Having written about nurturing resilience and prosocial behavior in children it is equally important to write about conduct disorders because sometimes, sadly, the negative behaviors exhibited by some children are as a result of conduct disorders and warrants clinical intervention.

What is Disruptive, Impulse Control and Conduct Disorders?

According to the Diagnostic & Statistical Manual of Mental Disorders 5th edition (DSM-5) this group of disorders include conditions involving problems in the self-control of emotions and behaviors. These disorders are manifested in behaviors that violate the rights of others e.g., aggression, destruction of property and/or that bring the individual into significant conflict with societal norms or authority figures. In this article we will look at oppositional defiant disorder (ODD).

What Is Oppositional Defiant Disorder?

Oppositional defiant disorder (ODD) is a behavior disorder classified under Disruptive, Impulsive and Conduct disorders. Children with ODD are uncooperative, defiant, and hostile toward peers, parents, teachers, and other authority figures. It is mostly diagnosed in childhood.

It is however normal and a sign of healthy development for children to be oppositional and defiant at least some of the time – they also have personal agency meaning they are not just mere recipients of information but are creators of their own realities as well.

For example, it is not unusual for preschool children to show temper tantrums on a weekly basis. Even well-behaved children do present their own

fair share of challenges for parents and caregivers at times. So how does a parent know when a child have oppositional defiant disorder? If your child present with: ODD is distinguished from normal oppositional behavior by severity and duration for it to warrant clinical attention. Behavior has to be extreme, affecting relationships in at least one environment for example, school, home, friendships etc., for at least six months.

What Causes ODD?

There’s no known clear cause of oppositional defiant disorder. It is believed that several factors are at play that is a combination of inherited and environmental factors, like:

•  Genetics — a child’s natural disposition or temperament and possibly neurobiological differences in the way the nerves and the brain function.
•  Environment — abuse or neglect can contribute to a child being ODD. A child who lives with an abusive parent/s or family discord or has a parent with a mental health or substance use disorder can end up developing ODD. Oppositional and defiant behaviors can be strengthened and reinforced through negative attention from peers, family and any other authority figures.
•  Problems with parenting – lack of parental supervision, inconsistent or harsh discipline. The use of negative reinforcement increases the child’s ODD behaviors (e.g., a child does something wrong a parent always shouts). Negative reinforcement strengthens the behaviors in that a child learns that their behaviors allows them ‘to get back’ at the parent because they almost always get negative attention and reaction.
•  Temperament — a child who has a temperament that includes difficulty regulating emotions, such as being highly emotionally reactive to situations or having trouble tolerating frustration will mostly like suffer ODD. Children who had a lot of difficulty soothing themselves as toddlers and continue to struggle with an age-appropriate ability to control their emotions in the face of disappointment or frustration can sometimes develop ODD.

Children who have experienced a lot of life stressors and trauma are also more likely to develop ODD.

What Are The Symptoms Of ODD?

The essential feature of oppositional defiant disorder is a frequent and persistent pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness. A frequent and persistent pattern of anger that is not proportional to the situation/s.

Angry/Irritable Mood

Irritability, arguing, defiance or vindictiveness toward you and other authority figures, he or she may have oppositional defiant disorder (ODD).

•  Often loses temper.
•  Is often touchy or easily annoyed.
•  Is often angry, resentful and irritable

Argumentative/Defiant Behavior 

•  Often argues with authority figures.
•  Often actively defies or refuses to comply with requests from authority figures.
•  Deliberately breaks rules.
•  Often deliberately annoys and upsets others.
•  Often blames others for his or her mistakes or misbehavior.

Vindictiveness

•  Being spiteful or vindictive on a regular.
•  Doing things to annoy or upset others, including adults deliberately.
•  Speaking harshly or unkindly. Other factors should also be considered, such as whether the frequency and intensity of the behaviors are outside a range that is normative for the individual’s developmental level, gender, and culture. It is not uncommon for individuals with oppositional defiant disorder to show symptoms only in one setting like the home and only with family members or at school only. However, the pervasiveness of the symptoms is an indicator of the severity of the disorder. Mild: Symptoms are confined to only one setting like at home, at school, or with peers. Moderate: Some symptoms are present in at least two settings.
  Severe: Some symptoms are present in three or more settings. The symptoms of the disorder often are part of a pattern of problematic interactions with others. Furthermore, individuals with this disorder typically do not regard themselves as angry, oppositional, or defiant. Instead, they often justify their behavior as a response to unreasonable demands or circumstances. How is ODD diagnosed? There is no medical or a physiological exam to determine the presence of ODD, a diagnosis is given by a Child Psychiatrist, a Psychologist or any other qualified mental health expert. The mental health expert will talk with the parents, caregivers and teachers about the child’s behavior and may observe the child. In some cases depending on the child’s age, a mental health testing can be done using a test where a child and or the parent answers some questions which will be scored and evaluated by the expert .So if you notice symptoms of ODD in your child or teen, it is important to seek help right away. Early intervention can often prevent future problems.

Treatment & Prevention

There is no medication for ODD though some clinicians especially a child psychiatrist can make use of other medications like the ones for ADHD or for depression as mood regulators or to treat any other comorbidities and in some cases there is marked improvement in behavior.

The most common intervention to date is behavior management through some of these therapies:
Cognitive-behavioral therapy (CBT) – A child learns to better solve problems and communicate. He or she also learns how to control impulses and anger.
Family therapy – This therapy is all about making changes in the family. It improves communication skills and family interactions and helps families get rid of unhelpful systems and adapt new ways. Having a child with ODD can be very challenging for parents and can cause problems for siblings as all emotional resources are drained just by that one individual. Parents and siblings need help themselves so that they are better able to support and understand the individual with ODD.

•  Peer group therapy – A child gets therapy through a group of individuals who share similar challenges or not, as a peer group is easier for the child to identify with and in the process develops better social and interpersonal skills.
•  Parent training – A parent/s gets training on how to best help their child and understand their condition and are equipped with tools to guide the child to more acceptable behaviors. This therapy helps parents find the middle ground between being too authoritative and too permissive. It also helps parents learn how to train their child’s behavior through setting clear expectations, praising kids when they follow through and using effective consequences when they don’t. Parents play a key role in treatment for oppositional defiant because the parent-child relationship needs to be repaired, which means both parties need to make changes to get back on track. Therapy can help restore the child’s self-esteem and rebuild a positive relationship between parent and child. It also improves the child’s relationships with other authority figures such as teachers and care providers. On prevention, there’s no guaranteed way to prevent oppositional defiant disorder. However, positive parenting and early intervention have been proved to help improve behavior and prevent the situation from getting worse. The earlier that ODD can be managed, the better the outcome.

Effects on Functioning

As with any other developmental disorder, normal functioning and development of a child is hindered. Some children with ODD find themselves suspended or even expelled from schools and have strained relationships that further does more harm than good.

•  Children and teenagers with oppositional defiant disorder may have relational problems at home with parents and siblings, in school with teachers, and any authority figures in their life.
•  Children with ODD may struggle to make and keep friends and relationships.
•  ODD causes poor performance in school other areas of functioning.
•  It also brings about antisocial behavior which further alienates a child and heightens the severity of ODD.
•  It causes problems in impulse control.
•  In later childhood, children with ODD turn to substance abuse and if left untreated can become comorbid with other disorders like Conduct disorder and Substance use disorder.
•  Due to the strain in relationships some children with ODD can become suicidal. Factors Affecting ODD There is a very high overlap in kids who have ADHD who are also diagnosed with ODD. The reason being ADHD already present with impulsivity, difficulty in emotional regulation, hyperactivity and problems with attention. So children with ADHD will mostly engage in things that parents, educators and caregivers will perceive as off limits and then when those children get negative feedback, they start to become even more negatively oriented towards adults. These repeated patterns of negative interactions can lead to developing ODD. Other mental health disorders that are comorbid with ODD include:

•  Conduct disorder
•  Depression
•  Anxiety
•  Learning and communication disorders

Talent Adamson Behaviour Therapist

BA (Health and Social Services) Applied Psychology, BA Hon (HSS) Psychological Counselling – (UNISA)