How do you diagnose Oppositional Defiant Disorder?

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A psychologist diagnostic a man with Oppositional Defiant Disorder

Introduction

Oppositional Defiant Disorder (ODD) is a persistent and recurring pattern of defiance, anger, disobedience, irritability, arguing, hostility, vindictiveness, or negativity toward the parents or other persons of authority which can affect the child’s normal functioning and day to day activities whether at home, in school, or in other settings.

It can be quite challenging to differentiate a defiant, emotional, or strong-willed child with a child with ODD. The exhibiting of the oppositional behavior of kids from time to time is normal in certain stages of his/her development. Even the most behaved children can be quite difficult and challenge at times. All kids act up from time to time to cope up with situations such as when they are tired, hungry, frustrated, or upset. When the child’s behavior becomes more frequent and consistent, it stands out compared to other kids of his/her age or with the same developmental level, and it’s already affecting your child’s functioning, your child most likely has a more serious problem and it needs to be diagnosed and treated immediately.

symptoms

To be able to diagnose Oppositional Defiant Disorder, it is important to know the signs of symptoms of the disorder. The signs and symptoms of ODD normally begin during a child’s preschool years or before he/she turns 8. ODD may develop at a later age at times but almost always occurs during adolescence. These behaviors may cause compelling damage to the family, school, work, and social activities. The following are the different symptoms of ODD:

Cognitive Symptoms

  • Difficulty in concentrating
  • Frequently frustrated
  • Failure to think before speaking

Behavioral symptoms

  • Frequent outbursts or throwing repeated tantrums
  • Refusing to follow rules
  • Blatantly disobedient
  • Easily loses his/her temper
  • Arguing all the time
  • Unwilling to compromise or negotiate
  • Ignoring requests
  • fighting
  • Deliberately annoying others
  • Chronic aggression
  • Blatant hostility towards other people
  • Blaming others for his/her errors or mistakes
  • Being spiteful and seeking revenge
  • Willingly destroying friendships

Psychosocial symptoms

  • Consistent feeling of annoyance
  • Persistent negativity
  • Difficulty in making friends and in playing with other kids
  • Loss of self-esteem

The American Psychiatric Association has published the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) which lists the criteria for diagnosing ODD. Mental health providers use the manual to diagnose mental disorders and the insurance companies use it for the reimbursement of treatment.

According to DSM-5’s criteria for diagnosing ODD, an individual with ODD shows a pattern of behavior that:

  • Causes significant and quite disturbing problems at home, in school or at work
  • Occurs with at least another individual other than a sibling. It can be a parent, a teacher, a classmate, or anyone else.
  • Lasts for at least six months or more
  • Occurs on its own instead of being a part of another mental health disorder or condition such as bipolar disorder, substance use disorder or depression
  • Includes at least 4 symptoms based on the categories listed in the manual: irritable and angry mood, vindictiveness, and defiant and argumentative behavior

Irritable and angry mood:

  • Often loses temper
  • Often resentful and angry
  • Often touchy and easily annoyed by others

Defiant and argumentative behavior:

  • Often argues with parents, other adults, or people in authority
  • Often refuses to comply with or defies rules, requests, or directions from adults or other people in authority
  • Often blames other people for his/her mistakes, errors, or misbehavior
  • Often deliberately annoys people

Vindictiveness:

  • Often vindictive or spiteful
  • Has shown vindictive or spiteful behavior at least twice in the past 6 months

Both behavioral and emotional symptoms are included in DSM-5’s criteria for diagnosing of ODD.

To be able to diagnose an individual with ODD, the behaviors should be displayed more often than what is normal or usual in other children of the same age or level of development. For kids who are younger than 5 years, the behavior needs to occur on most days for a period of 6 months or more. For kids who are more than 5 years of age, the behavior needs to occur at least once a week for 6 months or more.

To determine if your child has Oppositional Defiant Disorder (ODD), a comprehensive psychological evaluation can be performed by the mental health provider. The evaluation includes the assessment of:

  • Your child’s overall health
  • The intensity and frequency of your child’s misbehavior
  • Your child’s behavior across multiple relationships and settings
  • The presence of other disorders that may coexist with ODD

ODD often occurs with other mental health or behavioral problems such as ADHD, learning disabilities, anxiety disorders, language disorders, intellectual developmental disorder, intermittent explosive disorder, and mood disorders like bipolar disorder and depression. It may be quite difficult to differentiate the symptoms of ODD from that of other disorders especially for those overlapping symptoms like for example ADHD and ODD. About 40% of children with ADHD develop ODD. It is important to diagnose and treat the coexisting conditions because they can either create or make ODD symptoms worse if left untreated.