Definition
The American Psychiatric Association’s
Diagnostic and Statistical Manual, Fourth Edition (
DSM IV),
defines oppositional defiant disorder (ODD) as a recurrent pattern of
negativistic, 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 of uncooperative,
defiant, hostile, and annoying behavior toward people in authority. The
child’s behavior often disrupts the child’s normal daily activities,
including activities within the 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 the neurotransmitter activity of the brain.
Neurotransmitters help nerve cells in the brain communicate
with each other. If these chemicals are out of balance or not working
properly, messages may not make it through the brain correctly, leading
to symptoms of ODD, and other mental illnesses. Also, some studies
suggest that defects 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 parent’s prior
aggressive behavior (in childhood) has been shown to manifest 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 may contribute 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
Diagnosis
To fit this diagnosis, the pattern must last for at least 6 months
and must be characterized by 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 of adults,
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 and resentful, 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
positive reinforcement of appropriate behaviors. Apply effective
contingencies that are consistent responses to the child’s behavior,
following through with appropriate rewards and consequences when these
are needed.
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