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 another.
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:
-Losing his 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.
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
screening test. Go to: ODD Screening Test
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 that Oppositional Defiant
Disorder comes as a response to negative interactions. The
techniques used by parents and authority figures with these
children bring about the oppositional defiant behavior.
Co-morbidity
Oppositional Defiant Disorder usually does not occur alone.
50-65% of ODD children also have ADD ADHD 35% of these
children develop some form of affective disorder 20% have
some form of mood disorder, such as Bipolar Disorder or
anxiety 15% develop some form of personality disorder 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.
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.
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.
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.
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. 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 is still viewed as the main
treatment for Oppositional Defiant Disorder. Our program,
How to Improve Your Child's Behavior which is available
online, or some other parent training program is still
considered essential if you want to help your child. Also,
the younger your child is when you enroll in such a
program, the better the results.
Conclusion: Advice to Parents
Currently, there is still far too little research on this
very common disorder.
Medically, the most important consideration is to treat
other disorders that come along with ODD. Considering that
Ritalin may help alleviate the problem in 75-90% of ODD
children who have ADHD, and considering that most children
with ODD also have some degree of ADHD, I feel that it is
very worth your while to try your ODD child on Ritalin
unless you know for sure that he does not have ADHD. The
other treatments may also be worth a try depending upon the
nature of your child.
I feel that using Omega-3 supplements and a vitamin E
supplement should be tried in all children. This is because
most children are deficient in these nutrients. Even if it
does not help with the ODD, it should make your child
healthier.
Parent training is still the most effective means of
dealing with Oppositional Defiant Disorder. The two main
drawbacks of most of these programs are the expense and the
availability.
Some practitioners charge $100 or more per visit and
considering the program will take several months costs add
up. Insurance usually will not pay for such programs. Many
parents complain to me that they can not afford the program
that their child so desperately needs.
In addition, these programs are not available everywhere.
Over the years, numerous parents have told me that where
they live there are no programs for Oppositional Defiant
Children.
I created How to Improve Your Child's Behavior to address
these two problems. It allows parents to help their
children regardless of where they live and at a cost that
is less than one office visit.
Even though it was an experiment to try to administer such
a program online and to date no one else is doing this,
over the past two years How to Improve Your Child's
Behavior has proven time and again to help parents gain
control of their defiant children.
It is tough to live with children who have ODD. 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 his future.
Anthony Kane, MD ADD ADHD Advances
----------------------------------------------------
Anthony Kane, MD has been helping parents of ADHD and
Oppositional Defiant Disorder children online since 2003.
Get help for your Oppositional Defiant Disorder child. Go
to http://addadhdadvances.com/betterbehavior.html to learn
about How to Improve Your Child's Behavior. Get help with
defiant teens at http://addadhdadvances.com/ntpcentral.html
and ADHD treatment and ADHD information at
http://addadhdadvances.com/childyoulove.html .