Tuesday, September 02, 2014

Oppositional Defiant Disorder

Definition

Oppositional Defiant Disorder (ODD), or social aggression, is defined as a pattern of disobedient, negativistic, and provocative opposition to authority figures. More commonly seen in boys than girls, ODD can be diagnosed in children as young as 3 years of age.

Description

ODD is defined by less severe behavior than a conduct disorder. One-third of children and adolescents seen in community-based clinics with psychiatric diagnoses are considered oppositional.

Causes

The causative factors can be divided into five categories: biological, familial, sociocognitive/peer-related, psychosocial adversity and co-morbidity.

Biological Factors

Researchers believe that aggressive behavior may be caused by alterations in the neurotransmitter activity of the brain. Youngsters diagnosed with ODD appear to differ from normal and clinical comparison samples of children in two ways:

1. They display low cortical arousal

2. They display low autonomic reactivity

The assumption is that the low cortical arousal and reactivity responses diminish avoidance conditioning to socialization stimuli and fuels poor response to punishment.

Familial Factors

Familial influences on child development may be genetically linked, attributed to conflict in the family home or based on parent-child interactions.

Researchers have documented that parents who have been diagnosed with antisocial personality disorder (APD) or exhibit the signs of this disorder are strongly and specifically linked back to ODD in early childhood and conduct disorder (CD) in late childhood and in the adolescent years. Additionally, a parent's prior aggressive behavior (in childhood) has been shown to manifest itself in their child at the same age.

Dysfunctional familial functioning - including marital conflict, divorce and child abuse - have been implicated in the onset and maintenance of antisocial behavior. Effects of marital conflict, divorce and its hostility appear to be mediated by the parent's lack of availability to and negativity to the child. A history of abuse and family violence in the home attributes to aggressive behavior in other settings as well.

Aggressive behavior can also stem from poor parent-child interaction, such as parent's uninvolvement in their children's activities, poor supervision and harsh and inconsistent discipline practices.

Sociocognitive/peer-related Variables

At an early age, children start to understand the social world - the "do's" and "don'ts," the "rights" and "wrongs." Through this learning period a child learns to adjust accordingly. A child with ODD has a hard time adjusting to the right way of interacting, but instead does what his upbringing has shown him. In other words, a child exposed to a harsh, abusive upbringing may begin to attribute malicious intent to others, fueling negative and aggressive interchanges that reinforce his "knowing" of the world.

Psychosocial adversity

Investigators have noted that a clear link between the measures of psychosocial adversity - including impoverishment, high rates of crime in the neighborhood, family crowding, parental antisocial personality disorder, and deviant peer groups - can lead to a child's risk for aggressive behavior.

Co-morbidity

Co-morbidity is a greater-than-chance association between two or more independent disorders. Some researchers believe that there is a co-morbidity relationship between ODD and/or Conduct Disorder (CD) and Attention Deficit/Hyperactivity Disorder (ADHD).

CD is a disruptive behavior disorder that involves the infliction of pain or the denial of the rights of others (i.e., initiating fights, breaking into others' homes, fire setting). ADHD is a disorder that involves inattentiveness, lack of impulse control and excess energy (hyperactivity).

Researchers have found that (1) there is an overlap in the symptoms of all three conditions, (2) ADHD clearly increases the risk for early onset of ODD and CD.

Symptoms

The symptoms of ODD may include:

  • Temper tantrums
  • Continuous arguing
  • Defiance of rules
  • Continual blaming of others
  • Angry and resentful affect
  • Spiteful and vindictive behavior
  • Frequent use of obscene language

Diagnosis

A thorough family, birth and general medical history will be taken. The information should be gathered from family as well as school and day-care workers. The physician will then ask the child and parents a series of questions as well as observe the child's behavior.

Treatment

Some cases of ODD resolve without treatment. In other cases, treatment is necessary. One successful form of treatment for ODD is parent management training. Parent management training focuses on how to:

  • Develop and apply well defined house rules, with clearly set expectations concerning routines for meals and other activities;
  • Consistently monitor the behavior of the child, so that they know what the child is doing and how they are feeling;
  • Apply effective contingencies, that is consistent responses to the child's behavior, following through with appropriate rewards and consequences when these are needed;
  • Apply effective techniques for dealing with crises or problems in the family, so that tensions and disputes are resolved before they get out of hand

Questions

Is the condition genetically, psychologically or environmentally based?

Can the symptoms appear sooner than 3 years of age?

Should a child psychologist be consulted?

Where do I go for parent management training?