What Is Oppositional Defiant Disorder?
The term “oppositional defiant disorder” (ODD) describes a group of behaviors that are often present in children and adolescents with attention deficit hyperactivity disorder (ADHD). These behaviors include:
Being unwilling or unable to comply with adult requests or rules; being impulsive; not following through on plans; speaking out of turn or disagreeing when told so; and refusing to follow directions.
These symptoms may be accompanied by a lack of empathy, emotional instability, and impulsivity. They are often associated with poor social skills. ODD is usually diagnosed after a thorough evaluation of the child’s behavior and history. A number of different diagnostic criteria have been proposed over time, but there appears to be no single correct diagnosis for this condition. There is some evidence that ADHD itself might increase the risk for developing ODD later in life.
People with ODD tend to engage in a variety of disruptive behaviors such as:
Repeatedly interrupting others;
Failing to obey instructions;
Acting without thinking, and/or acting recklessly; and/or,
Inappropriate physical contact or aggression towards peers or teachers.
ODD is most commonly diagnosed between the ages of four and twelve and is one of the three disruptive behavior disorders, along with conduct disorder and defiance (which is a form of ADHD but involves only the defiant behavior trait). Oppositional defiant disorder affects about 3-5% of school-aged children and is four times more common in boys than in girls. The lifetime prevalence in boys and girls is about 10% and 5%, respectively.
Treatments for ODD include:
It is important to note that many children display oppositional behavior and do not have ODD. Children may have temporary oppositional behavior when they are not in the mood to complete a homework assignment or don’t want to go to bed. In order to be diagnosed with ODD, the child’s oppositional behavior must be excessive and persistent and occur across a variety of situations. There must also be clear evidence that the child has a grating attitude and resistance to authority. The child must recognize that this behavior is excessive or unreasonable.
Oppositional defiant disorder occurs in children who have had significant problems with their families or caregivers. These children have experienced chronic frustration, such as long-term separation from parents, frequent changes in caregivers, severe neglect, or abusive parenting. In addition, these children usually have abnormalities in the frontal lobes of their brains. This part of the brain controls reasoning abilities, and ODD children tend to have less activity in this area of the brain.
The National Institute of Mental Health estimates that between 2 and 5 million children in the U.S. show symptoms of ODD. Boys are four times more likely to have the disorder than girls, and children from low socioeconomic environments are more likely to have oppositional behavior. Children whose parents have criminal records for domestic violence or substance abuse are also at risk.
The boundary between normal and abnormal behavior is somewhat arbitrary. For example, it may be normal for a male child to oppose going to bed, but if he is consistently defiant toward authority figures in other respects, he may have ODD. A casual comment such as “eat your vegetables” may cause a child with ODD to consider flinging his dinner across the room.
The causes for oppositional defiant disorder are not yet well-understood. Some researchers have found that adults with the disorder experienced traumatic childhoods marked by abuse, neglect, or unstable home lives. Others have focused on a theory that there is a biological factor of the disorder (i.e. damage to the frontal lobe), and still others focus on psychosocial factors such as family stress and poverty.
ODD behaviors are sometimes seen in children but are more common in teenagers and young adults. Some of the symptoms that characterize this disorder include:
Although it is rare for adults to have ODD, some do display these symptoms. It is important to be aware of these signs in order to seek help if necessary.
It is also important to note that people with ODD are not intentionally trying to alienate those around them. Rather this behavior seems to come naturally and is a coping mechanism for them. This in no way excuses the negative effects of their actions.
The main goal of treatment for oppositional defiant disorder is to eliminate the symptoms that make this condition a disorder. This can be a difficult task, because many children with ODD have other disorders as well. Some of these include attention-deficit hyperactivity disorder (ADHD), conduct disorder, anxiety, depression, and bipolar disorder. Psychiatric drugs are sometimes prescribed to treat these comorbid conditions.
In cases where children display more serious symptoms of ODD such as threatening or hurting others, they may be referred to therapy. Psychotherapy is a common method for treating this condition. There are several different types of psychotherapy that have been proven to be effective in helping children with ODD.
Although psychotherapy can be an effective form of treatment for childhood ODD, research has shown that it is less successful in adult patients.
There is no cure for ODD, and treatment is often times a long process. Some children see significant improvements after several months of therapy, while others do not improve as much or at all. It is important that parents, guardians, and other caregivers are consistent with implementing discipline methods. Also, it is important that they show unconditional love and support for their child in order for any treatment to be as effective as possible.
Although there is no cure for ODD, there are many treatment options available that can help children and adults who suffer from this condition. People with ODD usually benefit from psychotherapy and medications.
Many people with ODD also have other disorders like depression, anxiety, substance abuse, or bipolar disorder. Psychotherapy can help treat these conditions as well as help the person learn new skills to handle stressful situations.
The two types of psychotherapy that have been proven to be most effective for treating ODD are Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT). These types of psychotherapy help the person learn how to interpret events in a more positive manner and change the way they react to negative situations.
For children, family therapy can be helpful in teaching the child skills to manage their outbursts and anger in a positive manner.
There are no medications that have been approved by the Food and Drug Administration (FDA) to specifically treat ODD. However, some medications such as antidepressants or other psychiatric drugs may be given to help treat comorbid disorders such as depression or ADHD. These drugs can also help in reducing irritability and impulsiveness, which are common symptoms of ODD.
Over time, if comorbid disorders are present, these drugs can help decrease the symptoms of those disorders as well. It is important to consult a medical professional before stopping or starting any medication. Also please note that not all medications are approved by the FDA for the treatment of every disorder. It is important to consult a medical professional before starting or stopping any medications.
Since oppositional defiant disorder is a condition that is most frequently found in younger children, the prognosis for this disorder is generally good. Children with ODD are often able to learn strategies to deal with stressful situations and control their defiance as they get older. Although some people may have long-lasting mild ODD symptoms as teenagers or adults, the majority of people eventually overcome their ODD tendencies.
In some cases though, ODD in children can persist into teenage years and adulthood. In these cases, it is very important that the person continues to work on assertiveness, impulse control, and dealing with stressful situations in a positive manner. These skills can be improved with practice and help from a therapist or medical professional.
There are several factors that can cause a child to develop ODD. It is important to remember that no single factor causes ODD to develop. It is the accumulation of negative life experiences that causes the most likelihood for the development of ODD.
Neglect or abuse:
One of the most prominent factors that leads to the development of ODD is childhood trauma. In particular, childhood neglect or child abuse has been shown to be a significant factor in the development of ODD in children.
A stressful or negative family environment:
Other factors that may contribute to childhood ODD are a stressful home environment or negative family interactions. This may include experiencing high levels of conflict within the family, particularly between parents.
Also, there may be biological factors that cause a child to become defiant. Researchers believe there may be a genetic link to the development of ODD because children with family members who display signs of antisocial or criminal behavior are more likely to develop ODD.
Another factor that may contribute to the development of ODD is over-protection of a child by their parents or guardians. This could be due to a parent’s fear of child abduction or some other factor. A parent who is overprotective of their child may set strict boundaries for the child, but have very little positive interaction with him or her.
The most effective way to treat ODD is by using an integrated approach that addresses the multiple factors that may have contributed to its development. These factors could include family environment, parental upbringing, biological factors, or the presence of a comorbid disorder.
The various types of treatment for ODD include: psychotherapy, parental support and education, and medication.
The most common form of treatment for ODD is psychotherapy, which primarily includes social skills training and cognitive behavioral therapy (CBT).
Social skills training involves the child learning how to interact with others in a positive manner. This type of treatment is particularly beneficial for children who display signs of ODD due to social isolation or lack of positive interactions with their peers.
Cognitive behavioral therapy involves the child undergoing therapy in order to change his or her negative thoughts and beliefs, which contribute to disruptive or aggressive behavior.
The next most common form of treatment for ODD is parental support and education. In particular, parents of children with ODD typically seek advice on how to support their child and modify their parenting techniques.
A less common approach to treating ODD is medication. Antisocial or aggressive behavior may be treated with antidepressants, while children who have trouble paying attention may be prescribed a stimulant.
Antisocial personality disorder is different from conduct disorder in that people with APD have a history of juvenile delinquency as well as a failure to conform to social norms. The exact cause is unknown, but it is theorized that there may be a genetic factor involved in the development of APD. Antisocial personality disorder is believed to be maintained by biological, social, and environmental factors. Factors that maintain this disorder include a disconnection from society as well as the presence of stress.
The symptoms of APD are as follows:
APD has been linked to neurological differences such as a smaller hippocampus and amygdala, which are part of the limbic system. The limbic system is responsible for producing emotions as well as Memories.
The DSM-V describes a difference between “high” and “low” expression of antisocial behavior. A person with high expression is someone who has been convicted of a crime and served time in jail for said crime, including misdemeanors or felonies; a person with low expression is someone who does not have a criminal record of any kind. High expression has a higher risk for physical and mental problems in later life, such as drug abuse and risky sexual behavior; low expression has a higher chance of succeeding in school.
The incidence of APD is unknown, although it occurs more often in males than females. Onset is usually during adolescence or early adulthood. There is controversy about whether or not APD can be diagnosed in childhood, although there are some practitioners who believe that the disorder can be diagnosed in children as young as age 6.
There is no known cure for APD; treatment options include therapy and medication. Treatment options vary depending on the patient’s needs. There are three types of psychotherapy used in treating APD: cognitive-behavioral, psychodynamic, and humanistic. For medications, the two types that have been confirmed to be somewhat effective in treating APD are antipsychotics and mood stabilizers. Other types of medication have also been used.
In addition, treatment for persons with APD may also include group and family therapy.
The disorder was first identified in 1945 by American psychiatrist Hervey M. Cleckley, in his book “The Mask of Sanity”. The DSM-IV diagnosis is called psychopathy.
Diagnosis of APD is indicated when three (or more) of the following apply:
There are a number of scales designed to measure the symptoms and diagnosis of APD. The Antisocial Process Screening Device (APSD) is a measure designed for use in correctional settings, while the Psychopathic Deviate Scale (PDS) was designed for use in psychiatric patients. The Levenson Diagnostic Scale (LS) rates personality based on a retrospective of the subject’s history.
The Hare Psychopathy Checklist – Revised (PCL-R) is the most widely used diagnostic tool in the U.S. and is designed to assess the presence of psychopathic traits in a subjects childhood and adulthood. It is also used to help determine a subject’s “dangerousness” and likelihood of re-offending.
Mental health professionals most often use the PCL-R when diagnosing APD, although it is not the only option and other tools may be used. The PCL-R consists of 20 different factors, which are rated 0, 1 or 2 depending on their relevance to the patient being assessed. The scores are then used to determine whether the patient has APD and to what extent.
The PCL-R is not a self-test and should only be administered by a physician or other trained professional. The test takes into account the individual’s life history and patterns of behavior. There are also separate versions for adolescents and for children between the ages of 12 and 18, called the PCL:YV (for youngsters).
The PCL-R tool has many statistical strengths. It is excellent at distinguishing between different types of offenders and levels of danger they present to the public. The PCL-R also corrects for the gender, age and education bias inherent in other diagnostic tools, such as the PDS, LS and APSD. The psychometric strength of the PCL-R is reflected in its variability and its validity.
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