Oppositional Defiant Disorder - Report Example

Oppositional Defiant Disorder Oppositional Defiant Disorder Oppositional defiant disorder is a psychiatric pathology common in children and adolescents, which is characterized by negative behavioral responses, resistance to follow orders, sudden temper flare-ups and behaviors that are unexpected for a particular child’s age. It is most commonly observed in children and adolescents with a frequency of 16 to 22 percent cases observed in the school-going children. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-4-TR) the estimate prevalence of oppositional deficit disorder has been established as 2 to 16 percent. The age of onset of this psychiatric problem has been observed as early as three years and the clinical features can be identified easily at the age of eight years. It is very uncommon after adolescence. Boys show a greater ratio of this psychiatric disorder as compared to girls up till puberty and after gaining puberty this ratio becomes equal. (Sadock et al 2009). Oppositional defiant disorder (ODD) has various underlying causes and risk factors and it presents with different signs and symptoms and it can be identified by the set diagnostic criteria. The risk factors and etiological factors for ODD are not very clear and the family background, hereditary, environmental and social factors are mostly the underlying causes for the eruption of the symptoms in the child. Child’s natural predisposition plays a critical role in the development of this disorder. Assertive nature of the child and the similar authoritative reaction shown by the parents to discipline their child causes them to retaliate and disobey their authority figures. With the passage of time the child needs to develop a sense of self-confidence and self-determination. However, in cases of difficulty in compliance, this behavior is exaggerated and when he/she steps into adolescence, this oppositional response is intensified. Sexual or physical abuse, lack of proper supervision by parents or neglected childhood, mental retardation in late childhood, chemical imbalance for instance of serotonin and any environmental trauma can also trigger ODD. Families that have undergone problems like divorce, troubled parental relationship, frequent school changes, financial instabilities and strict and harsh discipline maintenance are other etiological factors responsible for ODD. A single factor cannot be pointed out as the cause of ODD in any affected individual (Mayo Clinic Staff 2012; Sadock et al 2009). Classic psychoanalytical theory has explained that the oppositional behavior of the children is the outcome of accumulating aggressive responses against their authority figures and is a way of expressing control over them. This control is expressed through tantrums, temper outbreaks and other negative attitudes (Sadock et al 2009). The clinical features of ODD start presenting before 8 years of age and intensify over the early teen years. It takes months and years for the clinical signs and symptoms of the child to worsen and complicate. The behavior of the child is to be noticed if he/she presents with aggressive nature and various incidents of moodiness over the past six months at least and have been persistent throughout. The symptoms include temper tantrums which are persistent, poor compliance with disobedience for rules, arguing with authority figures like parents, blaming others for own mistakes, anger and aggressive behavior, revenge taking behaviors, easily annoyed and irritated over petty issues, intentional gestures to annoy others and persistent disobedience against the parents. These symptoms can be observed both by parents at home or by teachers and friends in the setting of school. Aggressiveness is expressed by the children more often through verbal communication and harsh attitude against parents or teachers. Physical aggressiveness is less common in ODD, but more common in Conduct Disorder. Children with these features are affected severely in terms of their social, academic and environmental development and relationships. In later years of life occupational functioning is also impaired (Mayo Clinic Staff 2012; American Academy of Child & Adolescent Psychiatry 2009; Grohol 2010). The child is oppositional mostly to his peers and parents and people that he knows well. Therefore, the clinical features of these children cannot be demonstrated on clinical examination. Moreover, the child refuses his disobedient nature and usually explains it as a result of unfavorable and undesirable conditions at his home or school. He supports his behavior as a normal reaction to unwanted circumstances and harsh discipline (Sadock et al 2009). Diagnostic criteria for ODD have been described by DSM-4-TR. According to this criterion it is important to observe that the symptoms do not occur due to any co-existing mood or psychotic disorder, the symptoms cause problematic social, academic and occupational functioning and the criteria does not resemble that of conduct disorder. The symptomatic criteria described should extend over a period of six years and any four symptoms from the following should be present- temper outburst, arguing with adults, disobedience, annoying people, blaming others for mistakes, easily annoyed, frequently angry and spiteful behavior. No specific laboratory test has been designed for this disorder. However, low levels of serotonin can be detected in these individuals as they get older (Sadock et al 2009). For a correct evaluation of the child, it is necessary that his clinical signs and symptoms should be thoroughly assessed over an extended period. Parental observation and history notes are of significant value in this area. ODD should be differentiated from other similar psychiatric situations of children like attention deficit hyperactivity disorder, bipolar disorder, depression, mood disorders and anxiety disorders. Some children might also present with ODD and co-existing psychiatric disorders mentioned above. Hence, it is important to identify both the disorders and manage them at the same times to obtain effectual results (American Academy of Child & Adolescent Psychiatry 2009). Oppositional defiant behavior of the child that extends over a shorter time period should be diagnosed as adjustment disorder. Conduct disorder is considered as a variant of ODD which is developed by a prolonged progression of the ODD. However, not all children with ODD progress into conduct disorder in later years of life. Hence, two subtypes of ODD have been established. One which presents with some clinical features of conduct disorder like physical aggression (fighting) and it extends into conduct disorder later on. The other type is of lesser aggressive behavior, few antisocial characteristics and more ODD characteristic features. This subtype does not complicate into conduct disorder (Sadock et al 2009). The treatment for ODD is categorized into Individual psychotherapy, Family Psychotherapy, parent management training programs, Individual social and cognitive skill training programs and therapies and medications for the child (American Academy of Child & Adolescent Psychiatry 2009). The parent training focuses on training the parents how to deal with their child’s difficult behavior and tantrums. They are encouraged to ignore any oppositional problems and divert their attentions towards the positive behaviors of the child. Mild punishments are also included which should be immediate and predictable to the child. Programs for children who present with mild conditions extend over a period of 6-8 weeks while more severe cases that have progressed into Conduct disorder require 12 to 25 weeks. Another technique includes Group discussion videotape modeling programs that comprises of ten videotapes and demonstrates scenes where parents are interacting with their children. The parents are then homework exercise for their children. Play and reinforcement skills, lesser violence and limit setting techniques are explained to parents (Fonagy and Kurtz 2002). Individual psychotherapy includes exposing the children to situations with an authority figures and they are taught how to adapt to that particular situation. Parent-child relationship and interactions should also be monitored and if there are any conflicts they should be resolved as it greatly affects the course and prognosis of the disorder (Sadock et al 2009). Medications have not been proved yet as an effectual treatment and are not recommended for the management of ODD. Many parent support groups have been established which provide awareness about the disease, support single parents and counsel them (Grohol 2010). Parents should develop certain skills and techniques in managing their child’s behavior like time-outs when they are in the mid of a worsening conflict, age appropriate punishments, indulge in ODD support groups and parents in similar conditions for personal support and encouragement and develop an optimistic and positive attitude towards their child (American Academy of Child & Adolescent Psychiatry 2009). Children with ODD have a good prognosis and their condition can improve if proper skills, psychotherapy and family interactions are developed within the early years of life. For the best therapeutic results, it is important that parents develop a positive attitude and should be aware of the clinical aspects and therapeutic techniques related to oppositional defiant disorder. References American Academy of Child & Adolescent Psychiatry. (2009). “Facts for Families: Children with Oppositional deficit Disorder.” American Academy of child & adolescent psychiatry:aacap.org. Retrieved from: http://www.aacap.org/page.ww?name=Facts+for+Families§ion=Facts%20for%20Families Fonagy, P., & Kurtz, A. (2002). What works for whom?: A critical review of treatments for children and adolescents. New York: Guilford Press. Grohol, J. M. (2010, June 1). “Oppositional Defiant Disorder.” PsychCentral.com: Conditions. Retrieved from: http://psychcentral.com/disorders/sx73.htm Mayo Clinic Staff. (2012, January 6). “Oppositional Defiant Disorder: Basics.” MayoClinic.com: Diseases and Conditions. Retrieved from: http://www.mayoclinic.com/health/oppositional-defiant-disorder/DS00630 Sadock, B. J., Sadock, V. A. & Kaplan, H. I.. (2009). Kaplan & Sadocks concise textbook of child and adolescent psychiatry. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. Read More