Most children are oppositional from time to time. It is a normal developmental behaviour of two to three year olds and early adolescents. They may be oppositional when hungry, angry or stressed out.
However uncooperative and hostile behaviour should be paid serious consideration when it becomes so frequent that it stands out in comparison with other children of the same age group.
Is your child being disobedient towards you? Has his sheer rudeness towards you begun to worry you? You may have been receiving repeated complaints of misbehaviour from your child’s teachers. If your child has been acting more stubborn than other children his age then it may be time to look into the possibility of oppositional defiant disorder.
What is oppositional defiant disorder (ODD)?
Oppositional defiant disorder is a childhood disorder that is characterised by negative, hostile and defiant behaviour towards adults, parents or authority figures. These symptoms must be present for a period of at least six months in order to be diagnosed as oppositional defiant behaviour.
Most manifestations of this disorder will be found in a home setting or in front of adults that the child is comfortable around. So it is often difficult to reproduce them in front of a doctor or therapist.
According to DSM-IV, any four of the following symptoms present for a period for at least six months with a pattern of negative, hostile and defiant behaviour present over this period will be characterised as oppositional defiant disorder.
The criterion is met when occurring more frequently in comparison to other individuals in the same age group or developmental level. These symptoms should produce significant impairment in social, academic or occupational settings.
· Losing temper
· Arguing with adults
· Denying/ refusing to comply with requests/rules set by adults
· Doing activities to deliberately annoy other people
· Blaming others for their own misbehaviour
· Being sensitive and easily annoyed by others
· Being angry and resentful
· Being spiteful or vindictive
Negative or defiant behaviours are shown as:
· Persistent stubbornness
· Resistance to instructions
· Being unwilling to compromise, agree or negotiate with adults or friends
· Deliberate testing of limits by disobeying orders, arguing and failing to accept responsibility for misdeeds
Hostility is directed at adults and is shown by deliberating annoying or by expressing verbal aggression
The symptoms should not fall in the category of psychotic or mood disorder, ADHD, learning disabilities, conduct disorder and antisocial personality disorder (if over 18 years of age). These disorders may coexist with ODD so it is important to have a comprehensive evaluation.
There are there treatment modalities that seem to be helpful in oppositional defiant disorder:
The focus on therapy is mainly behavioural and works on training the parents.
1. Parent training: This is to help parents manage their child’s behaviour. This training can be done in either a group setting. It is almost as effective as family therapy which involves both the parent and the child. These psychoeducational techniques help parents learn and adopt behaviours which can help maintain a balanced relationship with their child. It teaches them how to keep their child in control. It is a gradual process which incorporates more age-appropriate behaviours in the child. This is done by the implementation of a behaviour monitoring and a reward program.
2. Family therapy: This method of therapy is considered as effective as parent training in most cases. Family therapy is a highly effective way to treat the issues that are existing in the relationships between the family members.
3. Individual psychotherapy: This is to help anger management in the child. It will teach a child with ODD methods that will help him deal with his anger and defiance.
4. Cognitive problem solving therapy: Not only does it helps solve the problem in the child it will also decrease the element of negativity.
5. Social skills training: This will help redirect the child’s frustration. It will teach him basic social skills which will ensure that he interacts better with his peers. It teaches the child tolerance to those around him.
Very little research has been performed in this arena so giving medication has not been an approved method of treatment for oppositional defiant disorders. But medication can be used to reduce some of the distressing symptoms of ODD or if there is a coexistent mood disorder or ADHD.
· Self help
Support groups can help parents who are suffering from similar problems with their children. They can discuss their problems and work out a common way of finding a solution. It is also easy for the parents to discover that they are not going through this problem alone. So going to a local community group for parents is highly recommended. Some parent training classes may be running independent of mental health professionals which can sometimes benefit these parents. Parents can learn positive parenting techniques through various programs to help their child with ODD.
photo credit: @rtimage – Debora Bogaerts