Little kids have tantrums, and bigger kids can be irritable, snotty and moody. So how do you know when it’s a difficult phase or when there is a bigger problem brewing that needs attention? A…
Little kids have tantrums, and bigger kids can be irritable, snotty and moody. So how do you know when it’s a difficult phase or when there is a bigger problem brewing that needs attention? A child need not rise to the level of harming people or animals, destroying property or stealing to have a diagnosable issue that can really benefit from treatment.
Oppositional defiant disorder is a repetitive pattern of emoting and behaving that lasts for at least six months and is specifically directed towards some authority figure in their lives, such as a parent, teacher or coach. If the aggression is physical, then it is another problem called conduct disorder. ODD is verbal and not physical. The latest version of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, the DSM-5, states that a child must exhibit four of these eight symptoms:
— 1. Often loses temper.
— 2. Is often touchy or easily annoyed.
— 3. Is often angry and resentful.
— 4. Often argues with authority figures or for children and adolescents, with adults.
— 5. Often actively defies or refuses to comply with requests from authority figures or with rules.
— 6. Often deliberately annoys others.
— 7. Often blames others for his or her mistakes or misbehavior.
— 8. Has been spiteful or vindictive at least twice within the past six months.
If this is a child younger than 5, these behaviors would occur most days; in an older child they would be seen at least twice a week. The point is really that you are noting this behavior in a frequency and intensity that is really beyond what one would see in a typical kid and that it is causing impairment in that child’s life.
The impairment can be a lot of disruption at home and significant difficulty in parenting the child, but it could also be getting in trouble at school, doing poorly academically or losing friends and becoming marginalized socially. This is a disorder of childhood. In other words, the first symptoms show up in childhood or at latest in adolescence. A number of children with ODD also have other mental health issues, such as attention deficit disorder or attention deficit hyperactivity disorder, depression, anxiety and substance abuse. It is important to screen for and treat these issues because they can make the oppositional defiant symptoms even worse.
It’s estimated that somewhere around 3% of children struggle with ODD, and the proportion of kids who have this disorder may actually be higher since it’s likely a diagnosis that is underreported. Boys are more likely to have ODD than girls, but it occurs in both.
It’s not entirely clear from research what causes ODD, and questions remain about possible neurobiological differences in the brains of children with ODD. But studies indicate some factors are associated with a higher risk for the disorder. There does seem to be some sort of genetic component to both ODD and conduct disorders. First-degree relatives of kids with ODD tend to have traits of antisocial personality, or attention deficit disorder and ADHD, mood disorders or substance abuse disorders. But there’s also evidence to suggest it’s an interaction between genes and the environment that brings out the symptoms of ODD.
A lack of parenting, neglectful parenting, overly permissive parenting and abusive parenting increase the incidence of ODD. So can having family members with significant mental illness or who abuse drugs or alcohol, particularly as it affects the home environment and the level of stability and nurturing available to the child. One difficulty in looking at these phenomena is that it is hard to show whether ODD results from a child being abused in some way or whether a child who already is exhibiting ODD is driving a parent to become hostile, argumentative and abusive. Of course, parents should never, under any circumstance, emotionally or physically abuse a child. No matter what a child’s behavior is like, the child is never responsible for a parent who crosses that line.
Left untreated and unchecked, a child with ODD is likely to wreak havoc on their own life as well as that of others. The more socially destructive and academically destructive a child becomes, the more likely it is that child will start associating with other high-risk kids and engage in disruptive and damaging behaviors. Kids with untreated ODD are more susceptible to negative influences, and hence they may evolve onto adults with antisocial personality disorder. This describes a long-term pattern of irresponsible, impulsive and aggressive behavior that may also be criminal, a lack of empathy for or concern about others and an inability to sustain long-term social relationships.
Intervention as early as possible to treat associated conditions and to teach methods of managing impulsivity, frustration and anger, gaining insight into what they are responsible for rather than always blaming others, and working with families around how to parent such a child can make a significant difference in both the short term and long term for these kids.
Treatments range from psychotherapy with the child to teach social skills and manage emotional states, to talk therapy with the family to work on emotional dynamics and parenting skills that reinforce managing emotions. Sometimes medication can be helpful, if it is aimed at specific symptoms or other mental health issues, such as an antidepressant for depression or a stimulant for attention deficit disorder. Psychotherapy with both the child and parents, however, is really key in treating ODD.