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Oppositional Defiant Disorder

Definition

The American Psychiatric Associations Diagnostic and Statistical Manual, FourthEdition (DSM IV), defines oppositional defiant disorder (ODD) as a recurrent pattern ofnegativistic, 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 ofuncooperative, defiant, hostile, and annoying behavior toward people in authority. The

childs behavior often disrupts the childs normal daily activities, including activities withinthe 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 theneurotransmitter activity of the brain. Neurotransmitters help nerve cells in the brain

communicate with each other. If these chemicals are out of balance or not workingproperly, messages may not make it through the brain correctly, leading to

symptoms of ODD, and other mental illnesses. Also, some studies suggest thatdefects 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 parents prior aggressive behavior (in childhood) has been shown tomanifest 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 maycontribute 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

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Diagnosis

To fit this diagnosis, the pattern must last for at least 6 months and must be characterizedby 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 ofadults, 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 andresentful, 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 positivereinforcement of appropriate behaviors. Apply effective contingencies that are

consistent responses to the childs behavior, following through with appropriaterewards and consequences when these are needed.