Oppositional Defiant Disorder

Behavior problems in children are nothing new. Many children present with concerns regarding oppositional and defiant behavior. In fact, studies have indicated that the highest rates of referral for mental health services for children involve aggression, acting-out, and disruptive behavior patterns (Achenbach & Howell, 1993). Oppositional Defiant DisorderAggressive child (ODD) is a diagnostic condition that focuses on a pattern of negative, hostile, and defiant behaviors lasting at least six months. The Diagnostic Statistical Manual, Fourth Edition, Text Revised (American Psychiatric Association, 2000) indicates that four or more of the following behaviors must be present in the child to make the diagnosis: often loses temper, often argues with adults, often actively defies or refuses to comply with adult’s requests, often deliberately annoys others, often blames others for his or her own mistakes or misbehaviors, is often touchy or easily annoyed by others, is often angry or resentful, and/or is often spiteful or vindictive.

ODD is believed to be a fairly common disorder in children.  The condition is thought to occur in 5-16% of children under 18 years old (Burke, 2002). The majority of children who exhibit ODD show signs of behavioral dyscontrol prior to their ninth birthday. The condition is more common in boys than girls before puberty; however, it is thought that the rates are equivalent for children after puberty. Boys are more likely to engage in ‘direct aggression,’ in which the child actively engages in verbal or physical aggression towards another child. Girls, by contrast, are more likely to engage in ‘indirect aggression,’ in which third parties are used to get even (e.g. spreading rumors) (Hinshaw & Anderson, 1996). ODD is thought to highly co-exist with other mental health conditions including ADHD, Mood Disorders, and Learning Disorders. Thus, a comprehensive evaluation is often warranted for children who exhibit behavioral problems in order to ensure that the most appropriate intervention is applied.

The treatment of ODD focuses on behavior management. Behavioral therapy focuses on working not only with the child who exhibits the behavioral concerns, but also with parents and teachers, to help create appropriate behavioral reinforcement schedules across all environments. In addition, pharmacological intervention might be implemented for children who demonstrate co-existing ADHD, or academic tutoring might be in place for those with significant learning disorders.

In summary, ODD is a fairly common disorder of behavioral dysregulation in childhood. It is a condition that often presents simultaneously with other conditions, and as a result a comprehensive evaluation is often recommended to determine whether or not the child also has these conditions. Additionally, the treatment of choice is behavioral therapy, in which a therapist works with the child, parents, and teachers to discuss methods of increasing the frequency of positive behaviors while extinguishing the negative oppositional and defiant behaviors.

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