Oppositional Defiant Disorder - Term Paper Example

? Oppositional Defiant Disorder Oppositional defiant disorder (ODD) is a behavioral condition that canaffect the manner by which children interact with other people in the society. It is one of the main concerns in the medical field because it can affect a significant number of people in the population. The paper is aimed to define and to discuss the symptoms, treatments, and management methods related to ODD. Oppositional Defiant Disorder Oppositional defiant disorder (ODD) is one of the conditions that can affect the behavior, personality and performance of a person at home and in the society. The condition commonly affects individuals during childhood. The concern of the medical authorities regarding ODD can be attributed the high percentage of children diagnosed with the condition. In fact, it is considered as the most commonly diagnosed mental health condition in children (Hamilton and Armando, 2008, p.861). Based on the studies conducted in the community level approximately 3 percent of children have ODD with the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) description as the sole basis. When other parameters and criteria were considered the prevalence ranges from 1 to 16 percent (Hamilton and Armando, 2008, p.861). The paper is aimed to define and to discuss ODD and the different pertinent concepts related to the condition such as the symptoms, risks, management methods, treatments, and related researches and studies. The said objective of the paper can be achieved through the data gathering from significant academic and medical references, e.g. journals. In addition, the main focus of the process is the educational perspective which is either to educate the public or to present the methods of educating the individuals with ODD. Definition of ODD Oppositional defiant disorder, ODD, is officially defined by the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) as a condition wherein a “recurrent pattern of negativistic, disobedient, and hostile behavior by young people toward authority figures” (Hamilton and Armando, 2008, p.861; Weiner and Craighead, 2010, p.1129). The behavioral indications of ODD can be commonly observed in the preschool years but due to other developmentally troublesome behavior that can also be observed, the method of diagnosis is based on more than one symptom or criterion (Hamilton and Armando, 2008, p.861). Upon the determination of the meaning of ODD, the methods of diagnosis and the symptoms are needed to be given attention to achieve better understanding of the disorder. It is also important to focus on the methods of treatments and management of ODD since it is known as a subset and a precursor to a more serious condition referred to as conduct disorder (Chakraburtty, 2009). Recorded data show that one third of the children diagnosed with ODD will develop into conduct disorder while 40 percent will lead to antisocial personality disorder during adult years (Hamilton and Armando, 2008, p.863). The oppositional behavior of the children of the children ranges from passive to active forms of non-compliance. Ignoring the direction given by adults such as parents and teachers is an example of passive ODD. Active non-compliant behavior ranges from mild refusal to angry rejection of parents or elders commands and guidance (Matthys and Lochman, 2010, p.1). There are levels of opposition from children and adolescents which can be considered normal for their age. Thus, the determination of the levels of oppositional behavior considered abnormal is needed to be given attention for the early diagnosis and treatment of the problematic child. Methods of Diagnosis of ODD There are eight standard symptoms included in the description of ODD as the bases for diagnosis. Four of the eight symptoms of the condition should be present for an individual to be considered to possess ODD. The standard symptoms include: “lost of temper; argument with adults; defying adults’ requests and/or rules actively; annoying others deliberately; blaming others for mistakes; being easily annoyed; being angry and resentful; and being spiteful and vindictive” (Weiner and Craighead, 2010, p.1129). In addition to the expression of four of the eight symptoms of ODD, there are other prerequisites to the ODD diagnosis. One requirement is that the symptomatic behavior is exhibited for more than six months and based on analysis of medical experts is not related to psychosis or any mood disorder. In addition, there is a negative effect of the behavior on the different aspects of the child’s life such as social, academic, or occupational functioning (Hamilton and Armando, 2008, p.861). Another factor that can lead to the diagnosis of ODD is the frequency of the oppositional defiant behavior. When the frequency of the actions that can be considered symptoms can be observed significantly higher than the normal “developmentally appropriate” which then lead to problematic and detrimental effects to the social and academic well-being of the person, ODD is the diagnosis (Weiner and Craighead, 2010, p.1130). In addition to the said indications, it is important to remember that in most cases of ODD, the behavior can only be observed either at home or in school. In such cases, the responsibility of giving attention to the children can either fall on the hands of the parents or the teachers, thus, both are needed to be educated regarding the disorder (Weiner and Craighead, 2010, p.1130). When the different behavioral sigs and symptoms of ODD are observed, additional indications of the disease are then studied. Medical history and physical examination are the ways to solidify the diagnosis of ODD. Elimination of other behavioral and mental disorders similar to ODD in symptoms can be done on the basis of the medical history and observations. Physical parameters that can indicate and can eliminate other disorders in the diagnosis are undertaken through x-rays and blood tests (Chakraburtty, 2009). Once a person specifically a child is diagnosed to have ODD, recommendation to either a psychiatrist or a psychologist is the next phase. This is important to specifically determine the type of condition and the proper treatment and management techniques that can be applied to handle the patient. Basis of diagnosis by the psychiatrists and psychologies are the interviews and the assessment tools as well as the data and observation gathered from the people in close interaction to the child such as the parents, the teachers and other adults (Chakraburtty, 2009). Included in the screening tools that are used for the assessment of ODD are the Pediatric Symptom Checklist which although not ODD specific can determine if there are issues in the cognitive, behavioral, or emotional aspects of a child’s personality and the SNAP-IV Teacher and Parent Rating Scale for children with ADHD which can also point out the presence of ODD (Hamilton and Armando, 2008, p.863). Symptoms of ODD The basic symptoms of ODD had been discussed in the process of diagnosis but there are more behaviors and indicators exhibited by persons with ODD. Included in the common symptoms of ODD are lost of temper and argument with adults. The excessive will to defying adults’ requests and rules, the desire to annoy other people deliberately, and the observed annoyance which can easily be triggered are also included in the signs of having ODD. Other characteristics can also be clearly observed such as frequent blame on others of his or her own mistakes, annoyance, resentment, and anger (Weiner and Craighead, 2010, p.1129). Other symptoms of ODD can be observed in the manner of self-expression. In terms of language, swearing and the use of obscene language can be indications of the disorder. Mean and hurtful things can also be expressed specifically when upset. Moodiness, frustration and low self-esteem are also considered as signs and symptoms of ODD. Risk for substance abuse and alcohol can also prove cases of ODD. Adults who have problems with substance and/or alcohol abuse were often diagnosed with ODD during childhood (Chakraburtty, 2009). Other characteristics of ODD defined in the book by Lewis and Bear (2002) include the difficulty in being soothed and comforted as well as the observed high motor reactivity in the early childhood. Stubborn behavior, resistance to directions, unwillingness to compromise, testing of limits, and inability to accept blame are also evident characteristics of children with ODD. Also, the indication and symptoms are observed to intensify and increase as the child grows up. In terms of the trends related to gender, symptoms can be considered similar for both male and female but the indications of ODD for the male children are more intense and persistent. Important point is that the symptoms can commonly be observed in only one setting, example at home or in school (Lewis and Bear, 2002, p.285). Probable Causes of ODD There are different theories and models regarding the probable causes of ODD. The Biopsychosocial Model One of the most common views is that cases of oppositional defiant disorder can be caused by the interaction of biological, genetic, and environmental factors. This is referred to as the biopsychosocial model wherein biologic vulnerabilities and protective factors interact with the different stimuli in the environment increasing the risk of developing ODD (Hamilton and Armando, 2008, p.862). The biological causes of ODD can be related to the physiological structure and composition of a person’s brain, which can either be innate or due to defects or injuries. People with ODD had been known to have an abnormal amount of neurotransmitters, which are specialized chemical with specialized functions. Abnormalities in the neurotransmitters can also lead to other mental conditions, e.g. ADHD (Chakraburtty, 2009). The genetic causes of ODD can be related to the abnormalities and susceptibility of the brain to different factors which had been passed from the ancestor to the child. The sensitive brain of the child then is susceptible to different forms of illnesses which include ODD. Other diseases that can be caused by the said factor are mood, anxiety and personality disorders (Chakraburtty, 2009). Environmental factors can also contribute to the development of ODD. Prevalent examples of the factors that can lead to the development of ODD and other behavioral disorders are problematic and dysfunctional family life and history of mental illnesses and substance abuse in any members of the family especially the parents (Chakraburtty, 2009). Transactional Conceptualization of ODD The transactional conceptualization of ODD is about the view that children behaving in a problematic manner lack the skill to control their actions. Deficits in different forms of cognitive or emotional elements that are required for obedience toward figures of authority such as the parents and other adults in close interaction e.g. school teachers. One example is the lack of affective modulation that leads to outbursts and emotional overreactions. Another is the lack of cognitive skills for proper reasoning regarding the relationship with the adults (Hamilton and Armando, 2008, p.863). Neurobiologic Theories Another perspective on the cause of ODD is through the neurobiologic theories which are focused on the role of the different neurotransmitters in aggression. No single neurotransmitter had been recognized to cause ODD but the interaction of the different neurotransmitters had been considered namely serotonin, nor epinephrine, and dopamine. Prenatal causes were also considered though more proofs of the relationship in the development of ODD are needed. Effects of malnutrition and smoking during pregnancy are examples of prenatal factors that increase the risk of the development of ODD (Hamilton and Armando, 2008, p.863). Effects of ODD The expression of the different symptoms of ODD can affect the aspects of life of the child. One is the negative effect on school achievement and social success. Due to the oppositional behavior of the child, school achievement due to antagonizing other people can reflect on the school marks. In addition, hostility can occur and can also leave a mark on the school performance of the child. Social success is a given failure since it is a common notion that a child with bad temper would have difficulty in interacting with other children and establishing friendships. This results in peer rejection and even social isolation. Due to constant issues in interacting with peers and other children in school, ODD had been considered to increase the risk of potential school drop out (Lewis and Bear, 2010, p.285). Another effect is the worsening of ODD that can lead to the development of conduct disorder and antisocial personality, delinquency, and potential future criminality. These are the worst scenarios that can be attributed to oppositional deviant disorder. In addition, the child in the future will have no capability to establish healthy and long term relationships with other people even his or her own family since the care and patience of the family members had continuously been tested since childhood (Lewis and Bear, 2010, p.285). Treatments for ODD There are two general types of ODD treatments, the nonpharmacologic treatment and the pharmacologic treatment. Nonpharmacologic Treatment The nonpharmacologic treatment is composed of different types of interventions aimed to help not only the child but the adults and people in close interaction with the ODD patient. There are different types of nonpharmacologic treatments such as psychotherapy, parent training, multisystematic therapy, One of the methods of treatment is the psychotherapy which is a form of counseling that is not only focused on the child but on other members of the family and the community. There are different methods of psychotherapy for the children but the general aim of these interventions is to enable to proper emotional expression and to improve the ability to control anger (Chakraburtty, 2009). Parent training or parent management training (PMT) is proven to resolve disruptive behavior since the parents can achieve a deeper understanding of the child’s behavior. Conflicted relationship between parent and children is due to the parent’s view that oppositional behaviors of the child are deliberate, intentional, and under the child’s control. But through parent training, the parents are taught to be more positive and to prevent harsh process of discipline towards their children. The intervention also supports to parents so they can feel less alone and no detrimental effects on their own health can be incurred due to the experienced with their children with ODD. Based on studies, training both parents and children is considered to be the optimum set up (Chakraburtty, 2009; Hamilton and Armando, 2008, p.863; Matthys and Lochman, 2010, p.129). The cognitive-behavioral therapy is a type of intervention that intends to improve the behavior of the child through the change in the manner of thinking or cognition (Chakraburtty, 2009). It specifically tries to eliminate the deviant social cognitions. As a result improvements in behavior and personality can be observed (Matthys and Lochman, 2010, p.141). The intervention is considered effective for children with externalizing behavior problems such as ODD (Reinecke, Dattilio and Freeman, 2006, p.50). There are also interventions that target the education of the community regarding ODD and other behavioral disorders. The multisystematic therapy is aimed to affect multiple numbers of real-life settings simultaneously which is important to be able to give attention to more cases of ODD but there are limitations in the efficacy of the treatment, e.g. the number of cases (Hamilton and Armando, 2008, p.864). (Matthys and Lochman, 2010, p.141). The collaborative problem-solving interventions are also used treat cases of ODD. The activities involve both the parents and the children who are taught to work through demanding situations that forces them to work together to achieve mutual satisfaction and build better relationships. The approach of the said intervention is similar to the parent training intervention (Hamilton and Armando, 2008, p.864). Pharmacologic Treatment The pharmacologic treatment means the use of medication to treat behavioral and mental disorders. Though there are medications recommended for ODD, there is no formal approval on such medications. The common recommended medicines for ODD cases are similar to other mental illnesses such as ADHD or depression to be able to give medical attention to certain symptoms similar to the said conditions such as distress (Chakraburtty, 2009). Medicines used for the treatment of ADHD which are also recommended for coexisting oppositional defiant disorder are methylphenidate or Ritalin, atomoxetine or Strattera, and amphetamine/dextroamphetamine or Adderall. Another medication with research back-up is clonidine or Carapres used for either monotherapy or as a support to other forms of medical therapy (Hamilton and Armando, 2008, p.865). Management of Children with ODD Prevention is one of the most important ways in managing ODD. Included in the ways that can contribute to the prevention of ODD are programs for preschool children that are aimed to reduce acts of delinquency as well as ODD. As children grow, additional ways of prevention can be employed. The parent management strategies which are also considered as important intervention is considered as a method of preventing the onset of ODD and other types of disruptive behavior. Examples of the parent-child approach are the Triple P-Positive Parenting Program and the Incredible Years which are aimed to influence the children with the parents’ confidence, knowledge and skills (Hamilton and Armando, 2008, p.865). In addition to the prevention approach targeting the parents, other family members are also needed to be educated to improve the atmosphere at home for the positive growth of children. Another importance of educating every family member is to learn the symptoms of relapse, thus, preventing its onset. Basically, the lesson needed to be learned by the whole family is the importance of giving positive encouragement towards the normal development of a child’s personality and behavior through proper support, nurturing, love and discipline (Chakraburtty, 2009). School-based programs are also effective in controlling the onset of ODD because of the amount time every child spends within the school campus. Programs such as anti-bullying, antisocial behavior and peer groups are some of the school-braced ways of preventing ODD (Hamilton and Armando, 2008, p.865). It is also essential to seek the help of the specialized medical professional regarding behavior problems to be able to achieve proper assessment at an early stage. This is important not only to prevent further worsening of the condition but to determine the appropriate management techniques that can be applied by the family member that can improve the behavior and for the ODD not to develop into more serious ailment (Chakraburtty, 2009). For the child with ODD, management of the disease is important to be able to survive in the society. Anger management and social skills are the important focus of management methods of ODD. Anger management can resolve high anger arousal which when left unresolved can lead to impulsive and explosive behavior later in life. When anger management issues are resolved, aggressive behavior can also be prevented. Examples of programs for anger-control are Managing Anger Skills Training, Helping kids Handle Anger: Teaching Self-Control, Stress Inoculation Training; “Think-Aloud” cognitive-behavioral approach, Adolescent Anger Control, Aggression Replacement Training, and comprehensive program for reducing aggressive behavior (Quay and Hogan, 1999, p.447). In terms of the social skills approach, although controversial had been considered by most people to be effective. This is due to directly inculcating social skills to achieve a prosocial behavior that can easily be accepted by peers and avoid interpersonal rejection. Social behaviors are behaviors that enable initiation and maintenance of social connection, lead to peer acceptance and allow effective coping to a larger social environment (Quay and Hogan, 1999, p.447). One important reminder needed to be given attention in management of children with ODD is that they do not resort to violence. In cases wherein violent actions can be observed, immediate professional help is required. Even threat of harm is a logical cause of alarm thus contacting therapist, psychologist or psychiatrist is required (Rutherford and Nickerson, 2010). Managing children with ODD had been expressed by Barkley and Benton (1998) in 8 steps. Step 1 is paying attention. The parents should pay attention to the behavior and the different activities and interests of the child. Step 2 is ‘start earning peace and cooperation with praise’ which can be considered as a highly positive parenting approach that can encourage the child to behave and follow rule. Step 3 is about giving rewards when praise is not enough. The problematic behavior of the child with ODD is a given, thus, multiple approaches of encouragements to improve behavior and attitude is important. The use of mild discipline is being taught in the 4th step. Strict discipline will not work for children with ODD because it can only increase the negative force brought about by the disease to the behavior and personality of the child. Step 5 is the use of time-out with other misbehavior. This is to be able to lessen the pressure of imposing discipline (even if it is mild discipline). Thinking aloud and thinking ahead is the step 6 which describes the different ways of coping in public situations. According to the said step, preparation is the key to handling the reaction of the child properly. The seventh step is geared toward teaching other people in the society who had effects on the children to cope with their condition. Helping the teacher help the child can reinforce the values and the training being undertaken at home. Step 8 is moving toward a bright future which discusses ways to be free from ODD and planning for the future of the child (Barkley and Benton, 1998). Current Issues in the ODD Research The similarities and differences of ODD with other conditions is an important issue in the paper since it can affect both the diagnosis and the treatment and management of the disorder. ODD coincides with other conditions in many aspects thus distinction is very important. In the study by Ghanizadeh (2011), the main focus is the overlap of conditions ADHD and the oppositional defiant disorder. The main basis of their differences is the description presented in the DSM-IV, which is about the eight symptoms. Based on the study though, it is hard to distinguish between the two conditions. This is true since diagnostic assessment and treatment procedures commonly reveal the application for both ADHD and ODD. The main conclusion of the paper focused on the need to update and to revise the DSM-IV description of the two disorders. In the study of the symptoms of the different disorders namely conduct disorder, ODD, ADHD, and callous-unemotional traits as unique predictors of psychosocial maladjustment in boys, preparation for evidence base of DSM-V had been established. Based on the study, ODD is related to different criminal charges such as theft and violence. In addition, ODD symptoms are the ‘strongest predictor of future defiant behaviors (Pardini and Fite, 2010). Another focus of studies related to ODD is the correlation with behavioral problems and self-concept of the child. The study proved that children with ODD in general have ‘behavioral problems, poor social competence, and lower self concept’ which are reasons for having problematic social connections and relationships and can lead to deviant activities in the future (Chen et al., 2011, p.220) In the study of the co-occurrence of anxiety disorder (AD) and ODD, the question is whether AD can mitigate or exacerbate ODD symptoms. Although there are problems with the procedure, risks had been observed regarding child temperament, aggression, limbic system processes, executive functioning abilities and social issues (Drabick, Ollendick and Bubier, 2010, p.307). These are the studies that had been published from the past few years to the present year. It can be considered then, that there is a continuous process of updating of data regarding ODD which is important in the search of clear understanding of the condition. Conclusion Based on the detailed research of oppositional defiant disorder, ODD, it had been determined that the symptoms are very similar to other behavioral disorders such as ADHD. The effects and symptoms of ODD can lead to problematic interaction with other people and can develop to more serious conduct disorder and even criminal activities in the future. This is the main reason for the attention given to the condition in addition to the fact that it is one of the most common diagnoses for children with disruptive behavior. In conclusion, ODD, although misjudged as a simple condition can detrimentally affect the development and the life of the child. References Barkley, R.A. and Benton, C.M. (1998). Your Defiant Child: 8 Steps to Better Behavior. Guilford Press. Chakraburtty, A. (2009, September 16). Oppositional Defiant Disorder. Retrieved June 19, 2011, from http://www.webmd.com/mental-health/oppositional-defiant-disorder Chen, L., Luo, X., Wei, Z., Guan, B., Yuan, X., Ning, Z., Ding, J. and Yang, W. (2011). Correlation Study on Behavioral Problems and Self-concept of Children with Oppositional Defiant Disorder. J Cent South Univ (Med Sci), 36 (3), 220–225. Drabick, D.A.G., Ollendick, T.H., and Bubier, J.L. (2010). Co-occurrence of ODD and Anxiety: Shared Risk Processes and Evidence for Dual-Pathway Model. 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