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Oppositional Defiant Disorder

Every child will test boundaries and disobey parents at times, especially during toddler years and adolescence. However, if a child exhibits frequent uncooperative or hostile behavior that significantly interferes with family, social activities and academic performance, it could be oppositional defiant disorder (ODD). This disorder can only be diagnosed after a thorough mental health evaluation done by a professional. If left untreated, some children develop conduct disorder, which is associated with more aggressive, violent and destructive behaviors.

Symptoms
Signs of ODD often arise during preschool years, but may appear later. Some children only display symptoms at home, while others also exhibit symptoms at school and other settings. Signs include:

  • Frequent temper tantrums
  • Excessive arguing with adults
  • Often questioning rules
  • Active defiance and refusal to comply with adult requests and rules
  • Deliberate attempts to annoy or upset people
  • Blaming others for his or her mistakes or misbehavior
  • Often being touchy or easily annoyed by others
  • Frequent anger and resentment
  • Mean and hateful talking when upset
  • Spiteful attitude and revenge seeking

Source: American Academy of Child and Adolescent Psychiatry

In order to make a diagnosis the child must meet certain criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association’s. The criteria are:

  • Includes at least four symptoms
  • Occurs with at least one individual who is not a sibling (usually an authority figure)
  • Causes significant impairment at school, home or work
  • Behavior is not the result a substance use disorder or another mental illness, such as depression or bipolar disorder
  • Is constant for at least six months

Treatment
The treatment for ODD varies for each person and is be based on age, severity of disorder, and the family situation. The most common therapies used are parent training, individual and family therapy and problem-solving skills training. In addition to treating ODD, it is critical to treat any co-occurring disorder that may be present.

  • Parent Training – This involves teaching parents and caregivers how to manage the child’s behavior. Positive reinforcement and discipline techniques are taught. One form of training is parent-child interaction training (PCIT). During PCIT sessions, therapists watch through a one-way mirror and coach caregivers through an earphone as they interact with the child.
  • Individual and Family TherapyCognitive behavioral therapy techniques are used during both individual and family therapy sessions. In individual sessions, the therapist works with the child to help them develop anger management techniques and discuss healthy ways to express emotions. Family sessions usually focus on improving communication between caregivers and children.
  • Cognitive Problem-Solving Training – This therapy teaches healthy, productive ways to respond to the stressful situations that trigger negative behaviors. By identifying negative thought patterns and behaviors, the child learns how to approach the situations differently.
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    One thing to keep in mind is extreme punishment and “tough love” should not be used because it isn’t effective and can actually worsen the behaviors. It’s important to emphasize positive reinforcement and work with the professionals to determine what discipline techniques might be helpful.

    Resources
    American Academy of Child and Adolescent Psychiatry

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