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These children can be manipulative and
often induce discord in those around them. Commonly they turn
attention away from themselves by inciting parents and other family
members to fight with one and other.
> Behavioral
Symptoms
Normal children occasionally have episodes of defiant behavior,
particularly during ages of transition such as 2 to 3 or the teenage
years where the child uses defiance in an attempt to assert himself.
Children who are tired, hungry, or upset may be defiant. Oppositional
defiant behavior is a matter of degree and frequency. Children with
Oppositional Defiant Disorder display difficult behavior to the extent
that it can interfere with learning, school adjustment, and,
sometimes, with the child's social relationships.
> Common behaviors
seen in Oppositional Defiant Disorder include:
-Losing one’s temper
-Arguing with adults
-Actively defying requests
-Refusing to follow rules
-Deliberately annoying other people
-Blaming others for one's own mistakes or misbehavior
-Being touchy, easily annoyed
-Being easily angered, resentful, spiteful, or vindictive.
-Speaking harshly, or unkind when upset
-Seeking revenge
-Having frequent temper tantrums
Many parents report that their ODD
children were rigid and demanding from an early age.
-Diagnosis
The diagnosis of ODD is not always straight forward and needs
to be made by a psychiatrist or some other qualified mental health
professional after a comprehensive evaluation.
If you feel your child may have ODD, there is a quick ODD Screening
Test at
http://addadhdadvances.com/ODDtest.html
-Causes
It is not clear what causes Oppositional Defiant Disorder. There are
currently two theories.
The developmental theory suggests that ODD is really a result of
incomplete development. For some reason, ODD children never complete
the developmental tasks that normal children master during the toddler
years. They get stuck in the 2-3 year old defiant stage and never
really grow out of it.
The learning theory suggests that Oppositional Defiant Disorder comes
as a response to negative interactions. The techniques used by parents
and authority figures on these children bring about the oppositional
defiant behavior.
-Co-morbidity
Oppositional Defiant
Disorder usually does not occur alone.
50-65% of ODD children also have:
-ADD ADHD
-35% of these children develop some form of affective disorder
-20% have some form of mood disorder, such as
-Bipolar Disorder or anxiety
-15% develop some form of personality disorder
-Many of these children have learning disorders
Any child with Oppositional Defiant Disorder must be evaluated
for other disorders as well. If your child has ODD it is imperative to
find out what are the co-existing problems. This is the key to
treating the condition, as we shall soon discuss.
-Prognosis
So what happens to these children? There are four possible paths.
-Some will grow out of it. Half of the preschoolers that are labeled
ODD are normal by the age of 8. However, in older ODD children, 75%
will still fulfill the diagnostic criteria later in life.
-The ODD may turn into something else. 5-10% of preschoolers with ODD
have their diagnosis changed from ODD to ADHD. In some children, the
defiant behavior gets worse and these children eventually are
diagnosed with Conduct Disorder at
http://addadhdadvances.com/CDtest.html . This progression usually
happens fairly early. If a child has ODD for 3-4 years and he hasn't
developed Conduct Disorder, then he won’t ever develop it.
-The child may continue to have ODD without any thing else. This is
unusual. By the time preschoolers with ODD are 8 years old, only 5%
have ODD and nothing else.
-The child develops other disorders in addition to ODD. This is very
common.
-Treatment: Medical Intervention
There have been some recent studies that have examined the effects of
certain medications on Oppositional Defiant Disorder. All the
research is preliminary and just suggests that certain treatments may
help.
One study examined the use of Ritalin to treat children with both ADHD
and ODD. This study found that 90% of the children treated with
Ritalin no longer had the ODD by the end of the study. The researchers
skewed the results a bit because a number of children were dropped
from the study because they wouldn't comply with the treatment
regimen. Still if these children are included as treatment failures
the study still showed a 75% success rate.
There have been two studies examining the effect of Strattera on
children with both ADHD and ODD. One study showed that Strattera
helped with ODD, one study showed it did not help.
There was a large Canadian study that showed that Risperdal helped
with aggressive behavior in children with below normal intelligence.
It did not matter if the child had ADHD or not.
There was study showing that 80% of children with explosive behavior
improved when given the mood stabilizer, divalproex.
There was another pilot study examining the use of Omega-3 oils and
vitamin E in ODD children. Both helped the ODD behavior to some
degree.
-Treatment: Psychological Intervention
Parent management training is still viewed as the main treatment for
Oppositional Defiant Disorder. Our program, How to Improve Your
Child's Behavior, located at
http://addadhdadvances.com/betterbehavior.html which is
available online, or some other parent training program is still
considered essential if you want to help your child. Also, the younger
your child is when you enroll in such a program, the better the
results.
-Conclusion: Advice to Parents
Currently, there is still far too little research on this very common
disorder.
Medically, the most important consideration is to treat other
disorders that come along with ODD. Considering that Ritalin may help
alleviate the problem in 75-90% of ODD children who have ADHD, and
considering that most children with ODD also have some degree of ADHD,
I feel that it is very worth your while to try your ODD child on
Ritalin unless you know for sure that he does not have ADHD. The other
treatments may also be worth a try depending upon the nature of your
child.
I feel that using Omega-3 supplements and a vitamin E supplement
should be tried in all children. This is because most children are
deficient in these nutrients. Even if it does not help with the ODD,
it should make your child healthier.
Parent training is still the most effective means of dealing with
Oppositional Defiant Disorder. The two main drawbacks of most of these
programs are the expense and the availability.
Some practitioners charge $100 or more per visit and considering the
program will take several months costs add up. Insurance usually will
not pay for such programs. Many parents complain to me that they can
not afford the program that their child so desperately needs.
In addition, these programs are not available everywhere. Over the
years, numerous parents have told me that where they live there are no
programs for Oppositional Defiant Children.
I created How to Improve Your Child's Behavior to address these two
problems. It allows parents to help their children regardless of where
they live and at a cost that is less than one office visit. Even
though it was an experiment to try to administer such a program online
and to date no one else is doing this, over the past two years How to
Improve Your Child's Behavior has proven time and again to help
parents gain control of their defiant children.
Get more information on Oppositional Defiant Disorder- ODD Help at
http://addadhdadvances.com/betterbehavior.html
It is tough to live with children who have ODD. However, if you make
sure that your child has his other problems addressed and you improve
your parenting skills by enrolling in a parent training program, you
can do a great deal to improve your child’s condition and his future.
Anthony Kane, MD
ADD ADHD Advances
http://addadhdadvances.com |
