Oppositional Defiant Disorder

Definition

The American Psychiatric Association’s Diagnostic and Statistical Manual, Fourth Edition (DSM IV), defines oppositional defiant disorder (ODD) as a recurrent pattern of negativistic, defiant, disobedient, and hostile behavior toward authority figures that persists for at least 6 months. ODD is a condition in which a child displays an ongoing pattern of uncooperative, defiant, hostile, and annoying behavior toward people in authority. The child’s behavior often disrupts the child’s normal daily activities, including activities within the family and at school.

Causes and Risk Factors

The causative factors can be divided into categories, namely:

• Biological Factor. Aggressive behavior may be caused by alterations in the neurotransmitter activity of the brain. Neurotransmitters help nerve cells in the brain communicate with each other. If these chemicals are out of balance or not working properly, messages may not make it through the brain correctly, leading to symptoms of ODD, and other mental illnesses. Also, some studies suggest that defects in or injuries to certain areas of the brain can lead to serious behavioral problems in children.
• Familial Factor. Familial influences on child development may be genetically linked, attributed to conflict in the family home or based on parent-child interactions. Additionally, a parent’s prior aggressive behavior (in childhood) has been shown to manifest itself in their child at the same age.
• Genetics. Many children and teens with ODD have close family members with mental illnesses, including mood disorders, anxiety disorders, and personality disorders. This suggests that a vulnerability to develop ODD may be inherited.
• Environmental. Factors such as a dysfunctional family life, a family history of mental illnesses and/or substance abuse and inconsistent discipline by parents may contribute to the development of behavior disorders.

Clinical Manifestations

• Actively does not follow adults’ requests
• Angry and resentful of others
• Argues with adults
• Blames others for own mistakes
• Has few or no friends or has lost friends
• Is in constant trouble in school
• Loses temper
• Spiteful or seeks revenge
• Touchy or easily annoyed

Diagnosis

To fit this diagnosis, the pattern must last for at least 6 months and must be characterized by the frequent occurrence of at least four of the following behaviors: losing temper, arguing with adults, actively defying or refusing to comply with the requests or rules of adults, deliberately doing things that will annoy other people, blaming others for his or her own mistakes or misbehavior, being touchy or easily annoyed by others, being angry and resentful, or being spiteful or vindictive.

Management of Children with ODD

• Behavior management techniques. Use behavior contracts.
• Be fair but be firm, give respect to get respect.

• Using a consistent approach to discipline and following through with positive reinforcement of appropriate behaviors. Apply effective contingencies that are consistent responses to the child’s behavior, following through with appropriate rewards and consequences when these are needed.