| Oppositional Defiant Disorder | |
|---|---|
| Classification and external resources | |
| ICD-10 | F91.3 |
| ICD-9 | 313.81 |
| MeSH | D019958 |
Oppositional defiant disorder (ODD) is a diagnosis described by the Diagnostic and Statistical Manual of Mental Disorders (DSM) as an ongoing pattern of anger guided disobedience, hostilely defiant behavior toward authority figures which goes beyond the bounds of normal childhood behavior. People who have it may appear very stubborn and often angry.
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Common features of Oppositional Defiant Disorder (ODD) include excessive, often persistent anger, frequent temper tantrums or angry outbursts, as well as disregard for authority. Children and adolescents with ODD often purposely annoy others, blame others for their own mistakes, and are easily disturbed. Parents often observe more rigid and irritable behaviors than in siblings.[1] In addition, these young people may appear resentful of others and when someone does something they don't like they prefer taking revenge more than sensitive solutions.[2]
For a child or adolescent to qualify for a diagnosis of ODD these behaviors must cause considerable distress for the family and/or interfere significantly with academic or social functioning. Interference might take the form of preventing the child or adolescent from learning at school or making friends, or placing him or her in harmful situations. These behaviors must also persist for at least six months. Effects of ODD can be greatly amplified by other disorders in comorbidity such as ADHD.[3]
Some signs and symptoms that must be perpetuated for longer than 6 months and must be considered beyond normal child behavior to fit the diagnosis are:[4] [5]
Generally, these patterns of behavior will lead to problems at school and other social venues.[5]
Children of alcoholic parents, or whose fathers have "been in trouble with the law" run a 18% chance of developing ODD, beginning very early in age.[3] This could suggest that the development of ODD concerning symptoms of dis-cooperativeness may be influenced by the behavior of the patient's parents.
According to a 1992 article, if left untreated, about 52% of children with ODD will continue to meet the DSM-IV criteria up to three years later and about half of those 52% will progress into conduct disorder.[7] This strong correlation between strong defiance in childhood and adulthood may suggest similar mechanisms for hostility towards established authority by children and by adults.
One of the key factors in the development and maintenance of the negative behaviors associated with ODD symptoms is reinforcement, whether intentional or not, of the unwanted behaviors. The most effective way of treating disruptive behavior disorders is behavioral therapies.[8] Behavioral therapy for children and adolescents focuses primarily on how to prevent problematic thoughts or behaviors from accidentally getting reinforced unknowingly within a young person's environment.
These reinforcements, positive and negative, often contribute to an increase in the frequency of ODD behaviors. Behavior therapies can be applied to a wide range of psychological symptoms among children, adolescents, and adults with ODD. In behavioral therapies, therapists encourage children and adolescents to try new behaviors and not to allow unwanted reinforcements to dictate the ways in which they act. Furthermore, therapists may work with parents to discontinue ways in which they are unintentionally reinforcing unwanted behaviors. An example of how positive reinforcements can occur is when the patient is rewarded with attention when performing ODD behaviors. Attention is reinforcing on its own, and the rewarding attention could be accidentally given, ironically, when trying to create a consequence.[9] Negative reinforcements occur is when the patient is inadvertently punished by aversive stimuli for not performing the ODD behaviors (of revenge, dis-cooperation, and frequent anger). These aversive stimuli that punishes patients for not performing ODD behaviors can include: humiliation, isolation, not being told the reason of rules (e.g. being told "the reason you should is because I said so"), not having opinions taken seriously, as well as "being pushed around".
Other approaches to the treatment of ODD, include parent training programs, individual psychotherapy, family therapy, cognitive behavioral therapy, and social skills training.[10][11] According to the American Academy of Child and Adolescent Psychiatry, treatments for ODD are tailored specifically to the individual child, and different treatment techniques are applied for pre-schoolers and adolescents.[12]
An approach developed by Russell Barkley[13][14][15] uses a parent training model and begins by focusing on positive approaches to increase compliant behaviours.
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