Oppositional defiant disorder (ODD)
Oppositional defiant disorder (ODD) is a behavioural disorder characterised by the presence of uncooperative, challenging, negative, irritable and angry behaviour toward parents, peers,teachers and other people in position of authority. These behaviours tend to appear firstly in the family environment and are progressively extrapolated to other environments, manifesting gradually and can be maintained for months or years.
The symptoms appear before the age of 8 and no later that the beginning of puberty. This type of disorder is more common in boys than in girls. The prevalence of this pathology is high, registering an increase in recent years that has led us to global figures between 4 and 7%.
Studies show that between 30% and 50% of children diagnosed with ADHD also have oppositional defiant disorder
Some children who have this disorder can develop an antisocial disorder.
There are many causes for determining this disorder since different factors influence.
Having a family history of psychiatric problems increases the predisposition for the appearance of the disorder.
The existence of significant brain disorder or having suffered brain damage, especially in areas such as the frontal lobe since it implies problems with controlling behaviour. It is important to bear in mind comorbidity with other disorders.
The lack of good emotional self management contributes to the disorder occurring, especially the bad management of emotions such as anger, frustration, sadness or anxiety levels.
The parenting styles, especially very authoritarian or disciplined, or the lack of parental control, either due to the absence of a parent in the family environment or to a parent suffering a mental disorder, can be a trigger for the development of the disorder.
Sometimes challenging behaviour can be reinforced by parental attention and create a conflicting discipline among the closest authority figures such as the parents or the teacher.
Living in a marginal neighbourhood or in an environment of poverty can favour the consolidation of this disorder.
According to DSM V, the diagnostic criteria for ODD are:
A pattern of anger/irritability, argumentative/challenging attitude or revengeful which lasts for at least six months, manifests with at least four symptoms from any of the following categories, and is exhibited during interaction with at least one individual who is not a sibling.
- Lose their cool.
- Fussy or easily bothered
- Angry and resentful
Argumentative/ Challenging attitude
- Argue with authority or adults, in the case of children or adolescents.
- Actively defy or refuse to satisfy the request of authority figures or rules.
- Deliberately annoy others.
- Blame others for their mistakes or misbehaviour.
- Has been spiteful or vengeful at least twice in the past six months.
This behavioural disorder is associated with discomfort in the individual or in other people in their immediate social environment (that is family, group of friends, coworkers), or it has a negative impact in the social, educational, professional or other important environments.
The behaviour does not appear exclusively in the course of a psychotic disorder, a substance use disorder, or a bipolar disorder. Furthermore that the criteria for a disruptive mood dysregulation disorder are not met .
We differentiate, according to severity, between:
Mild: If symptoms are limited to one single setting.
Moderate: Some symptoms appear in at least two settings.
Severe: When symptoms appear in three or more settings.
The prognosis depends on many variables, including the severity of the disorder, stability over time, the presence of other disorders, and the degree of family functioning.
If the disorder remains continuously over time, the child can frequently violate the rights of others and develop a dissocial disorder.
The psychological treatment must be adapted to each case and its particularities, but the joint work of the child with the family is required.
- From Individual Therapy, and following a mainly cognitive behavioural approach, the child is provided with strategies so that they have the ability to solve problems, improve their communication skills and develop self-control skills about anger and impulsiveness.
- In Family Therapy we work to introduce changes in the family environment, promoting more desirable behaviours and eliminating those that maintain the negative and challenging behaviour. The different relationships between the family members are also worked on, since it is very important that they are good, and that there be positive communication and interaction between all of them.
There is no pharmacological treatment for this disorder. The use of medication for the treatment of other disorders associated with ODD, positively affect the degree and frequency of reactions from children who suffer from it.
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