Even well-behaved children may be oppositional at some point in time. Oppositional behavior may be seen particularly when young children are stressed, upset, hungry or tired. This is considered a normal part of development in children between the ages of 2 – 3 years old and in the early adolescent period. However, it becomes abnormal when it is characterized by persistently disobedient, defiant and hostile behavior towards parents and other figures of authority.
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There is an array of negative behaviors associated with oppositional defiant disorder (ODD). These include poor temperament, argumentativeness, and vindictive attitudes.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition or DSM-5, defines ODD as a recurring pattern of irritable/angry mood, defiant/argumentative behavior, or vindictiveness that lasts for a period of at least 6 months.
It is estimated that up to as many as 16% of children and adolescents may have ODD. It usually manifests sometime during late preschool or early grade school.
Furthermore, in younger children, it is more prevalent in boys compared to girls, but this ratio becomes somewhat equal in school-aged children and adolescents. ODD may occur in children from diverse backgrounds, but is more often seen in those with a lower socioeconomic status.
Hostility and aggression, together with defiance, spitefulness, and general negativity, are the most common behaviors in children with ODD. They often question and break rules, deliberately attempt to upset others, especially those in authority, and have frequent temper tantrums.
Children with ODD tend to blame others for their own bad conduct. Moreover, they are easily annoyed, actively seek revenge when they feel someone has wronged them in some way or the other, and are filled with hate, many times for no apparent reason.
ODD-affected children who succeed in creating major disturbances at home or school are usually referred to and seen by a mental health specialist as soon as it is suspected that something is wrong.
It is imperative that these children receive treatment, because ODD may be and is often associated with other mental health disorders.
Untreated ODD may develop into more serious mental disorders that have the potential to significantly interfere with the normal social and academic growth of the child.
Additionally, these children are at an increased risk for abusing substances and becoming juvenile delinquents.
Estimates suggest that approximately 50% of patients with attention-deficit/ hyperactivity disorder (ADHD) have ODD.
When ADHD and ODD occur together, these children tend to be more aggressive and less interested in academic work. Other conditions that may coexist with ODD include anxiety and learning disorders as well as language and learning difficulties.
Mood disorders, such as bipolar disorder and depression, may also be seen accompanying ODD.
There is research that suggests that specific behavioral patterns seen in ODD are developed in children with mood/anxiety disorders as a means of coping.
There are studies that indicate that ODD may serve as the precursor to conduct disorders. These are more serious than ODD and often result in behavior that is antisocial and destructive.
In addition to this, ODD patients with other mental health comorbidities are at a particularly increased risk of developing conduct disorders.
Affected children and adolescents are at a very high risk of developing mood or other personality disorders later on in their lives.
Reviewed by Liji Thomas, MD