Oppositional Defiant Disorder
 

What is oppositional defiant disorder (ODD)? 

(ODD) is a type of behavior disorders, mostly diagnosed in childhood. 

Children with ODD are uncooperative, defiant, and hostile toward parent, teachers, and other authority figures. They are more troubling to others than they are to themselves. 

We should note that some disobedient and destructive behaviours is a part of normal development that usually diminishes with maturity, and a diagnosis should only be made when the behaviours are both extreme and, persistent, and results in impairment in everyday functioning (for example, in interpersonal relations or school). 

What are the symptoms of ODD in a child? 

Most symptoms seen in children and adolescents with ODD also occur at times in other children. This is seen in children around age 3, or during adolescence. 

Many children may argue with parent, disobey, or defy authority figures. But in children with ODD, these symptoms happen more often, with impairment in the child’s level of functioning (school and relationships with others). 

Symptoms of ODD my include: 

• Having frequent or severe temper outburst. 
• Often touchy or easily annoyed. 
• Often angry or resentful. 
• Arguing a lot with adults. 
• Often defies adult requests or rules. 
• Often do things to annoy or upset others, including adults. 
• Often blame others for his/her misbehaviors or mistakes. 
• Often spiteful or vindictive. 

Associated features: 

• ADHD: often co-exist, and often been poorly recognized. The comorbidity makes the outcome worse. 
• Emotional symptoms: Low mood with an increased risk of depression and self harm in adolescence and adulthood. 
• Learning disorder: for ex. specific reading disorder, with academic and school under achievement. 
• Poor interpersonal relations: Children with (ODD) commonly show poor social skills with both peers and adults. 

How is ODD diagnosed in a child? 

A child psychiatrist will need to evaluate the following: 

• Detailed history about the defiant, aggressive and antisocial acts, in the last month(s) or year(s), including the severity and frequency. 
• Detailed history of other symptoms:
  • ADHD & emotional symptoms. 
  • Learning disorders. 
• Parenting practices: what happens before, during, and after trouble some behavior. 
• Parents interactions with the child.
  • Ways of punishments, consequences, or ways of praise and encouragement. 
  • How much time is spent in joint activities and quality time. 
  • The parents’ emotional tone and attitude toward the child. 
• Detailed history about the child’s development and medical history. 
• Family history. 
• School report is essential, to evaluate:
  • Defiant or oppositional behavior. 
  • Antisocial behavior.
  • Ability to concentrate and self control 
  • Peer relations. 
  • Scholastic attainments.
  • Peer relations. 

Causes

There is no clear or definite cause behind this disorder, but it is rather the interaction of many risk factors, including: 

• The biological factors
  • Genetic factors: genetic influences seem to play a stronger role in the development of child’s disruptive behavioural disorders, if the child had a generally unfavourable parenting and rearing environment. 
  • Temperaments: affecting emotional response. 
• Environmental factors:
  • Child rearing practices: 
    • Lack of supervision and inconsistent discipline are strongly associated with ODD & disruptive bahvioural. 
    • Harsh discipline or hostility with the child. These parent management strategies have a strong causal role in initiating and maintaining oppositional behaviours. 
  • Parent – Child interaction patterns:
    • Lack of involvement in the child’s life. 
    • Lack of warmth. 
  • Family factors:
    • Marital discord. 
    • Parental psychiatric disorders, 
    • Personality disorders (including antisocial personality) and substance abuse problems. 
  • School factors:
    • Poorly organized & unfriendly school staff. 
  • Social factors: 
    • Over crowding or poor housing. 

Treatment

• Family and school focused:
  • Parent management training: is the best established approach
    • Promoting effective techniques for managing child’s behaviour (undesired). 
    • Promoting effective techniques for encouraging & reinforcing desired behaviours. 
    • Promoting positive ways of parent – child interactions and communications. 
  • Family therapy: aims to improve communication skill and family interactions. 
  • School: cooperation with class teachers, and implementing more functional management strategies for the child undesired behaviours & ways of promoting desired behaviours. 
• Child focused:
  • Cognitive behavior therapy:
    • Helping the child to learn how to control his impulses and anger outbursts.
    • Learning how to better solve problems and communicate more functionally. 
    • Social skills training. 
  • Medications: for comorbid disorder (ADHD) or depression.