A few years ago I wrote an article on Oppositional Defiant Disorder Symptoms and Treatment, discussing the condition, symptoms and treatment options. This article is an update on our current understanding of ODD, including the symptoms, diagnosis and tests, causes and risk factors as well as the current treatment strategies, including alternative medicine.
Oppositional defiant disorder(ODD) is a disruptive behavior disorder of children. The cardinal characteristics of ODD include obnoxious aggressive behavior and an intent to bother and irritate people, particularly adult authority figures. As you might expect, the obnoxious behavior of ODD children tends to create problems with family and friends, both in school and at home.
Description of Oppositional Defiant Disorder
Oppositional defiant children and defiant teens consistently refuse to follow commands or requests by adults. These children repeatedly lose their temper, test adults, and refuse to comply with rules and directions. Defiant children and teens become annoyed easily. They refuse to take responsibility and blame others for their mistakes. These children are stubborn and obnoxious, and even as young children they test your limits and your patience.
Defiant children and teens are extremely manipulative. Everywhere they go they are surrounded by discord. They incite family members to fight with each other and in doing so, turn attention away from themselves.
Most children are obnoxious and defiant during certain periods of their lives, particularly during ages of transition such as the toddler phase or the teen years. During these developmental stages chidren and teens are testing their limits so they normally act with defiance in order to assert themselves. At other times normal children can act out with defiance, particularly when they are tired, hungry, or upset. This makes the diagnosis of this condition even harder
The difference between normal bad behavior and oppositional defiant behavior is a matter of degree and frequency. Children with Oppositional Defiant Disorder display difficult behavior to the extent that it disrupts their learning, school adjustment, and, sometimes, with the child's social relationships.
Here is a list of characteristic behaviors seen in Oppositional Defiant Disorder children. They include:
* Getting angry easily
* Arguing and talking back to adults
* Defying reasonable requests
* Bucking rules
* Intentionally bothering people
* Pushing their limits
* Not taking responsibility for their mistakes or misbehavior
* Getting easily annoyed
* Getting angry easily * Being resentful, spiteful, or vindictive.
* Speaking harshly
* Being brutally unkind when upset
* Seeking revenge
* Having frequent temper tantrums
Parents of ODD children usually describe their children as being rigid and demanding, even from an early age.
Diagnosis of ODD
Mainly of the characteristic behaviors seen in Oppositional Defiant Children or ODD teens occur frequently in normal children, also. This makes the diagnosis of Oppositional Defiant Disorder a difficult one to make. An accurate diagnosis requires a psychiatrist, psychologist, or some other qualified mental health professional an usually entails a comprehensive diagnostic evaluation. There are no blood tests for this condition.
If you think you might have an ODD child or teen, there is a short ODD Screening Test
No one knows what causes Oppositional Defiant Disorder. There are currently two theories.
The developmental theory suggests that the persistent is really a result of incomplete development. For some reason, these children never complete the developmental tasks that normal children master during the toddler years. They get stuck in the 2-3 year old stage of child defiance and never really grow out of it.
The learning theory suggests that the ODD develops as a response to negative interactions. The techniques used by parents and authority figures on these children bring about the disobedient behavior. The parents are not to blame when this happens. These same techniques work quite well for normal children.
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ODD Risk Factors
Oppositional Defiant Disorder usually does not occur alone.
* 50-65% of these children also have ADD ADHD
* 35% of these children develop some form of affective disorder
* 20% have some form of mood disorder, such as Bipolar Disorder or anxiety
* 15% develop some form of personality disorder
* Many of these children have learning disorders
Any child with ODD should be evaluated for other disorders as well. If your child's disruptive behavior is excessive, then you must find out if there are other co-existing problems. The key to getting a handle on ODD child behavior is treating these other conditions, as we shall soon discuss.
Prognosis of Oppositional Defiant Disorder
So what happens to to ODD children? There are four possible paths.
* Some will grow out of it. Half of the preschoolers that are labeled ODD are normal by the age of 8. However, in older children, 75% will still be noticeably defiant later in life.
* The ODD may turn into something else. 5-10 % of preschoolers with ODD have their diagnosis changed to ADHD. In some children, the defiant behavior gets worse and these children eventually are diagnosed with Conduct Disorder. This progression usually happens fairly early. If a child has ODD for 3-4 years and he hasn't developed Conduct Disorder, then he wonג€™t ever develop it.
* The child may continue to have ODD without any thing else. This is unusual. By the time preschoolers with ODD are 8 years old, only 5% have just this condition and nothing else.
* The child develops other disorders. This is very common.
Medical Treatment of Oppositional Defiant Disorder
Recent studies demonstrate that certain medications can help with Oppositional Defiant Disorder. The research is preliminary, but the studies show that under certain circumstances medical treatments may help.
In one study, Ritalin was used to treat children with both ADHD and ODD. Researchers found that when treated with Ritalin, 90% of the children no longer had the ODD. However, this was a poorly executed study. The researchers dropped a number of children from the study because they were too defiant to take their medication as scheduled. Still, even if these children are included as treatment failures, the study still showed a 75% success rate with Ritalin.
In two separate studies, researchers examined the use of Strattera on children with both ADHD and ODD. One study showed that Strattera helped, one study showed it did not help.
In Canada, researchers found that Risperdal helps aggressive children of below normal intelligence. ADHD was not a factor. It didn't matter if the children had ADHD or not.
In another study, 80% of children with explosive behavior improved when given the mood stabilizer, Divalproex.
ODD Alternative Medical Treatment
No extensive studies have been run testing alternative medicine in ODD children or defiant teens. However, an alternative medicine that helps with ADHD should be effective with ODD. There was a pilot study examining the use of Omega-3 oils and vitamin E in ODD children. Both helped the problem behavior to some degree.
Psychological Intervention for Defiant Child Behavior
The main treatment for Oppositional Defiant Disorder is parental management. That means parents of ODD children or defiant teens need to improve their parenting skills in order to meet their child's particular needs and maintain their own sanity.
Originally, these programs were given by health care professionals either privately or in group settings and were expensive and not available everywhere. However, research has come out that demonstrates that a well structure home study parenting program is just as effective, less expensive, and far more convenient.
A Note of Caution:
Programs designed to teach normal parenting skills are not effective with ODD children. You will need a program that is designed to help you with the special issues that ODD children have.
Also, teens are different than younger children, and you must parent them differently. There are a lot of programs being sold today that ignore this difference and give you a "one size fits all" remedy. Some of these programs are quite expensive, too. Be careful. You need a program that is designed for your child's age group category, either 2-11 years old or twelve and older.
We specifically designed our programs, How to Improve Your Child's Behavior for parents of children ages 2-11 and How to Handle Your Difficult Defiant Teenager for parents of children ages 12 and older to meet these two challenges. These programs are available online and come with complete support for one year so that we can tailor it to your specific child and the challenges you are facing as a parent.
Conclusion: For Parents of Oppositional Defiant Disorder Children and Teens
Currently, there is still far too little research on this very common disorder.
* The best conventional and alternative medicine treatments are those that address the conditions that accompany ODD.
We know that drugs for ADHD may alleviate the defiant behavior problems in 75-90% of these children who also have ADHD. This is important because most ODD children have ADHD, also. Therefore, if you suspect your child might ADHD, it is worth your while to treat the ADHD, even if it is mild, in order to best address the behavior issues.
* ODD alternative medicine treatments may help, but there has not been a lot of research on this.
I feel that using Omega-3 supplements and a vitamin E supplement should be tried in all children. This is not as an alternative medication, but rather because most children are deficient in these nutrients. Even if it does not help with the behavioral symptoms, it should make your child healthier.
* Parenting information and parent training programs are still the most effective means of dealing with ODD in children and teens. The two main drawbacks of most of these programs are the expense and the limited availability.
Some practitioners charge $100 or more per visit and considering the program will take several months costs add up. Insurance usually will not pay for such programs. Many parents complain to me that they can not afford the program that their child so desperately needs.
In addition, these programs are not available everywhere. Over the years, numerous parents have told me that where they live there are no programs to help them with their child. Other parents tell me that they found programs online programs, but these programs didn't their child's particular needs. Some of them are 'for children of all ages' type programs and they ignore the differences between teenagers and younger children. Big mistake!
I created How to Improve Your Child's Behavior for parents of children ages 2-11 and How to Handle Your Difficult Defiant Teenager for parents of children ages 12 to address all of these problems. It allows parents to help their children regardless of where they live and at a cost that is less than one or two office visits.
Over the past five years How to Improve Your Child's Behavior and How to Handle Your Difficult Defiant Teenager have proven time and again to help parents gain control of their Oppositional Defiant Disorder teens and defiant children.
Get more information on ODD Child Behavior Help for parents of children ages 2-11 or ODD Teen Behavior Help for parents of teens ages 12.
It is tough to live with an obnoxious disobedient child. However, if you make sure that your child has his other problems addressed and you improve your parenting skills by enrolling in a parent training program, you can do a great deal to improve your child's condition and his future.
Anthony Kane, MD
ADD ADHD Advances