Oppositional defiant disorder define
Oppositional defiant disorder (ODD) - Symptoms and causes
Even the best-behaved children can be difficult and challenging at times. But if your child or teenager has a frequent and persistent pattern of anger, irritability, arguing, defiance or vindictiveness toward you and other authority figures, he or she may have oppositional defiant disorder (ODD).
As a parent, you don't have to go it alone in trying to manage a child with ODD. Doctors, mental health professionals and child development experts can help.
Behavioral treatment of ODD involves learning skills to help build positive family interactions and to manage problematic behaviors. Additional therapy, and possibly medications, may be needed to treat related mental health disorders.
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Sometimes it's difficult to recognize the difference between a strong-willed or emotional child and one with oppositional defiant disorder. It's normal to exhibit oppositional behavior at certain stages of a child's development.
Signs of ODD generally begin during preschool years. Sometimes ODD may develop later, but almost always before the early teen years. These behaviors cause significant impairment with family, social activities, school and work.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, lists criteria for diagnosing ODD. The DSM-5 criteria include emotional and behavioral symptoms that last at least six months.
Angry and irritable mood:
- Often and easily loses temper
- Is frequently touchy and easily annoyed by others
- Is often angry and resentful
Argumentative and defiant behavior:
- Often argues with adults or people in authority
- Often actively defies or refuses to comply with adults' requests or rules
- Often deliberately annoys or upsets people
- Often blames others for his or her mistakes or misbehavior
- Is often spiteful or vindictive
- Has shown spiteful or vindictive behavior at least twice in the past six months
ODD can vary in severity:
- Mild. Symptoms occur only in one setting, such as only at home, school, work or with peers.
- Moderate. Some symptoms occur in at least two settings.
- Severe. Some symptoms occur in three or more settings.
For some children, symptoms may first be seen only at home, but with time extend to other settings, such as school and with friends.
When to see a doctor
Your child isn't likely to see his or her behavior as a problem. Instead, he or she will probably complain about unreasonable demands or blame others for problems. If your child shows signs that may indicate ODD or other disruptive behavior, or you're concerned about your ability to parent a challenging child, seek help from a child psychologist or a child psychiatrist with expertise in disruptive behavior problems.
Ask your primary care doctor or your child's pediatrician to refer you to the appropriate professional.
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There's no known clear cause of oppositional defiant disorder. Contributing causes may be a combination of inherited and environmental factors, including:
- Genetics — a child's natural disposition or temperament and possibly neurobiological differences in the way nerves and the brain function
- Environment — problems with parenting that may involve a lack of supervision, inconsistent or harsh discipline, or abuse or neglect
Oppositional defiant disorder is a complex problem. Possible risk factors for ODD include:
- 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
- Parenting issues — a child who experiences abuse or neglect, harsh or inconsistent discipline, or a lack of parental supervision
- Other family issues — a child who lives with parent or family discord or has a parent with a mental health or substance use disorder
- Environment — oppositional and defiant behaviors can be strengthened and reinforced through attention from peers and inconsistent discipline from other authority figures, such as teachers
Children and teenagers with oppositional defiant disorder may have trouble at home with parents and siblings, in school with teachers, and at work with supervisors and other authority figures. Children with ODD may struggle to make and keep friends and relationships.
ODD may lead to problems such as:
- Poor school and work performance
- Antisocial behavior
- Impulse control problems
- Substance use disorder
Many children and teens with ODD also have other mental health disorders, such as:
- Attention-deficit/hyperactivity disorder (ADHD)
- Conduct disorder
- Learning and communication disorders
Treating these other mental health disorders may help improve ODD symptoms. And it may be difficult to treat ODD if these other disorders are not evaluated and treated appropriately.
There's no guaranteed way to prevent oppositional defiant disorder. However, positive parenting and early treatment can help improve behavior and prevent the situation from getting worse. The earlier that ODD can be managed, the better.
Treatment can help restore your child's self-esteem and rebuild a positive relationship between you and your child. Your child's relationships with other important adults in his or her life — such as teachers and care providers — also will benefit from early treatment.
By Mayo Clinic Staff
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Oppositional Defiant Disorder (ODD) in Children
What is oppositional defiant disorder (ODD) in children?
Oppositional defiant disorder (ODD) is a type of behavior disorder. It is mostly diagnosed in childhood. Children with ODD are uncooperative, defiant, and hostile toward peers, parents, teachers, and other authority figures. They are more troubling to others than they are to themselves.
What causes ODD in a child?
Researchers don’t know what causes ODD. But there are 2 main theories for why it occurs:
- Developmental theory. This theory suggests that the problems start when children are toddlers. Children and teens with ODD may have had trouble learning to become independent from a parent or other main person to whom they were emotionally attached. Their behavior may be normal developmental issues that are lasting beyond the toddler years.
- Learning theory. This theory suggests that the negative symptoms of ODD are learned attitudes. They mirror the effects of negative reinforcement methods used by parents and others in power. The use of negative reinforcement increases the child’s ODD behaviors. That’s because these behaviors allow the child to get what he or she wants: attention and reaction from parents or others.
Which children are at risk for ODD?
ODD is more common in boys than in girls. Children with the following mental health problems are also more likely to have ODD:
- Mood or anxiety disorders
- Conduct disorder
- Attention-deficit/hyperactivity disorder (ADHD)
What are the symptoms of ODD in a child?
Most symptoms seen in children and teens with ODD also happen at times in other children without it. This is especially true for children around ages 2 or 3, or during the teen years. Many children tend to disobey, argue with parents, or defy authority. They may often behave this way when they are tired, hungry, or upset. But in children and teens with ODD, these symptoms happen more often. They also interfere with learning and school adjustment. And in some cases, they disrupt the child’s relationships with others.
Symptoms of ODD may include:
- Having frequent temper tantrums
- Arguing a lot with adults
- Refusing to do what an adult asks
- Always questioning rules and refusing to follow rules
- Doing things to annoy or upset others, including adults
- Blaming others for the child’s own misbehaviors or mistakes
- Being easily annoyed by others
- Often having an angry attitude
- Speaking harshly or unkindly
- Seeking revenge or being vindictive
These symptoms may look like other mental health problems. Make sure your child sees his or her healthcare provider for a diagnosis.
How is ODD diagnosed in a child?
If you notice symptoms of ODD in your child or teen, you can help by seeking a diagnosis right away. Early treatment can often prevent future problems.
A child psychiatrist or qualified mental health expert can diagnose ODD. He or she will talk with the parents and teachers about the child’s behavior and may observe the child. In some cases, your child may need mental health testing.
How is ODD treated in a child?
Early treatment can often prevent future problems. Treatment will depend on your child’s symptoms, age, and health. It will also depend on how bad the ODD is.
Children with ODD may need to try different therapists and types of therapies before they find what works for them. Treatment may include:
- Cognitive-behavioral therapy. A child learns to better solve problems and communicate. He or she also learns how to control impulses and anger.
- Family therapy. This therapy helps make changes in the family. It improves communication skills and family interactions. Having a child with ODD can be very hard for parents. It can also cause problems for siblings. Parents and siblings need support and understanding.
- Peer group therapy. A child develops better social and interpersonal skills.
- Medicines. These are not often used to treat ODD. But a child may need them for other symptoms or disorders, such as ADHD.
How can I help prevent ODD in my child?
Researchers don’t know what causes ODD. But certain approaches can help prevent the disorder. Young children be helped by early intervention programs that teach them social skills and how to deal with anger. For teens, talk therapy (psychotherapy), learning social skills, and getting help with schoolwork can all help reduce problem behaviors. School-based programs can also help to stop bullying and improve relationships among teens.
Parent-management training programs are also important. These programs teach parents how to manage their child’s behavior. Parents learn positive reinforcement methods, and also how to discipline their child.
How can I help my child live with ODD?
Early treatment for your child can often prevent future problems. Here are things you can do to help:
- Keep all appointments with your child’s healthcare provider.
- Take part in family therapy as needed.
- Talk with your child’s healthcare provider about other providers who will be involved in your child’s care. Your child may get care from a team that may include counselors, therapists, social workers, psychologists, and psychiatrists. Your child’s care team will depend on his or her needs and how serious the disorder is.
- Tell others about your child’s conduct disorder. Work with your child’s healthcare provider and school to develop a treatment plan.
- Reach out for support. Being in touch with other parents who have a child with ODD may be helpful. If you feel overwhelmed or stressed out, talk with your child’s healthcare provider. He or she may direct you to a support group for caregivers of children with ODD.
When should I call my child’s healthcare provider?
Call your child’s healthcare provider right away if your child:
- Feels extreme depression, fear, anxiety, or anger toward him or herself or others
- Feels out of control
- Hears voices that others don’t hear
- Sees things that others don’t see
- Can’t sleep or eat for 3 days in a row
- Shows behavior that concerns friends, family, or teachers, and others express concern about this behavior and ask you to seek help
Call 911 if your child has suicidal thoughts, a suicide plan, and the means to carry out the plan.
Key points about ODD in children
- Oppositional defiant disorder (ODD) is a type of behavior disorder. Children with ODD are uncooperative, defiant, and hostile toward peers, parents, teachers, and other authority figures.
- Developmental problems may cause ODD. Or the behaviors may be learned.
- A child with ODD may argue a lot with adults or refuse to do what they ask. He or she may also be unkind to others.
- A mental health expert often diagnoses ODD.
- Therapy that helps the child interact better with others is the main treatment. Medicines may be needed for other problems, such as ADHD.
Tips to help you get the most from a visit to your child’s healthcare provider:
- Know the reason for the visit and what you want to happen.
- Before your visit, write down questions you want answered.
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
- Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
- Ask if your child’s condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if your child does not take the medicine or have the test or procedure.
- If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.
Oppositional defiant disorder: label or diagnosis?
For ParentsPractices how toTeens
In recent years, more and more parents are worried that their child has Oppositional Defiant Disorder (ODD). The American Psychiatric Association defines ODD as anger, irritability, stubbornness, vindictiveness, and defiance.
Typically, parents will admit that a teacher or family doctor has stated that their child may have ODD, and when they read the description on the Internet, they find that some of the symptoms do match. They are confused and anxious, and this is quite understandable.
The OIA label, affixed by “well-wishers”, makes mothers and fathers think that their child is dangerously ill, and they themselves are worthless parents
In addition, such a preliminary diagnosis makes it difficult to understand where the aggression came from and how to eliminate behavioral problems. It is bad for everyone: both parents and children. Meanwhile, OVR is nothing more than a common "horror story" that can be overcome.
1. Get rid of the "shameful" stigma
Someone said that your child has ODD? It's OK. Let them say anything and even be considered experts, this does not mean that the child is bad.
“In my twenty years of practice, I have never met a bad child,” says psychotherapist Erina White. “In fact, most of them act aggressively or defiantly from time to time. And everything is fine with you, you are normal parents. Everything will be fine - both for you and for the child.
2. Understand what is bothering you
What is going on at school or at home? Perhaps the child refuses to obey adults or is at enmity with classmates. Of course, this behavior is frustrating, and you don't want to indulge it, but it's fixable.
3. Answer the question “why?”
Why does the child behave like this? Significant reasons are found in almost all children. Parents who think about the situations and events that may have triggered the disturbing behavior are more likely to discover something important.
Events at school. For example, a child becomes especially unbearable when the school day is obviously not a success. Maybe some bully bothered him more than usual. Or he feels unhappy because other children read better than him. At school, he diligently kept a straight face, but as soon as he returned home and found himself among his relatives, in a safe environment, all the difficult emotions splashed out. In essence, the child is experiencing severe anxiety, but does not yet know how to cope with it.
Problems in the family. Mum and dad might be getting a divorce. Or your beloved grandfather fell ill. Or a military father, and he was recently sent to another country. These are really serious problems. If the difficulties are related to one of the parents, they may feel guilty or become defensive.
“I always remind people that at any given moment we are doing our best. Even if the problem cannot be solved instantly, identifying it already means removing the stuck label, stop looking for signs of pathology and start correcting children's behavior, ”the psychotherapist emphasizes.
4. Return to treatable symptoms
You can help your child cope with aggression by teaching him to understand his own emotions. Then move on to work on self-control and gradually develop mental and bodily awareness. To do this, there are special video games, playing which children learn to speed up and slow down their heartbeat. In this way, they understand what happens to the body when violent emotions take over, and learn to automatically calm down.
Whatever strategy you choose, the key to success is creativity, a friendly and sympathetic attitude towards the child and your perseverance. It is depressing that this diagnosis can ruin a child's life. OVR first. Then antisocial behavior. By the time the child becomes a teenager, the people who had every chance to help him become afraid of him. As a result, these children are assigned the most severe course of treatment: in a correctional institution.
Extreme, would you say? Alas, this happens all too often. All practitioners, educators and doctors should expand their horizons and, in addition to the child's bad behavior, see the environment in which he lives. A holistic approach will bring much more benefit to children, parents and the whole society.
Text: Elena Anisimova Photo Source: Unsplash
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Oppositional defiant disorder
Alexander Borisychev, a psychiatrist and neurologist at the DocDeti clinic, wrote an article on the topic of oppositional defiant disorder.
Almost all parents face difficult behavior in a child. This also applies to situational stories when the baby is hungry or did not sleep well, and entire periods when it is difficult to agree with the child (often this happens at 2-3 years old).
But separately it is worth noting the states when the habitual way of the whole family is significantly and for a long time violated. Usually, parents describe that it is impossible to agree on anything with a child almost always. Family life turns into a constant dispute between parents and the child. Homework, cleaning the room, helping parents is an impossible mission, or after this was achieved, the parents remember with shame by what means they achieved this.
One possible reason for this behavior is oppositional defiant disorder.
Oppositional defiant disorder (ODD) is a persistent pattern of deliberately defiant, naughty, provocative, or aggressive behavior that occurs more frequently than children of a similar age and developmental level and is present not only when interacting with siblings.
The former is characterized by a persistent angry/irritable mood with occasional violent outbursts of anger.
For the second - stubborn, wayward and defiant behavior.
The causes of this condition are not completely known, but it is assumed that it depends on genetics and temperament:
- Low tolerance for frustration
- The presence of traits of insensitivity and callousness.
It should be understood that childhood abuse can also affect this disorder.
OVR is quite common:
- from 2 to 11% in the population
- There is evidence that up to 16%
- In certain groups up to 40% (in adolescents with bipolar disorder).
It is noted that boys experience this disorder more often, but in adolescents and young adults it becomes less noticeable.
The most pronounced period of OVR falls on the age of 5 to 10 years, then the symptoms, as a rule, smooth out.
It is worth suspecting OVR if the child has at least 4 symptoms most of the days for six months:
1. Loss of self-control
2. Resentment and anger
4. Argue with adults
5. Actively resists or refuses to comply with the rules and requests set by adults.
6. Purposefully annoying others
7. Blames others for your mistakes.
8. Can be vicious and vengeful.