Oppositional Defiant Disorder
What is oppositional defiant disorder (ODD)?Oppositional defiant disorder (ODD) is a behavior disorder,
usually diagnosed in childhood, that is characterized by uncooperative,
defiant, negativistic, irritable, and annoying behaviors toward parents,
peers, teachers, and other authority figures. Children and adolescents
with ODD are more distressing or troubling to others than they are
distressed or troubled themselves.
What causes oppositional defiant disorder?
While the cause of ODD is not known, there are two primary theories
offered to explain the development of ODD. A developmental theory suggests
that the problems begin when children are toddlers. Children and
adolescents who develop ODD may have had a difficult time learning to
separate and become autonomous from the primary person to whom they were
emotionally attached. The "bad attitudes" characteristic of ODD are viewed
as a continuation of the normal developmental issues that were not
adequately resolved during the toddler years. Learning theory suggests,
however, that the negativistic characteristics of ODD are learned
attitudes, reflecting the effects of negative reinforcement techniques
used by parents and authority figures. The use of negative reinforcement
by parents is viewed as increasing the rate and intensity of oppositional
behaviors in the adolescent as it achieves the desired attention, time,
concern, and interaction with parents or authority figures.
Who is affected by oppositional defiant disorder?Behavior disorders, as a category, are, by far, the most common
reason for referrals to mental health services for children and
adolescents. Oppositional defiant disorder is reported to affect between 2
and 16 percent of children and adolescents in the general population. ODD
is more common in boys than in girls.
What are the symptoms of oppositional defiant
disorder?Most symptoms seen in children and adolescents with
oppositional defiant disorder also occur at times in children without this
disorder, especially around the ages or 2 or 3, or during the teenage
years. Many children, especially when they are tired, hungry, or upset,
tend to disobey, argue with parents, or defy authority. However, in
children and adolescents with oppositional defiant disorder, these
symptoms occur more frequently and interfere with learning, school
adjustment, and, sometimes, with the adolescent's relationships with
others.
Symptoms of oppositional defiant disorder may include:
- frequent temper tantrums
- excessive arguments with adults
- refusal to comply with adult requests
- always questioning rules; refusal to follow rules
- behavior intended to annoy or upset others, including adults
- blaming others for his/her misbehaviors or mistakes
- easily annoyed by others
- frequently has an angry attitude
- speaking harshly, or unkindly
- seeking revenge
The symptoms of ODD may resemble other medical conditions or behavior
problems. Always consult your adolescent's physician for a diagnosis.
How is oppositional defiant disorder diagnosed?Parents, teachers, and other authority figures in child and
adolescent settings often identify the child or adolescent with ODD.
However, a child psychiatrist or a qualified mental health professional
usually diagnoses ODD in children and adolescents. A detailed history of
the adolescent's behavior from parents and teachers, clinical observations
of the adolescent's behavior, and, sometimes, psychological testing
contribute to the diagnosis. Parents who note symptoms of ODD in their
child or teen can help by seeking an evaluation and treatment early. Early
treatment can often prevent future problems.
Further, oppositional defiant disorder often coexists with other mental
health disorders, including mood disorders, anxiety disorders, conduct
disorder, and attention-deficit/hyperactivity disorder, increasing the
need for early diagnosis and treatment. Consult your adolescent's
physician for more information.
Treatment for oppositional defiant disorder:Specific treatment for adolescents with oppositional defiant
disorder will be determined by your adolescent's physician based on:
- your adolescent's age, overall health, and medical history
- extent of your adolescent's symptoms
- your adolescent's tolerance for specific medications or therapies
- expectations for the course of the condition
- your opinion or preference
Treatment may include:
- individual psychotherapy
Individual psychotherapy for ODD often uses cognitive-behavioral
approaches to improve problem solving skills, communication skills,
impulse control, and anger management skills.
- family therapy
Family therapy is often focused on making changes within the family
system, such as improving communication skills and family interactions.
Parenting adolescents with ODD can be very difficult and trying for
parents. Parents need support and understanding as well as help in
developing more effective parenting approaches.
- peer group therapy
Peer group therapy is often focused on developing social skills and
interpersonal skills.
- medication
While not considered effective in treating ODD, medication may be
used if other symptoms or disorders are present and responsive to
medication.
Prevention of oppositional defiant disorder in
adolescents:
Some experts believe that a developmental sequence of experiences
occurs in the development of oppositional defiant disorder. This
sequence may start with ineffective parenting practices, followed
by difficulty with other authority figures and poor peer interactions.
As these experiences compound and continue, oppositional and defiant
behaviors develop into a pattern of behavior. Early detection and
intervention into negative family and social experiences may be
helpful in disrupting the sequence of experiences leading to more
oppositional and defiant behaviors. Early detection and intervention
with more effective communication skills, parenting skills, conflict
resolution skills, and anger management skills can disrupt the pattern
of negative behaviors and decrease the interference of oppositional
and defiant behaviors in interpersonal relationships with adults
and peers, and school and social adjustment. The goal of early intervention
is to enhance the adolescent's normal growth and development, and
improve the quality of life experienced by children or adolescents
with oppositional defiant disorder.
More information:
Schneider Children's Hospital Adolescent
Medicine Division
To find a Schneider Children's Hospital physician click
here.
Important: This information is not intended
to substitute or replace the professional medical advice you receive
from your child's physician. The content provided on this page is
for informational purposes only, and was not designed to diagnose
or treat a health problem or disease. Please consult your child's
physician with any questions or concerns you may have regarding
a medical condition.
Click here to view the
Online Resources page of this Web. |