Oppositional Defiance Disorder - Essay Example

Oppositional Defiance Disorder Oppositional Defiance Disorder Introduction All children tend to behave in an oppositional manner from timeto time, especially when they are hungry, tired, upset or stressed and disobey, argue, talk back and defy teachers, parents or other adults. Oppositional behavior is a normal phenomenon among children who are two to three year old and early adolescents. But explicit hostile behavior and uncooperativeness is a serious concern if it is consistent and frequent and stands out in comparison to other children and pose a negative impact on the child’s academic, family and social life, especially their day to day activities. The symptoms of Oppositional Defiance Disorder (ODD) are observed in multiple settings with more noticeable actions at school or at home. The rate of ODD found in adolescents and school age children is 1-16 percent. The factors that cause ODD are not known however psychological, social and biological factors can play a role in the development of the disorder. Therefore it is essential to conduct a comprehensive evaluation of a child with ODD symptoms since there are chances that the child may have disorders like learning disability, ADHD (attention deficit hyperactivity disorder, anxiety disorders and mood disorders (bipolar disorder, depression). A comprehensive evaluation can diagnose these coexisting disorders that require preliminary treatment before treating the child for ODD (Children With Oppositional Defiant Disorder 2009). Definition The Diagnostic and Statistical Manual of American Psychiatric Association explains oppositional defiant disorder (ODD) as a recurrent process of defiant, negativistic, hostile and disobedient behavior exhibited towards authority personality that continues for a minimum period of six months. Some of the behaviors comprise arguing with adults, losing temper, actively resisting requests, purposely annoying people, refusal to obey directions and rules, being touchy, complaining others for the misbehavior and mistakes of the person, spiteful, resentful, easily angered or annoyed or vindictive. Oppositional defiant disorders can be diagnosed in a child when there is a consistent and persistent pattern of hostility and disobedience towards teachers, parents or other adults. Children with ODD show testing limits and stubbornness even their early childhood. The primary behavioral complexity of ODD is the constant pattern of refusal to follow the commands or obey the requests of adults. ODD is substantiated when problem behaviors take place more recurrently in a child when compared to other children of the same developmental stage and age. The behavior of children with ODD causes major difficulties with friends and family and the oppositional behaviors same at school and at home. In certain cases, ODD can be a sign for conduct disorder. In case the problematic behavior is an exclusive occurrence with psychotic or mood disorder, it is not a diagnosis for ODD (Tynan 2008). Clinical Features Oppositional defiant disorder is a division of disruptive behavior disorder that results in impaired academic or social functioning of the child. Though some refusal and defiance to follow the requests of adults is appropriate in their development stage, the severity and frequency of defiance reveals that there is a disorder that impairs the child from participating in normal activities. The characteristics of ODD is the enduring patterns of hostile behavior, negativism and disobedience towards adults figures and the incapability to take the responsibility when a mistake is committed that make lead them to blame others. Other characteristic include short temper and getting easily annoyed by the conduct of others that lead them to a condition of resentment and anger. Children with ODD will have struggle in the classroom and in maintaining peer relationship but they usually do not engage in physical advancement or other destructive behavior. ODD is unlike conduct disorder because children with conduct disorder usually involve in violent actions and aggressions that cause physical harm to the self and others and violate others right and cause destruction to property. Epidemiology Epidemiological research of negative behavior among non-clinical population indicates that such behavior appears in 16 to 22 percent children in the school age. American Psychiatric Associations, fourth edition of Diagnostic and Statistical Manual of Mental Disorders indicate that the rate of prevalence of the disorder varies between 2 to 16 percent. Though the ODD can start at the age of three, it is typically diagnosed by the age of eight and not after adolescence. The disorder is prevalent in boys when compared to girls before they attain puberty and after puberty the sex ratio is found to be equal. Another research suggests that frequent ODD is more among girls than in boys because boys are usually diagnosed early with conduct disorder. There has been no clear evidence of distinct family models but several parents who have children with ODD are basically more concerned about autonomy, control and power. Etiology During the development of a child, it is a normal characteristic to exhibit opposing traits. It indicates the child’s capability to communicate his or her will and opposing is a way towards establishing one’s autonomy, setting inner standards and forming an identity and controls. The extreme dramatic normal oppositional behavior is found when a child passes through 18 to 24 months. Toddlers exhibit negativism to express their growing autonomy. The pathology of ODD starts when this developmental stage continues abnormally, opposition behavior recurs or authority figures overreact comparatively more often than in majority of the children with the same mental age (Sadock, Kaplan & Sadock 2007 p.1218). Parents who exhibit extreme method of enforcing and expressing their will can contribute to the formation of chronic resistance with their children which is later reenacted to other authority figures. The effort of an infant to establish self determination can transform into an overstressed behavioral method. When the child pass through later stage of childhood, illness, chronic incapability or environmental trauma like mental retardation may activate oppositionalism as a defense to solve their anxiety, helplessness and the loss of self-esteem. Classic psychoanalytic theory suggests that unresolved conflicts can activate aggressive behavior towards authority figures. Research by behaviorists indicates that oppositionality is a resistant, learned behavior using which the child puts pressure on authority figures. For instance, the temper tantrum of a child emerges when parents request acts that are undesired by the child. Here the child pressurizes the parent to withdraw the requirement. Further, increased attention of parents on the child’s behavior, for example, continuous discussion about the child’s behavior will strengthen the aggressive behavior of the ODD child. Diagnosis Children with ODD actively defy the rules and requests of adults and purposely annoy others. Children with ODD blame others for their misbehavior and mistakes. Manifestation of the disorder is most invariably evident at home but the same may not be evident with other adults, at school or with peers. In certain cases the features of the disorder in the initial stage of disturbace are observed while outside the home but in some other cases, the behavior begins at home and it is later observed outside the home. Typically, the symptoms of ODD are clearly evident during interaction with peers whom they know well or with adults. Therefore, the child with ODD is most likely to exhibit little or no sign of ODD during clinical examination. Normally, children with ODD do not consider themselves to be behaving in a defiant or oppositional manner, instead they justify their conduct as a reaction to unreasonable circumstances. The disorder causes more concerns and distress to people around the child rather than to the child. Chronic ODD usually interferes with school performance and interpersonal relationships. These children consider that human relationships are unsatisfactory and usually have no friends. Though they have the required intelligence, they either fail or poor fair at school because they resist participation and do not give into external demands and are adamant to solve problems without the help of others. They also face with difficulties of poor tolerance towards frustration, low self esteem, temper outbursts and depressed mood. Adolescents are susceptible to illegal substance use and alcohol abuse. The disturbance usually evolves into mood disorder or conduct disorder. Differential Diagnosis Since oppositional behavior is adaptive and normal during a particular development stage, the negative conduct of the child should be differentiated from ODD. The oppositional behavior during developmental stage is of shorter duration when compared to ODD and it is not frequent and intense. ODD that takes place as a result of temporary reaction to a stress has to be diagnosed as adjustment disorder. Oppositional behavior that arises due to schizophrenia, conduct disorder or mood disorder should not be diagnosed as ODD. There are also chances for negativistic and oppositional behavior to appear in a person with ADHD (attention deficit / hyperactivity disorder). A concomitant diagnosis of ODD can be made based on the pervasiveness, severity and duration of the behavior. Young children diagnosed with ODD may also have the characteristics that form the reason for conduct disorder. Research indicates that the two disorders are developmental variants with conduct disorder becoming the natural progression of ODD when the child matures. However, most of the children with ODD does not later tend to meet the criteria required to be diagnosed with conduct disorder (Sadock, Kaplan & Sadock 2007 p.1219). Factors that increase the possibility of ODD in children Several factors are found to increase the severity and probability of Oppositional defiance disorder. Family stress, genetic factors, poor parenting skills and watching various acts of crime and violence on television (p.147) can also cause ODD. The three main factors that increase the risk of ODD in children are parents with marginal disciplining, poor nurturing skills and parental stress. It is difficult to parent some children due to their inherent temperament like throwing tantrums and being inconsolable at a very young age. Parental stress can cause ODD due to external factors like poor parenting skills and single parenting or due to internal factors like mood disorder or depression. Parents with low parenting skills strengthen non compliance by avoiding the requests when children turn defiant. If these factors are present in the living circumstances of a child the occurrence of ODD is almost inevitable. On diagnosing the child with ODD, the child has to be dealt in a planned manner to decrease negative behavior and increase positive conduct (Boynton 2005 p.148). Treatments and drugs ODD has to be treated by a primary care doctor and a child development professional or a qualified mental health professional. Treatment can also be availed from a psychologist who specializes in family therapy. The above health professional will screen the child and treat co-existing mental health problems. The successful treatment of coexisting conditions usually enhances the effectiveness of treating for ODD. In certain cases, the ODD symptoms disappear completely. The successful treatment of ODD requires commitment and thorough follow up by the parent and others involved in the care of the child. It is most important to show acceptance and consistent unconditional love to the child even during disruptive and difficult situations though it sounds tough even to the patient parents (Treatments and drugs 2009). ODD can be treated with:(i) Individual Psychotherapy to form more effective management of anger (ii) Family Psychotherapy to build mutual understanding and improve communication (iii) Parent Management Training Programs enable parents and others to manage the behavior of the child (iv) Social Skills Training improves tolerance and frustration with peers, increases flexibility and betters social skills (v) Cognitive problem-solving skills therapies and training is provided to help decrease negativity and assist the problem solving task of the child. Parents can support their ODD child in several ways. Parents should add on to the positive and praise the conduct when the child shows cooperation and flexibility and nurture positive reinforcement. Parents should take a break from managing conflict with the child if the situation worsens. This is a good step for the child to learn to avoid overreacting and take a time out during conflicting circumstances. Since children with ODD have trouble in avoiding power struggles, parents should prioritize the actions of the child. When parents give a time out for a child in his room for misbehavior it is advisable not to extend the arguing time. The parent can say that the time for time out will begin when he enters his room. Parents are required to set age appropriate and reasonable limits to the child with the consistent enforcement of consequences. Parents should take care to maintain other interest in their daily life besides the care of the ODD child to reduce the stress, energy and time spent exclusively to care for the child. Parents can increase the effectiveness of their care by working with and by acquiring support from their spouse, coaches and teachers involved in the care of the child. Parents can reduce self stress by maintaining a healthy lifestyle with relaxation and exercise with adequate breaks and respite care. It is found that a child with ODD responds well to positive parenting methods. Parents can request their family physician or pediatrician to refer to a mental health professional or an adolescent psychiatrist to treat any coexisting psychiatric disorders and ODD. Medication may help in controlling distressing symptoms of Oppositional Defiance Disorder and coexisting conditions like mood disorders, anxiety and ADHD (Children With Oppositional Defiant Disorder 2009). Misconceptions regarding ODD Harsh punishments: It is a misconception that that harsh punishment can improve the behavior of children with ODD. In reality, punishments do not mean that they are being corrected and they do not make any change to their impulse led behavior. Ignoring the behavior: If the behavior of ODD children are ignored it will not be effective because negative behavior is induced by their impulses. Moreover, ODD children do not notice that they are ignored and so they do not react to that response. Students will correct themselves in the long run: It is a misconception that ODD children will correct themselves to achieve long term rewards though they respond to achieve short term goals. The impulsive behavior keeps them away from attaining long terms goals. Idle time supports ODD children to improve their behavior: In fact, ODD children behave in a better manner in task oriented and active circumstances (Boynton 2005 p.148). Analysis There are doubts about the validity of ODD as a specific category of behavioral disorder. Existing evidence implicate a distinction between conduct disorder and ODD however there is controversy while considering aggressive symptoms as an indicator of ODD that later develop into conduct disorder. It is also found that one-third children with any type of psychiatric condition are also diagnosed with ODD that becomes stable over a period of time. It has also been found that the reliability of ODD diagnosis is low to consider the disorder as an oppositional aggressive psychological dimension that varies from delinquent dimension (Geller & DelBello 2006 p.83). Conclusion It may be concluded that Oppositional Defiance Disorder can be diagnosed and controlled by the patient intervention of parents and other adults who involve with the child. Parents play the most significant part in controlling the ODD condition of the child by following the therapies prescribed by the mental health professional or doctor. Since there is no specific medication for ODD, the child should be gradually brought into a normal condition by providing a suitable environment and response whenever the child exhibit negative behavior and show temper tantrums. Thus Oppositional Defiance Disorder is a curable condition if treated properly under the guidance of therapists and doctors with major involvement of the family, especially the parents of the child. Reference Boynton, C. 2005 The educators guide to preventing and solving discipline problems. Alexandria, VA.: ASCD Children With Oppositional Defiant Disorder June 2009 Available: http://www.aacap.org/cs/root/facts_for_families/children_with_oppositional_defiant_disorder Accessed on June 26, 2009 Geller, B. & DelBello, M.P. 2006 Bipolar Disorder in Childhood and Early Adolescence New York: Guilford Press Sadock, B.J., Kaplan, H.I. & Sadock, V.A. 2007 Kaplan & Sadocks synopsis of psychiatry Philadelphia: Lippincott Williams & Wilkins Treatments and drugs 2009 Available: http://www.mayoclinic.com/health/oppositional-defiant-disorder/DS00630/DSECTION=treatments%2Dand%2Ddrugs. Accessed on June 26, 2009 Tynan, W.D. Feb 8, 2008 Oppositional Defiant Disorder Available: http://emedicine.medscape.com/article/918095-overview. Accessed on June 26, 2009 Read More