Oppositional Defiant Disorder (ODD): Symptoms, Causes, Risks, Complications, Diagnosis, Treatment and Prevention

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1Overview

Raising children is a daunting task as you need to teach them proper manners, what is right from wrong and how to treat other people. Even the best-behaved kids can be hard to deal with sometimes.

In fact, it is normal for kids, especially those in their ‘terrible twos’ or during their adolescence, to defy rules and people in authority once in a while. However, when your child has persistent anger outbursts, argue with you all the time, irritability and defiance regarding rules at home or school, and these last for more than six months, he or she may have a condition called oppositional defiant disorder (ODD).

Many children and teenagers who have ODD may have other behavioral problems including learning disabilities, mood disorders like depression, anxiety disorders and attention deficit hyperactivity disorder (ADHD). Some kids who are diagnosed with ODD may develop conduct disorder, a more serious behavioral problem.

ODD usually starts before the age of 8 years old but no later than 12 years old. According to doctors, ODD is a pattern wherein the child becomes hostile, disobedient and defiant toward authority figures such as parents, teachers and other officials in school. Those with ODD often rebel, argue with adults, don’t want to obey rules and they become stubborn. Often, they have outbursts of anger and may have a difficult time controlling their temper.

According to statistics, there is a prevalence of about 2 to 16 percent of oppositional defiant disorder in the general population. Meanwhile, approximately 50 to 65 percent of kids with ODD have an accompanying diagnosis of ADHD. Moreover, 15 percent of cases with ODD have a personality disorder, 20 percent with ODD have mood disorders, and 35 percent of kids with ODD develop some form of the affective disorder.

In 52 percent of ODD cases, if the ODD is not treated, the children may develop conduct disorder.

2Symptoms

Some children may become defiant once in a while, but it’s difficult to tell the difference between an emotional child or a strong-willed kid and a child with oppositional defiant disorder (ODD). The signs of ODD may begin as early as preschool years and in some children, the signs may manifest later, but would always appear before they reach adolescence.

The most common behaviors seen in children and teens with ODD include:

  • Defiance
  • Negativity
  • Spitefulness
  • Hostility
  • Verbal aggression

However, the American Psychiatric Association has released the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) for diagnosing ODD.

ODD symptoms include both behavioral and emotional symptoms such as:

Angry and irritable mood:

  • Often angry and resentful
  • Often touchy or easily annoyed
  • Often loses temper

Vindictiveness:

  • Spiteful or vindictive
  • Has shown vindictive behavior at least twice in the past six months

Argumentative and defiant behavior:

  • Often deliberately annoys other people
  • Often blames others for his mistakes
  • Often argues with adults or other people in authority
  • Often defies or refuses to comply with the requests or rules of adults

The severity of ODD symptoms:

Mild – The symptoms happen in one setting. For instance, it happens only at home, school or work.

Moderate – The symptoms occur in at least two settings.

Severe – Some symptoms happen in three or more settings.

3Causes

The exact cause of Oppositional Defiant Disorder is still unclear, but there are contributing causes for the development of this behavioral problem.

Biological Factors

  • Age could influence the development of ODD as children and adolescents are prone to have ODD.
  • A parent with a history of ADHD, ODD or Conduct disorder
  • A parent with a mood disorder like bipolar disorder and depression
  • Brain chemicals or neurotransmitter imbalance
  • Impairment in the part of the brain responsible for impulse, judgment, and reasoning
  • A mother who smoked tobacco during pregnancy
  • Poor nutrition
  • Exposure to some chemicals or toxins
  • A parent who has a substance abuse

Social Factors

  • Poverty
  • Abuse
  • Neglect
  • Lack of supervision
  • Inconsistent discipline
  • Family instability
  • Divorce of parents
  • Frequent moves
  • Chaotic environment

Psychological Factors

  • Absent parent
  • Neglectful parent
  • Inability to form social relationships
  • Poor relationship with one or more parent

4Risk Factors

Some risk factors of ODD may increase the likelihood of a child to develop this behavioral problem.

Problems with parenting

The parents are supposed to guide their children to the right path, able to distinguish right from wrong. However, a child who experiences neglect or abuse, lack of guidance from the parents and inconsistent discipline is prone to developing ODD.

Temperament

When a child or teenager has a temperament that makes him hard up in regulating his emotions, he may develop ODD.

Other problems in the family

A child who lives with a parent or relative with a mental health problem or substance abuse.

5Complications

The long-term consequences of ODD that has not been treated can lead to various problems in a child’s life. The complications and effects vary depending on the severity of symptoms, the presence of co-occurring problems, genetic makeup, risk factors, and usage of drugs or alcohol.

The most common complications may include:

  • Poor interpersonal relationships
  • Poor work and school performance
  • Inability to hold a job
  • Antisocial behavior
  • Suicide
  • Substance use disorder
  • Impulse control problems
  • Delinquency
  • Antisocial personality disorder
  • Self-harm
  • Conduct disorder

Many children with ODD have other co-occurring conditions such as:

6Diagnosis

There is no single test to diagnose ODD but a mental health practitioner can determine if a child or teenager has the disorder through assessing the symptoms and behaviors of the child.

During the assessment, the child’s primary care clinician will look for other mental health issues and physical diseases that may cause problems. However, when there are no physical problems, the doctor may refer the child or teen to a qualified medical health professional.

Usually, the parents are needed when a child goes to a mental health specialist. This is because some of the questions the doctor may ask are directed to you.

Some of the topics asked during the consultation include:

  • The perception of the parents on the cause of ODD in their child
  • Other possible causes
  • Is the condition temporary or long lasting?
  • Factors that might contribute to the problem

The mental health professional will use the DSM-5 criteria to diagnose ODD. The patient should show a pattern of behavior that:

  • Includes at least four of the symptoms stated above
  • Happens in one person who is not a sibling
  • Causes problems in school and work
  • Happens on its own, not a part of another mental health problem
  • Lasts at least six months

Aside from these, the doctor will also check for the following:

  • The child or teenager’s overall health
  • Intensity and how often the behaviors happen
  • The child’s behavior across various settings and relationships
  • The presence of other mental health issues, learning disorders and communication problems

7Treatment

The treatment for ODD is based on various factors like the age of the child, the severity of the symptoms and the ability of the child or teenager to participate in therapies.

Medications alone are not used unless there’s another mental disorder that co-occurs with ODD. Usually, the treatment of ODD involves the combination of two or more treatment options.

Parent Training

Parent training is done to help parents manage and interact with their kids. The program involves the incorporation of behavioral techniques to reinforce good and acceptable behavior in children. Also, this technique will help break the bad habits and behaviors.

Functional Family Therapy

This method is to help teach family members to communicate with each other more effectively and to solve problems efficiently.

Consistency of Care

This method means that all caregivers, including the parents, grandparents, child care workers and teachers need to be consistent regarding their behavior towards the child’s actions.

Cognitive Problem-solving Training

This type of therapy aims to help your kid identify thought patterns that lead to the problems in behaviors. As a result, he or she can change these thought patterns for a better outlook in life.

8Prevention

Even though it is not possible to prevent ODD, especially for children who are susceptible to developing the condition, it may be important to recognize the early symptoms and act on them to reduce the distress to the child and his or her family.

Consequently, there are ways to begin changing problem behaviors of children with ODD through strategies like:

  • Praise the positive behaviors of the child. Be sure to recognize the behavior and tell your child about it.
  • One of the effective ways to help manage the condition is to model the behavior you want your child to practice.
  • Enforce reasonable consequences for every action.
  • Spend quality time with your child and build in time together.
  • Set up a routine by developing a schedule for the child.

9Conduct Disorder vs. Oppositional Defiant Disorder

Put simply; conduct disorder is a complication of an untreated oppositional defiant disorder. In children, ODD is a condition wherein they defy rules and policies of people in authority, like their parents or teachers.

However, when it becomes conduct disorder, this entails a child seriously misbehaving with aggressiveness behaviors toward other people, property, and even animals. They can harm other people and animals too. The negative behaviors of people with conduct disorder include becoming destructive, threatening, deceitful, disobedient, and physically cruel.