Oppositional Defiant Disorder (ODD) in Children

8/3/2019 Oppositional Defiant Disorder (ODD) in Children

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Oppositional Defiant DisorderOppositional Defiant Disorder((ODD) inODD) in Children andChildren andAdolescents: Diagnosis andAdolescents: Diagnosis and

TreatmentTreatment

by Jim Chandler, MD, FRCPC


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W hat is it?W hat is it?y ODD is a psychiatric disorder that is

characterized by two different sets of problems. These are aggressiveness and a

tendency to purposefully bother andirritate others. It is often the reason thatpeople seek treatment. W hen ODD ispresent with ADHD, depression, anxietydisorders, or other neuropsychiatricdisorders, it makes life with that child farmore difficult.


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The criteria for ODD are:The criteria for ODD are:A pattern of negativistic, hostile, and defiant

behavior lasting at least six monthsduring which four or more of thefollowing are present:

y 1 . Often loses tempery 2. often argues with adultsy 3. often actively defies or refuses to

comply with adults' requests or rulesy 4. often deliberately annoys people


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The criteria for ODD are:The criteria for ODD are:A pattern of negativistic, hostile, and defiant

behavior lasting at least six monthsduring which four or more of the

following are present:y 5 . often blames others for his or her

mistakes or misbehaviory 6. is often touchy or easily annoyed by

othersy 7. is often angry and resentfuly 8. is often spiteful and vindictive


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How often is "often"?How often is "often"?

Has occurred at all during the last threemonths -

y 8. is spiteful and vindictivey 5 . blames others for his or her mistakes

or misbehavior


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Occurs at least twice a week y

6. is touchy or easily annoyed by othersy 1 . loses tempery 2. argues with adultsy

3. actively defies or refuses to complywith adults' requests or rules


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Occurs at least four times per week y

7. is angry and resentfuly 4. deliberately annoys people


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W hat causes it?W hat causes it?y No one knows for certain. The usual pattern

is for problems to begin between ages 1 -3. If you think about it, a lot of these behaviors

are normal at age 2, but in this disorder theynever go away. It does run in families. If aparent is alcoholic and has been in troublewith the law, their children are almost threetimes as likely to have ODD. That is, 1 8% of children will have ODD if the parents arealcoholic and the father has been in troublewith the law.


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W ho gets it?W ho gets it?

y A lot of children! This is the mostcommon psychiatric problem in children.Over 5 % of children have this. In youngerchildren it is more common in boys thangirls, but as they grow older, the rate is

the same in males and females.


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W hat happens to children who haveW hat happens to children who have

this when they grow up?this when they grow up?y Second, ODD may turn into something else.

About 5 -10 % of preschoolers with ODDwill eventually end up with ADHD and nosigns of ODD at all. Other times ODD turnsinto conduct disorder (CD). This usuallyhappens fairly early. That is, after a 3-4 years

of ODD, if it hasn't turned into CD, it won'tever. W hat predicts a child with ODDgetting CD? A history of a biologic parentwho was a career criminal, and very severe

ODD.


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this when they grow up?this when they grow up?y Second, ODD may turn into something else.

About 5 -10 % of preschoolers with ODDwill eventually end up with ADHD and nosigns of ODD at all. Other times ODD turnsinto conduct disorder (CD). This usuallyhappens fairly early. That is, after a 3-4 years

of ODD, if it hasn't turned into CD, it won'tever. W hat predicts a child with ODDgetting CD? A history of a biologic parentwho was a career criminal, and very severe

ODD.


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this when they grow up?this when they grow up?y Third, the child may continue to have

ODD without any thing else. However, bythe time preschoolers with ODD are 8years old, only 5 % have ODD and nothingelse.


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this when they grow up?this when they grow up?y Fourth, They continue to have ODD but add

on comorbid anxiety disorders, comorbidADHD, or comorbid Depressive Disorders.By the time these children are in the end of elementary school, about 2 5 % will have

mood or anxiety problems which aredisabling. That means that it is veryimportant to watch for signs of mooddisorder and anxiety as children with ODD

grow older.


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W hat is the difference betweenW hat is the difference between

ODD and ADHD?ODD and ADHD?y ODD is characterized by aggressiveness,

but not impulsiveness. In ODD peopleannoy you purposefully, W hile it is usuallynot so purposeful in ADHD. ODD signsand symptoms are much more difficult to

live with than ADHD. Children with ODDcan sit still.


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My child has been diagnosed withMy child has been diagnosed withODD. I don't like to say this, but noODD. I don't like to say this, but noone can stand him. Is this common?one can stand him. Is this common?


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y U nfortunately, it is quite common. In comparison toADHD alone, children and adolescents with ODDplus ADHD or just ODD are much more difficult tobe with. The destructiveness and disagreeableness arepurposeful. They like to see you get mad. Everyrequest can end up as a power struggle. Lyingbecomes a way of life, and getting a reaction out of others is the chief hobby. Perhaps hardest of all tobear, they rarely are truly sorry and often believenothing is their fault. After a huge blow up, the child

with ODD is often calm and collected. It is theparents who look as they are going to lose it, not thechild. This is understandable. The parents haveprobably just been tricked, bullied, lied to or havewitnessed temper tantrums which know no limits.


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My father in law says the wholeMy father in law says the wholeproblem is my husband and I. Myproblem is my husband and I. My

daughter convinced him that she isdaughter convinced him that she isa victim of uncaring parents. Howa victim of uncaring parents. Howoften does this happen?often does this happen?


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Too often! Children and adolescents with ODDproduce strong feelings in people. They are trying toget a reaction out of people, and they are oftensuccessful. Common ones are: inciting spouses tofight with each other and not focus on the child,making outsiders believe that all the fault lies with theparents, making certain susceptible people believethat they can "save" the child by doing everything thechild wants, setting parents against grandparents,setting teachers against parents, and inciting the

parents to abuse the child. I frequently see childrenwith ODD in which teachers and parents andsometimes others are all fighting amongst each otherrather than with the child who is causing all theturmoil in the first place.


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W hat can be done?W hat can be done?Containment:y 1 . Come togethery 2. Have a plany 3. Decide what you are going to ignorey 4. Try very hard not to show any emotion

when reacting to the behaviors of children and adolescents with ODD.


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W hat can be done?W hat can be done?The Good of Containment:y especially helpful for dealing with less

aggressive behavior.y Supports all who are dealing with childy Can lead to the child abandoning his

efforts at annoying others and choosingto do more reasonable things with histime.


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W hat can be done?W hat can be done?

The Bad of containment:y

Time consumingy Must have a lot of patiencey Doesn't work as well with severe

aggressiveness


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Additional advices:y

Make sure that you are as healthy andstrong as you can bey Limit Televisiony Eliminate or reduce video and Computer

games


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Medical Interventions ODD are usuallyco-morbid with other problems. If yourchild has another co-morbid condition,you should look at the handout forinformation on the medical and non

medical treatment of that disorder


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W hat can be done?W hat can be done?More non-Medical Interventions:y Enlist others to help youy W hat you should do is everything you can

to share the parenting.y Discover what your child is truly

interested in.y Hospitalize the child.


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In summaryIn summaryy ODD is one bad problem. There is no

one thing that will probably fix it. Makesure you are not prematurely ruling out

any of the possible interventions above. If you are not careful, it can destroy youlong before it ruins the kid. If nothing isdone, the outcome can be dismal. It is

absolutely key to keep working to doeverything you can to keep this problemfrom devastating your life and your child's.

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Oppositional Defiant Disorder (ODD) in Children