normal
children learn to master during the toddler years.
The learning theory suggests that ODD comes as a response to
negative interactions. The techniques used by parents and
authority figures on these children bring about the oppositional
defiant behavior.
ODD is the most common psychiatric diagnosis in children and it
usually persists into adulthood. One would think a lot of
research would be done on this condition. That is not the case.
While there are hundreds of research studies on ADHD and
childhood mood disorders, there is very little research on ODD.
Co-morbidity
ODD is frequently goes along with other disorders. 50-65% of
ODD children also have ADHD. 35% of these children develop some
form of affective disorder. 20% have some form of mood disorder,
such as depression or anxiety. 15% develop some form of
personality disorder. These children frequently have learning
disorders and academic difficulties.
If your child has ODD it is important to know there are other
co-existing problems. These other problems usually must be
addressed before you can begin to help your child with ODD.
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
Most of these children have some other disorder along with their
ODD. Treating this other disorder is the key to proper ODD
management. This frequently means giving medication. Although
this type of medical intervention does not make the children
"normal", it can make a big difference. It often allows other
non-medical interventions to work much better.
For example, if a child has both ODD and ADHD, then giving the
child Ritalin may have a significant effect on his ODD, also.
This positive effect does not seem to be related to the severity
of the ADHD. That means even if the child has mild ADHD and
could do without Ritalin, if he is treated medically, you might
see an improvement in his ODD.
Once the other problems are under control, the best treatment
for ODD is parent training. In a study published in 1998,
eighty-two research studies were evaluated were examined for
efficacy. Approaches focusing on parent training were the most
affective techniques.
The main point is that some parent-training program is essential
in addressing ODD. This is not going to work for everyone, but
it is the best treatment that we have available for ODD.
Advice to Parents
That is with regard to your child. If your child has ODD you
need to take care of yourself, also. No child needs a martyr as
a parent.
Here are some of the things you can do:
· Maintain interests other than your child with ODD.
You have to be a person.
· Try to work with and obtain support from the other
adults (teachers, coaches, and spouse) dealing with your child.
· Take time to work on your relationship with your spouse.
Raising these children is very difficult and can put a strain
on the best of marriages.
· Manage your own stress with exercise and relaxation.
· Take frequent vacations. This is a must.
Conclusion
It is tough to live with children who have ODD. What is worse
is that there does not seem to be any cure. However, if you
make sure that your child has his other problems addressed and
you improve your parenting skills by enrolling in a parent
training program, you can do a great deal to improve your
child’s condition and your own.
Good luck-
Anthony Kane, MD
ADD ADHD Advances
http://addadhdadvances.com
================================================================
Anthony Kane, MD is a physician, an international lecturer, and
director of special education. He is the author of a book,
numerous articles, and a number of online programs dealing with
ADHD treatment (http://addadhdadvances.com/childyoulove.html),
parenting issues (http://addadhdadvances.com/betterbehavior.html),
ODD, and education.
Visit his website at http://addadhdadvances.com.
Sign up for the free ADD ADHD Advances online journal. Send
an email to: subscribe@addadhdadvances.com?subject=subscribeart
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