Oppositional Defiant Disorder


Children’s choices are heavily shaped by the context in which they live. All children are oppositional from time to time. The challenge is to distinguish between what is considered normal childhood behaviors and those that fall under the category of Oppositional Defiant Disorder. Oppositional Defiant Disorder is categorized as a disruptive behavior disorder by the American Psychiatric Association as documented in the Diagnostic and Statistical Manual, Fourth Edition (DSM IV). The more ways we have of looking at a complex problem such as Oppositional Defiant Disorder, the better able we are to understand how to engage it. The Comorbid conditions include, but are not limited to, attention deficit hyperactivity disorder and conduct disorder. The clinical course of Oppositional Defiant Disorder varies considerably across age and gender categories. Due to the nature of Oppositional Defiant Disorder it is important to reduce the frequency and severity of the conflict and stress as well as to prevent progression to Conduct Disorder. Left untreated, Oppositional Defiant Disorder can progress into other more serious and challenging disorders such as Conduct Disorder. Specific treatments focus on areas of social skill development as well as coping mechanisms and stress relief. The antisocial and aggressive behaviors of Oppositional Defiant Disorder children become more serious with age, and unless treated these children grow into angry and aggressive adults.


What is Oppositional Defiant Disorder? The Gale Encyclopedia of Medicine defines defiance as the act or example of defying or bold resistance to an oppositional force or authority; this includes intentionally contemptuous behavior or attitude. The behavior disturbances cause clinically significant problems in social, school, or work functioning. Children with this disorder show their behaviors through defiance, stubbornness, and resisting directions. (p.2619)


DSM-IV diagnostic criteria for Oppositional Defiant Disorder


A. A pattern of negativistic, hostile, and defiant behavior lasting at least six months, during which four(or more) of the following are present:


1) Often loses temper


2) Often argues with adults


3) Often actively defies or refuses to comply with adults’ requests or rules


4) Often deliberately annoys people


5) Often blames others for his or her mistakes or misbehavior


6) Is often touchy or easily annoyed by others


7) Is often angry or resentful


8) Is often spiteful or vindictive


NOTE: Consider a criterion met only if the behavior occurs more frequently than is typically observed in individuals of comparable age and developmental level.


B. The disturbance in behavior causes clinically significant


Impairment in social, academic, or occupational functioning.


C. The behaviors do not occur exclusively during the course of a


psychotic or mood disorder


D. Criteria are not met for conduct disorder, and, if the individual is


age 18 or older, criteria are not met for Antisocial Personality


Disorder.


*adapted from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition


Associated features of Oppositional Defiant Disorder include low self-esteem, mood liability, low frustration tolerance, swearing, and possible early onset alcohol and substance experimentation. Being unhappy, easily frustrated, hostile, and overwhelming senses of inferiority are also associated with this disorder. The direct relationship between Oppositional Defiant Disorder and aggression is generally weak. Conflicts tend to be verbal and do not escalate to physical aggression. Oppositional Defiant Disorder is typically more prevalent in boys than girls and the onset usually begins by age eight. Specific causes as to the onset of this behavior are unknown, however adults who are overly concerned with power and control may cause an eruption to occur. Several symptoms are prevalent through the literature on this topic. Included are the child’s temperament and the caregiver responses to that temperament, an inherited predisposition to the disorder, or a neurological cause. Oppositional Defiant Disorder is seen more common in families where at least one parent has a history of a mood type disorder. (Doermann, p. 2601) Children with this disorder are generally unwilling to compromise, or negotiate anything with adults. They may persistently test limits, ignore orders, and fail to accept blame for deeds. Additional problems that may present themselves include learning problems, a depressed mood, hyperactivity, and dramatic or erratic behavior. Oppositional Defiant Disorder is also seen to stem from inconsistent, overly lax or overly harsh discipline. Power struggles and lying is frequent. The key point to remember when looking toward a diagnosis of Oppositional Defiant Disorder is that the pattern of defiant, disobedient, negativistic, and hostile behavior toward authority figures