Overview
If asked to diagnose a child that is moody, talks back, won’t follow rules, and can be vindictive most people will say that is normal childhood behavior. It may be, but if the behavior is severe enough it could be Oppositional Defiant Disorder. Hopefully this information will allow you to tell the difference.
Many of the behaviors present in Oppositional Defiant Disorder are seen in normal development when the child is trying to push limits, create independence, and question boundaries. A child may feel as though they are “babied” too much or that they are given too much responsibility and can act out. The difference in normally developing children and those with Oppositional Defiant Disorder is that the behavior is constant, intense, and not similar to what is typically observed in the peer group. The behaviors last for at least 6 months and usually start before the age of 8 but can develop at a later age. The behavior must also greatly disrupt the environment of the child and cause distress to the family or caretaker. If the child has been diagnosed with a conduct disorder then that will supersede the diagnosis of ODD. The causes of ODD are not fully known but in most situations the environment in which the child is raised or developmental difficulties can contribute to the behavior and development of this disorder. There are possibly some inherited traits or a lack of serotonin in the brain that also contribute to the behavior.
Symptoms
A child with Oppositional Defiant Disorder will show consistent and disruptive levels of defiance, disrespect, breaking or disregarding rules, and spiteful behavior. Oppositional Defiant Disorder is diagnosed in children who are very easily annoyed and continuously and purposefully try to annoy others. They may feel vindictive towards those that annoy or harm them emotionally and physically even if it was accidental. A defining factor of this disorder is a desire to blame others for their wrongdoings. Taking responsibility and giving appropriate apologies is very difficult and may be outright refused by some children. The behavior should be present in more than one environment such as at school and home. Often these children will be labeled as bullies and may not have any close friends. The behavior ultimately impacts most relationships, academics, and opportunities for emotional growth.
Treatment
If left untreated, the child may go on to develop Antisocial Personality Disorder in adulthood, so early intervention is important. Treatment will usually require individual therapy for the child in addition to family counseling and parenting skills training developed specifically for those with children with Oppositional Defiant Disorder. A form of therapy called Parent Child Interactive Therapy is commonly used with positive results. The family works on real world situations in a therapy room while the therapist observes by camera or two-way mirror. The parents will have the help of the therapist through an earpiece from which the therapist can guide appropriate interactions, reactions, and discipline for the child. This helps put the skills learned in parenting classes and in therapy to use so that they can be more effectively transferred to the home and school environment. If it is discovered that the defiance is due to a learning disability or other developmental issues, this may be the focus in the school environment. A child may be using defiance to avoid certain activities in which they feel inept or afraid of judgment by peers so it is important to get school evaluations done to determine if there is an issue. Medication is not currently used for this disorder because it is not believed to be a brain based condition. By creating consistency and positive discipline in the home with the help of a therapist the child can be expected to improve.
