3. Isn't it normal?
•As any parent knows, children and adolescents are
oppositional from time to time. Frequently when when
tired, hungry, stressed or upset children may argue,
talk back, disobey, and defy parents, teachers, and
other adults.
•Oppositional behavior is often a normal part of
development for two to three year olds and early
adolescents. However, openly
uncooperative and hostile behavior becomes a serious
concern when it is so frequent and consistent that it
stands out when compared with other children of the
same age and developmental level and when it affects
the child's social, family, and academic life.
4. Basic Info
•Oppositional defiant disorder is a psychiatric
category listed in the Diagnostic and
Statistical Manual of Mental Disorders.
•I t is described as an ongoing pattern of
disobedient, hostile, and defiant behavior
toward authority figures which goes beyond
the bounds of normal childhood behavior.
5. Possible Causes
•There's no clear cause underpinning
oppositional defiant disorder. Contributing
causes may include:
•The child's inherent temperament
•The family's response to the child's style
•A genetic component that when coupled with
certain environmental conditions: lack of
supervision, poor quality child care or family
instability - increases the risk of ODD
•A biochemical or neurological factor
•The child's perception that he or she isn't
getting enough of the parent's time and
attention
6. DSM Criteria
•To meet DSM-IV-TR criteria, certain factors
must be taken into account.
•First, the defiance must interfere with the
child's ability to function in school, home, or the
community.
•Second, the defiance cannot be the result of
another disorder, such as the more serious
Conduct disorder, depression, anxiety, or a sleep
disorder such as DSPS. Third, the child's problem
behaviors have been happening for at least six
months.
7. Diagnostic Criteria
•I f the child meets at least four of these
criteria, and they are interfering with the
child's ability to function, then he or she
technically meets the definition of
Oppositionally defiant.
•A pattern of negativistic, hostile, and defiant
behavior lasting at least 6 months,during
which four (or more) of the following
symptoms on the next page are present.
•Note: Consider a criterion met only if the behavior occurs more frequently than is
typically observed in individuals of comparable age and developmental level.
8. Diagnostic Criteria cont.
•often loses temper
•often argues with adults
•often actively defies or refuses to comply
with adults' requests or rules
•often deliberately annoys people
•often blames others for his or her
mistakes or misbehavior
•is often touchy or easily annoyed by
others
•is often angry and resentful
•is often spiteful or vindictive
9. Diagnostic Criteria cont.
•The disturbance in behavior causes
clinically significant impairment in
social, academic, or occupational
functioning.
•The behaviors do not occur
exclusively during the course of a
Psychotic or Mood disorder.
•Criteria are not met for Conduct
Disorder, and, if the individual is age 18
years or older, criteria are not met for
Antisocial personality disorder.
10. Prevalence
•The DSM- I V- TR cites a prevalence of 2-16%,
"depending on the natureof the population
sample and methods of ascertainment."
•The Mayo Clinic Reports that up to 10% of
teens may have ODD
11. Prognosis
•Childhood Oppositional Defiant
Disorderis strongly associated
with later developing Conduct
disorder.Untreated, about 52% of
children with ODD will continue to
meet the DSM-I V criteria up to
three years later and about
half of those 52% will progress
into Conduct Disorder.
12. Treatment
•There are a variety of approaches to the treatment of
Oppositional Defiant Disorder, including parent training
programs, individual psychotherapy, family therapy,
cognitive behavioral therapy, and social skills training.
•According to the American Academy of Child and
Adolescent Psychiatry, treatments for ODD are
tailored specifically to the individual child, and
different treatments are used for pre-schoolers and
adolescents.
•An approach developed by Russell Barkley uses a
parent training model and begins by focusing on
positive approaches to increase compliant behaviors.
Only later in the program are methods introduced to
extinguish negative or noncompliant behaviors.
•Risperidone is one medication that has been used by
psychiatrists to treat this condition.
13. Controversy
•According to The American Journal of Psychiatry, there are
several sources of controversy around the diagnosis of ODD.
One concerns the fact that the DSM-IV criteria differ slightly
from those of the World Health Organization's criteria, as
outlined in the ICD-10. Diagnosis of ODD is further complicated
by the high occurrence of comorbidity with other disorders
such as ADHD, though a 2002 study provided additional support
for the validity of ODD as an entity distinct from Conduct
disorder.
•In another study, the utility of the DSM-IV criteria to
diagnose preschoolers has been questioned because the
criteria were developed using school-age children and
adolescents. The authors concluded that the criteria could be
used effectively when developmental level was factored into
assessment.
14. What's a parent to do?
•Always build on the positives, give the child praise and positive
reinforcement when he shows flexibility or cooperation.
•Take a time?out or break if you are about to make the
conflict with your child worse, not better. This is good
modeling for your child. Support your
child if he decides to take a time?out to prevent
overreacting.
•Pick your battles. Since the child with ODD
has trouble avoiding power struggles, prioritize the things you
want your child to do. If you give your child a
time?out in his room for misbehavior, don't add time for
arguing. Say "your time will start when you go to your room."
•Set up reasonable, age appropriate limits with consequences
that can be enforced consistently.
•Maintain interests other than your child with ODD, so that
managing your child doesn't take all your time and energy.
Try to work with and obtain support from the other adults
(teachers, coaches, and spouse) dealing with your child.
•Manage your own stress with exercise and relaxation. Use
respite care as needed.
