Causes Of ODD In Children, Types, Symptoms, And Treatment

Oppositional defiant disorder (ODD) is a disruptive behavior disorder, usually diagnosed in childhood. It is characterized by ongoing patterns of anger, disobedience, defiance, irritability, and hostility toward peers, teachers, parents, and other people in authority (1) (2).

Aggressive behavior often affects children’s school performance and social relationships (3). According to the American Academy of Child & Adolescent Psychiatry, around 1 to 16% of school-age children and adolescents deal with ODD. The condition usually starts at around eight years and is more commonly seen in boys than girls. However, it affects boys and girls in older age (1) (4).

Read about the causes, symptoms, risks, complications, diagnosis, and treatment of a child with ODD.

What Are The Symptoms And Complications Of ODD In Children?

Children argue, disobey, or feel angry and irritated at times, especially if they are tired, hungry, or upset. If these symptoms are seen more often and continue for around six months, children are believed to have ODD.

Some ODD symptoms in children are (4) (5):

• Frequent temper tantrums
• Constant arguments with adults
• Refusal to accept adults’ requests
• Inability to follow rules
• Intention to annoy others
• Blame others for mistakes
• Frequent annoyance and anger
• Harsh behavior toward others
• Seek revenge
• Use hateful words and actions

Children with ODD may also have other complications such as

• ADHD
• Learning disabilities
• Mood disorders (bipolar disorder, depression)
• Anxiety disorders

To treat ODD successfully in children, it is important to treat the co-existing disorders. If left untreated, it may lead to depression, substance use disorders, or a more aggressive behavioral disorder called conduct disorder. People with conduct disorder are likely to break the law, destroy property, and show cruelty toward animals and people (5) (6).

What Are The Causes And Risk Factors Of ODD In Children?

The exact cause of ODD is not known, but the condition is believed to result from the following factors (5) (7):

1. Developmental factors: According to a theory, children with ODD may

• Deal with some underlying challenges that make them lose their cool and get angry quickly.
• Experience problems as toddlers.
• Have difficulty separating from parents during a young age.
• Have an unresolved developmental issue that grows into behavioral problems in later life.

2. Learned factors: According to another theory, children with ODD may

• Develop excessive negativity and pessimism because a parent or another authoritative figure would have punished them harshly or treated them wrongly.
• Associate parent’s or another authoritative figure’s negative attitude to receive more attention or time.
• Act in a way to get extra attention.

3. Biological factors: Some studies show that ODD in children may also occur due to defects or injuries in some parts of the brain. These injuries affect the neurotransmitters that help communicate brain nerve cells. As a result, the brain does not function properly, resulting in the disorder (4).

4. Genetic factors: Children may also inherit ODD if close family members have mental disorders (4).

5. Other factors

• Permissive parenting style (parents easily accept children’s demands)
• Permanent personality characteristic
• Mother exposed to harmful chemicals during pregnancy
• Not positively attached to parents
• Stressful home or community environment
• Family history of ODD or mood disorders
• Malnourishment
• Poverty
• Lack of proper parenting

Children with mental health conditions such as mood or anxiety disorder, conduct disorder, personality disorders, and attention-deficit/hyperactivity disorder (ADHD) are more likely to develop ODD (2).

When To See The Doctor?

You should see a healthcare provider immediately if children (2)

• Feel intense anger, depression, fear, or anxiety
• Become difficult to control
• Hear voices not heard by others and see things invisible to others
• Unable to eat or sleep for more than three days
• Display behaviors that cause concern

How Is ODD Diagnosed In Children?

The steps followed for the professional diagnosis of ODD are as follows (4):

• Children are first evaluated by a healthcare professional based on their symptoms, medical history, and physical examination.

• They are then suggested blood tests to rule out signs of physical illnesses or side effects of medications. Symptoms of other disorders such as ADHD, depression, and personality disorders are also checked.

• If no sign of physical illness is found, children are referred to a child psychiatrist or psychologist to treat mental health disorders.

• The psychiatrist or psychologist assesses children’s attitudes and behavior. They also design specific interview and assessment tools for a complete evaluation of the ODD and other psychiatric conditions.

• They also interview children’s parents, teachers, and other related adults to know more about the problems and the related symptoms.

• Finally, ODD is determined if children’s symptoms match with the symptoms mentioned in the standard reference book for mental illnesses, the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association.

How Is ODD Treated In Children?

ODD treatment depends on a child’s health and medical history, the severity of symptoms, and response to medications, therapies, and procedures.

The following is the common treatment approach (8) (9):

1. Individual psychotherapy involves cognitive-behavioral approaches (therapy used to change negative thought and behavior patterns) to focus on

• Problem-solving skills
• Communication skills
• Anger-management skills
• Impulse-control skills

2. Dialectical behavior therapy is used for children with severe emotional issues.

3. Family therapy involves altering the family system to suit the child’s needs. The steps include:

• Improving family interactions and communication
• Supporting parents in managing their children
• Initiating parent training programs to counsel parents and develop a positive parenting style

4. Peer group therapy involves developing social and interpersonal skills.

5. Medications are used only if ODD is accompanied by other illnesses or disorders responsive to medicines. Some medications are:

• Antipsychotic medications (for children with extreme ODD behaviors)
• Stimulant medications (for children with ADHD)
• Antidepressant medications (for children with depression and anxiety)

How To Help A Child With ODD?

There are several things parents and teachers may do to help children with ODD.

For parents

• Stay positive and appreciate children when they cooperate with you.
• Remain calm or take a break if you sense that your conflict with your child is about to increase.
• Set reasonable and age-appropriate rules.
• Do not deal with children’s condition alone. Take support from teachers and coaches.
• Take part in family therapy activities and improve the parent-child relationship (2).
• Take care of yourself and indulge in activities that do not involve taking care of your child.
• Manage your stress by choosing a healthy lifestyle (6).

For teachers

• Make the students with ODD sit closer to you, so they do not disturb others.
• Give them an occasional break from classroom activities.
• Give them more time to complete their task.
• Set clear classroom rules and review them regularly.
• Plan on how to handle behavioral issues.
• Provide feedback to students privately.
• Praise them for their positive behavior when they stay seated in the class or pay respect (3).

References

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