A recurring pattern of irritable/angry mood, defiant/argumentative behavior, or vindictiveness, that lasts for a period of at least 6 months, defines oppositional defiant disorder (ODD). Seen in as many as 16% of children and adolescents, ODD usually manifests in late preschool or early grade school.
The exact etiology of ODD remains unclear, but genetic, biological and environmental risk factors have all been implicated. Children with an increased susceptibility include those with chemical imbalances in the brain and those born in a family with a positive history of mental health problems.
While oppositional behavior, to a certain degree, may be viewed as normal in young children, especially when they are stressed, upset, hungry, or tired, it can become pathological. ODD is considered when children are persistently hostile, aggressive, spiteful and defiant towards figures of authority. There is complete disregard for rules, deliberate attempts to annoy others, and the tendency to displace the blame for their own misconduct. There is no single test to diagnose ODD, but the clinical experience of a mental health professional in assessing the child’s behavioral patterns is vital.
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Managing ODD requires many forms of psychotherapy and training for the affected children and their parents/guardians. Since ODD often coexists with other mental conditions, it is important to identify and treat those as well. Untreated accompanying disorders can lead to more serious problems for the children in question. In general, a one-size-fits-all approach cannot be used to treat ODD, because there may be significant differences between cases. Furthermore, the severity of the disorder, comorbidities, and the child’s age must also be taken into account.
There are several important tools that may be used in the treatment and management of ODD. Parental education and training, development of social skills, problem-solving training, in addition to family and individual therapy, as well as interaction therapy between the parent and child, are the strategies usually employed. Parent training is essential to help guardians develop skills to reduce frustrations on both ends when it comes to handling problems. Social skills training enables children to learn how to interact more positively with their peers, while problem-solving training is done to help children with ODD identify and manipulate the thoughts that lead to their misconduct.
The goal of family and individual therapy is to ensure better communication between parties and foster a healthier relationship. Likewise, interaction therapy between the parent and child is necessary to enable parents to become more effective in their parenting techniques. Therapists may coach parents and train them in reinforcing positive behavioral traits in their children.
Generally, medications are not used to treat ODD; however, they may be needed if there are coexisting conditions, like mood disorders and anxiety.
It is not easy having to manage and cope with children who have ODD. However, proper counseling is a great outlet for allowing parents and guardians to deal with their concerns and frustrations. Therapy, when done correctly, can lead to a good outcome for the affected children. It not only helps them to recover, but also helps their parents and guardians to expedite that process, although it may take several months.
Children with ODD often do well with early treatment. In fact, the earlier the condition is managed, the better the prognosis. Many children are free of the behavioral patterns within three years of treatment.
It was once believed that those affected by the condition would outgrow it by early adulthood. However, children with ODD do not always outgrow the condition. For this reason, treatment is crucial to avoid long-term consequences such as the development of antisocial personality disorder later on in life.
A restoration of self-esteem and the ability to build positive relationships, not just with figures of authority, but with peers, is seen in successfully treated patients. ODD cannot be prevented, but circumstances that may worsen the condition can be circumvented.
Reviewed by Liji Thomas, MD