Oppositional defiant disorder in childhood
It's normal for children to be defiant and challenging from time to time. In fact, it's a sign of healthy development. So when is a child considered to have oppositional defiant disorder? The diagnosis shouldn't be given, for example, to a toddler who has just discovered that their new favorite word is "no."
Oppositional defiant disorder (ODD) is usually diagnosed at the start of elementary school, around six or seven years old, and is no longer diagnosed by adolescence. Children with ODD have a well-established pattern of behavioral problems.
Symptoms include:
- To be unusually angry and irritable.
- Losing patience frequently.
- Easily annoyed.
- Arguing with authority figures.
- Refusing to follow the rules.
- They are deliberately annoying people.
- Blaming others for mistakes.
- To be vengeful.
All children may experience these symptoms from time to time. What distinguishes ODD from normal oppositional behavior is its severity and the duration of these symptoms. A child with ODD will have exhibited extreme behavioral problems for at least six months . Another hallmark of ODD is the toll it takes on family relationships. Regular daily frustrations (ignored orders, arguments, explosive outbursts) accumulate over time, and these negative interactions damage the parent-child bond and reinforce hostile behavior patterns. It is estimated that 6% of children are affected by ODD. Approximately 30% of young people with attention deficit hyperactivity disorder (ADHD) also have ODD.
Children with behavioral problems push parents to their limits. Parents feel pressured to be both permissive and overly coercive, hoping that increased control will make the child listen. Neither extreme contributes to ideal parenting. Parents never intend to reinforce bad behavior, and often we don't realize when we're doing the opposite of what we'd like.
Why do some children have behavioral problems?
Two common scenarios are presented below:
- A father asks his son to stop playing and get ready for bed. The boy ignores the first two requests. The third time the father asks, he is so angry that he shouts.
- A father asks his son to stop playing and get ready for bed. The boy throws a tantrum because he wants to keep playing. The father doesn't want him to be so upset before bedtime, so he backs down and tells him he can play for another ten minutes, but then he has to go to bed.
In the first scenario, the child learns that yelling is an acceptable way to get a message across. More subtly, he might also be learning that he can continue ignoring those initial requests; it's when the parent escalates the situation that he knows they mean business.
In the second scenario, the child has learned that throwing a tantrum could get them something they want, so they will be more likely to do it again in the future.
Both scenarios can lead to future conflicts for families, and the more they are repeated, the more they become ingrained family patterns of behavior that are harder to break. A child doesn't need to have ODD for these scenarios to occur, but repeated negative interactions like these make a conduct disorder diagnosis much more likely.
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This also explains why children with ODD may behave worse at home . Children with ODD are likely to be more confrontational with people they know well, partly because the patterns of interaction between them are already well established. Whereas in a place like school, where a child generally has less control over their environment, the types of behaviors common to ODD may not produce the same results.
There is a very high rate of comorbidity (two or more disorders occurring simultaneously in the same individual) in children with ADHD who are also diagnosed with ODD. Depending on the study, the comorbidity rate could be between 30 and 50% in children with ADHD who also have ODD.
Children who had great difficulty calming themselves down as young children and continue to struggle to manage their emotions appropriately when faced with disappointment or frustration may sometimes develop ODD. The adults in their lives may be more inclined to accommodate their demands in order to keep the family functioning as harmoniously as possible. Children who have experienced significant stress and trauma in their lives are also more likely to develop ODD.
Parents play a key role in the treatment of ODD. This may be surprising, since children are the ones who receive the diagnosis, but in ODD, the parent-child relationship needs to be repaired, meaning that both parties must make changes to get back on track.
All treatment programs share certain common goals, such as helping parents find a balance between being too authoritarian and too permissive. A behavioral therapist will help parents learn how to manage their children's behavior by setting clear expectations, praising them when they comply, and applying effective consequences when they don't. Parents also learn to use these strategies consistently; one reason behavior management strategies sometimes fail is that parents try different and conflicting techniques or don't stick to a program long enough to see results. Parents and children will also learn problem-solving skills for when they need them.
A small percentage of children with ODD develop what is known as conduct disorder , which is a more serious condition that includes criminal acts such as stealing, starting fires, and harming people or animals.
This is an original article from the 12th FAROS Report "A look at the mental health of adolescents - Keys to understanding and supporting them".
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