Oppositional Defiant Disorder in Children
Oppositional Defiant Disorder (ODD) is a disorder presenting in children who have difficulties controlling both their emotions and behaviour. ODD is characterised by challenging behaviour, particularly towards adults and those in authority. Children with this diagnosis may:
- Be easily annoyed, become angry quickly or seem irritable
- Have frequent temper tantrums
- Argue with adults (particularly with those who are most familiar, such as parents)
- Refuse to follow rules
- Appear to annoy or aggravate others on purpose
- Have a low tolerance for frustration
- Blame other people for their mistakes
Of course, many of these behaviours common amongst children of all ages, however, children who display these behaviours persistently and to a degree that significantly interferes with how they function both individually and with others, may meet the diagnostic criteria for ODD.
Differences between common behaviour and Oppositional Behaviour in Children
To help determine the difference between typical childhood behaviour and that which is problematic enough for a child to be diagnosed with ODD, a psychologist, psychiatrist or paediatrician specialising in emotional and behavioural disorders can carry out a detailed assessment. A specialist will also aid in clarifying symptomatology and ensuring defiance and disobedience in a child is not related to any other significant issue, such as an inability to concentrate or language impairment.
How would my child be assessed for ODD?
A diagnostic assessment will usually look at how closely a child’s presenting pattern of behaviours match with those specified in the ‘diagnostic criteria’ set out by the DSM-V (Diagnostic and Statistical Manual of Mental Disorders), published by the American Psychiatric Association.
According to the DSM-V, an individual must display a significant pattern of angry or irritable mood, argumentative or defiant behaviour or vindictiveness for at least six months and these behaviours must be pervasive (that is, not only occur within a sibling relationship, for example).
Often a child’s symptoms will be most pronounced in familiar settings around familiar people, and, as such, may not appear significant in a psychologist or paediatrician’s office. For this reason, detailed interviews and reports from others involved with the child (eg. teacher) are necessary to consider. Comprehensive assessment tools, such as validated questionnaires, may also be given to parents and teachers to help in making a formal diagnosis.
How common is ODD and what are the causes?
While prevalence rates vary within the literature, the DSM-V reports that on average, around 3.3% of the population experience clinically significant ODD. Problem behaviours are usually first noted before the age of eight and generally no later than adolescence.
There is no single factor that has been identified as causing ODD. Rather, the research suggests that there are a number of factors in the environment, family and child that may place a child at greater risk of developing ODD. Family factors, such as inconsistent, harsh and neglectful parenting as well as child factors, such as being difficult to soothe and being very active, appear to play a role in the development of ODD in children. Overall, it is typically a combination of factors that appears to be important.
Intervention for ODD in Children
Intervention typically involves a team approach and usually includes a psychologist and/or psychiatrist, GP, paediatrician and the family. Intervention typically starts with the GP and/or Paediatrician, to ensure no underlying medical condition/s are impacting the child and their emotional and behavioural responses. Other aspects of intervention typically include parental support (eg. supporting parents to improve positive parenting skills and communication skills), individual child treatment (eg. developing coping and communication skills), family support (eg. counselling to help families manage stress within the home environment and develop positive family interactions) as well as support for the school (eg. developing behaviour management plans with the teacher, supporting social skills training in the school environment).
The intervention also aims to address any co-occurring factors such as any attentional or learning difficulties that may be affecting a child. The efficacy of pharmacological treatment of ODD remains largely unknown at present and a team-based, family-focused intervention remains to be the most effective form of treatment for ODD in children.
If you have concerns for your child, there is support available and the best place to start is with the family GP. Your GP will conduct initial assessments and help put you in contact with specialists who can help your family, such as a Psychologist specialising in child behaviour.
View article references
- Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) - American Psychiatric Association.
- Oppositional Defiant Disorder. Anne Fraser John Wray - Australian Family Physician (FRACP) Oppositional Defiant Disorder - www.betterhealth.vic.gov.au