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Oppositional Defiant Disorder

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References:

  1. Course Module

ODD consists of an enduring pattern of uncooperative, defiant, disobedient, and hostile behavior toward authority figures without major antisocial violations. Some of the behaviors presented may be normal in some age groups and with the appropriate frequencies, but abnormal behaviors are frequent, intensive, and cause dysfunction in social, academic, or work situations. Often, these behaviors are worse within the home environment than it is outside.

  • Onset, Incidence, and Etiology: Due to difficulties in distinguishing negative behaviors from ODD, estimates range from 2% to 15% of adolescents having it, averaging 3%. Males are more likely to be diagnosed with ODD. It is believed that a combination of genes, temperament, and adverse social conditions interact to create ODD.

Manifestations

  1. Children with ODD often have lower self-concepts and lack competence in social situations.
  2. Limitations in associating their behaviors with both positive and negative consequences (lacking Judgment), indicating a decreased sensitivity to reward and punishment.
  3. Impaired problem-solving abilities.
  4. Deficient attention, flexible thinking, and decision-making.
  5. All the previous manifestations are even greater in children with ODD.
    • Early onset results in worse symptoms, and comorbid conditions (often ADHD, anxiety, mood disorders) are associated with poorer long-term outcomes. Development of conduct disorders and antisocial personality disorder are more likely

Treatment and Management

  1. Parent Management Training Models of Behavioral Interventions are used because of a belief that problem behaviors are inadvertently trained and reinforced in the home or school environment.
    • A hierarchy of problem behaviors is created, and the most disruptive or problematic behaviors are targeted.
    • Parents should learn to ignore maladaptive behaviors rather than providing negative attention. Positive behaviors are rewarded with praise and reinforcers.
    • Consistent consequences for the child’s defiant behaviors are implemented for every occurrence of the behavior.
    • Adolescent children benefit from interventions that utilize personal strengths to improve behavioral and social functioning, such as the Coping Power Program.
  2. Individual Therapy may also be beneficial for older children.
  3. Psychopharmacologic Treatment has not been found to be useful for ODD, but is useful for comorbid conditions, the resolution of which may reduce the severity of ODD symptoms.
  4. Parent support also improves overall outcomes. As the behavior may be overwhelming, demanding, and unrelenting, two major challenges for caregivers are managing aggressive, defiant, and deceitful behaviors and interacting frequently with service providers and agencies.

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