OTHER DISORDERS
Oppositional Defiant Disorder (ODD)
What is Oppositional Defiant Disorder (ODD)?
ODD falls under the category of disruptive, impulse-control and conduct disorders in the DSM-5.
The characteristic features of ODD are the irritable/angry mood, and argumentative/defiant behaviours. These bring the child into conflict with social norms or authority figures (for children, usually adults).
The thing is, children and adolescents occasionally show defiance and disobedience. It would be unusual if they never threw any tantrums or acted out - small amounts of this constitutes a healthy part of development (hint: pubescent years, or with siblings - hello, sibling rivalry!).
However, when defiant behaviour persists and intensifies in frequency beyond expected norms, this is when behaviour or temper outbursts become concerning.
Diagnosis of ODD
Additional notes about the ODD diagnosis:
Those younger than 5 years old: behaviour occurs on most days for at least 6 months (excluding vindictiveness)
Those older than 5 years old: behaviour occurs at least 1x per week for at least 6 months (excluding vindictiveness)
Behaviours do not occur during course of psychotic, substance use, depressive or bipolar disorder
Criteria is not met for DMDD
Disturbances in behaviour is linked to distress in individual or others in immediate social context OR
Negatively impacts functioning (social, educational, occupational)
Symptoms of ODD typically appear in preschool years, and rarely later than early adolescence. Although ODD often precedes the development of Conduct Disorder (CD), many children and adolescents with ODD do not subsequently develop CD.
A significant proportion of children with ODD also have comorbid attention-deficit hyperactivity disorder (ADHD).
Risk Factors for Developing ODD
Like many other disorders, there is no single, contributing cause towards ODD. It’s often a multitude of reasons, with a combination of psychological, biological, and environmental causes.
However, to date, many studies have not studied children with ODD separated from those with Conduct Disorder, so more studies dedicated to markers of ODD are required.
Temperamental risk factors:
Ψ Emotional reactivity, poor frustration tolerance
Genetic or biological risk factors:
Ψ Lower heart rate, reduced basal cortisol reactivity; abnormalities in prefrontal cortex and amygdala
Environmental risk factors:
Ψ Changes in caregivers, or harsh, inconsistent or neglectful parenting
Ψ However, oppositional symptoms can also predict increases in harsh and inconsistent parenting - so it is difficult to determine what came first. The more definitive consideration though, is that a persistence in harsh, inconsistent or neglectful parenting will interfere in effective intervention.
Interventions for ODD
Ideally, intervention should involve, at the very least, therapy for both the child and the parent or family. As families and parents play an important role in a child’s development and being the authority figure and model for behaviour, parents are highly encouraged to be involved in intervention, to produce effective change.
Most of the therapies listed below factor in and address familiar or relational factors that contribute to how oppositional behaviours are perpetuated.
Ψ Multisystemic Therapy: Intervention is conducted directly in environments where problems present themselves (like at home, and in school). Therapists work closely with families to assess, reframe, modify and manage behaviours in these immediate environments as they present themselves.
Ψ Parent Management Training: Focused on training parents and teaching them appropriate interventions to manage behaviour and increase prosocial behaviour, little interaction may be required between the therapist and child. Many variations of PMT programmes exist, notably Helping the Noncompliant Child, The Incredible Years, Triple P, and Parent-Child Interaction Therapy.
Ψ Family Therapy: With an increased focus on family dynamics - interactions, attachment, conflict and communication habits, family therapy aims to improve relationship interactions between family members.
Ψ Individual Cognitive-Behavioural Therapy: Children are taught to cope with anger, stress and overwhelming emotions in healthy ways, problem-solve challenges, and challenge unhelpful thought processes.
Prognosis
The prognosis of ODD depends on various factors, such as the type of prevalent symptoms and quality of parent-child relationships.
Ψ Development of Mood/Anxiety Disorders: Associated with anger or irritable mood symptoms in ODD
Ψ Development of ADHD/Conduct Disorder: Associated with argumentative, defiant and vindictiveness symptoms
The therapies above have showed significant effects in improving the prognosis for children and adolescents with ODD. By addressing family dynamics and equipping parents with essential tools, it not only helps the child manage ODD symptoms but also fosters a healthier family environment, leading to improved long-term outcomes and brighter futures.