It is said that all children are oppositional from time to time, but Oppositional Defiant Disorder- ODD is a psychiatric disorder that is characterized by two different sets of problems. These are ferociousness and purposefully disturbing and annoying others.
This is the most common psychiatric problem in children. Over 5% of children have this. In younger children it is more common in boys than girls, but as they grow older, the girls also catch with their male counterparts.
It is the reason why people seek treatment.
When ODD is present with ADHD, depression, anxiety disorders, or other neuropsychiatry disorders, it makes life with that child far more difficult. For Example, ADHD plus ODD is much worse than ADHD alone, which by itself is
enough to make people seek treatment. The criteria for ODD are:
A pattern of negativistic, hostile, and defiant behavior lasting at least six months during which four or more of the following are present:
I.
Frequently loses temper
II.
Frequently argues with adults
III.
Actively defies or refuses to comply with adults' requests or rules
IV.
Often deliberately annoys people
V.
Frequently blames others for his or her mistakes or misbehavior
VI.
Is frequently touchy or easily annoyed by others
VII.
Is frequently angry and resentful
VIII.
Is frequently spiteful and vindictive
The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.
Most of the criteria above include the word "Frequent". But what does that mean? Recent studies have shown that these behaviors occur to a varying degree in all children. These researchers have found that the "Frequent" is best solved by the following criteria.
Has occurred at all during the last three months-
is spiteful and vindictive
Blames others for his or her mistakes or misbehavior
Occurs at least twice a week
is touchy or easily annoyed by others
loses temper
argues with adults
actively defies or refuses to comply with adults' requests or rules
Occurs at least four times per week
is angry and resentful
Deliberately annoys people
Treatment
Patients are usually placed in therapy with a psychologist or licensed clinical social worker. The parents (or guardians) are taught how to react better to the child's difficult behavior such as keeping a consistent daily schedule, limit-setting, discipline, and consistent rules and reward systems.
This is called behavior modification therapy.
Beyond this not much can be done for children directly. An adolescent will sometimes need to be sent to a special school for a year or two if the behavior doesn't improve or gets worse.
Residential treatment and medication are sometimes necessary as well. Medication is only given if the child has some other difficulty along with the ODD. Some of these expected problems are: depression, hyperactivity, addictions, compulsiveness, and an extreme anti-social personality.
It is very rare for a physician to see a child with only ODD. Almost always the child has some other psychiatric disorder along with ODD, such as ADHD, bipolar or depression, or an anxiety disorder. These disorders will also need treatment if the child is to improve.
Individualized Education Plans (IEPs) can be done at the schools to offer special programs when learning problems are present.
Joe Biederman, M.D., a leading pediatric psychopharmacologist working with Massachusetts General Hospital and Harvard Medical School, states that he prefers the effectiveness of the atypicals (brand names of these are
Risperdal,
Clozaril, Abilify and Seroquel) in the treatment of pediatric mania (such as bipolar conditions) over the mood stabilizers (which include Depakote and the lithium-based medications).
Although Oppositional Defiant Disorder is a different condition from the bipolar disorders of childhood, they can share some of the same symptoms, like irritability, agitation, defiance, anxiety, depression and episodes of anger and rage. The atypicals can treat these symptoms.
Causes
No one knows for certain.
The usual pattern is for problems to begin between ages 1-3. If you think about it, a lot of these behaviors are normal at age 2, but in this disorder they never go away. It does run in families. If a parent is alcoholic and has been in trouble with the law, their children are almost three times as likely to have ODD. That is, 18% of children will have ODD if the parents are alcoholic and the father has been in trouble with the law.
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