Oppositional defiant disorder (ODD) is a condition that occurs in children. It is characterized by defiant, hostile behavior that is not developmentally appropriate.
At certain ages, children may be naturally quite rebellious. Adolescence, for example, may be characterized by frequent bouts of anger and misbehavior, and toddlers generally go through a phase in which they exert their individuality by refusing to follow rules and exhibiting contrary behavior. However, both of these types of rebellious behavior are often simply part of the normal individuation process. They are not diagnosable behavioral conditions, although they may be frustrating and will often require some parental skills with boundaries, patience, discipline, and good communication.
According to the DSM, for a child to be diagnosed with ODD, the behavior must not be typical of the child's current developmental stage. Recurrent tantrums in a two-year-old, for example, would not indicate a diagnosis of ODD, while they might in an eight-year-old who exhibited the same behavior. Symptoms of the condition include:
Anxiety, posttraumatic stress and depression can cause symptoms in children that are similar to the symptoms of ODD, so a mental health professional will generally rule out other conditions that present similarly.
Defiant children may show remorse some of the time: making promises, asking forgiveness, and appearing to try to do better. Some such promises may be manipulative, though some may be sincere, and many children revert to the defiant behavior. Often, oppositional children do not any signs of remorse. Some children with ODD seem to have no regard for the consequences of their behavior, for themselves or for other people, and they may report emotional numbness and unhappiness.
No single factor can predict whether a child will develop a pattern of oppositional behavior, as many different factors may contribute to a child's persistent acting out. ODD is considered by some to be a reaction to a chaotic environment.
Inconsistent child-rearing or overly harsh forms of discipline are considered to be significant factors in the development of the condition, and research shows that the children of parents who are incarcerated or addicted to drugs or alcohol are more likely to develop the condition. Early trauma and abuse can also contribute to the development of ODD: Children who have a history of abuse, neglect, or trauma may exhibit oppositional behavior as a response to their experiences. Experiencing any kind of traumatic event increases a child's likelihood of acting out, as the child must cope with challenging feelings, thoughts, and memories. If these feelings are not dealt with, ODD may result.
In some children a chemical issue may be present, as women who use drugs or alcohol during pregnancy may increase the odds of oppositional behavior in their children. In others, oppositional behavior may be the symptom of an underlying mental health condition. Oppositional behavior may also develop when parents do not succeed in teaching boundaries or other social skills. At times, it may not be possible to determine the cause of a child's oppositional behavior, and this may make treatment more difficult.
Defiant behavior can be frustrating in the home and potentially devastating in school, as it can lead to suspension and expulsion and at, the very least, may have a negative effect on a child's ability to learn and his or her relationships with peers. If untreated, oppositional behavior can escalate as the child ages. In the teenage years or during adulthood, oppositional or defiant behavior may have significant and lasting consequences socially, legally, occupationally, and psychologically. A correlation between childhood ODD and later development of a conduct disorder has also been seen in research, and early treatment of ODD may help prevent this development.
When treating a child who exhibits oppositional behavior, especially one who is diagnosed with ODD, a mental health professional will typically consider and address all of the factors that may be contributing to the child's misbehavior. Most children who exhibit oppositional behavior on an ongoing basis have a difficult time with emotional expression and may benefit from learning about emotions, which may render them more able to understand their emotional response and teach them how to verbally express their feelings instead of relying solely on physical outbursts.
Children who struggle with emotional regulation also tend to have trouble controlling their anger, and anger management therapy may be beneficial when this is the case. Some of the strategies that are taught in anger management include relaxation, goal setting, problem solving, trigger identification, and recognition of consequences.
Individual therapy is also helpful when children cannot maintain control over their behavior. Therapists may use behavior modification techniques such as rewards and consequences, or they may employ play therapy, family therapy, or other techniques, depending on the needs of the particular child. In therapy, a child can often learn behavior modification and communication skills that may allow them to better interact with peers, family members, and authority figures. With the help of a therapist, a child may also be able to more deeply explore any personal issues that contribute to the child's defiant behavior.
When a child exhibits defiant and oppositional behavior, it can affect the child's entire family, and family therapy may also be helpful. Oppositional behavior can cause stress in relationships between intimate partners, parents, and siblings, and in order to effectively manage oppositional behavior, the entire family can often benefit from exploring ways to address and cope with their own feelings in order to better support the child during treatment. In family therapy, parenting skills may be addressed, as might the alteration of the family environment, should it be chaotic.
Last updated: 05-21-2015
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