Oppositional Defiant Disorder is classified in the DSM-IV-TR as a disruptive behavior disorder. An Oppositional Defiant Disorder child displays an ongoing pattern of uncooperative, defiant, aggressive, and disobedient behavior toward authority figures. Children with Oppositional Defiant Disorder are usually in constant trouble at school, have difficulty making or keeping friends, do not follow adults’ requests, blames others for their mistakes, are easily annoyed, and loses their temper at the drop of a hat. In the United States Oppositional Defiant Disorder is thought to affect about six percent of all children; with the majority of them coming from families in the lower class. One study stated that about eight percent of children from low-income families were diagnosed with Oppositional Defiant Disorder. The disorder is often observed by the time a child is six years old but no later than a child’s preteen years. With this disorder boys also tend to be diagnosed more often than girls in the preteen years. However, it is equally common in males and females by adolescence. Recently, it has been discovered that girls may show the symptoms of Oppositional Defiant Disorder differently than boys. Girls with this disorder may show their ferociousness through words rather than actions and in other indirect ways. For example, girls with Oppositional Defiant Disorder are quicker to lie and to be uncooperative; while boys are more likely to lose their temper and argue with adults. It has also been estimated that about one-third of the children who have this disorder also have Attention Deficit Hyperactivity Disorder. Children who have Oppositional Defiant Disorder are often diagnosed with anxiety or depression as well.
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Part of childhood is arguing with your parents or defying authority from time to time, especially when the child is tired, hungry, or upset. Some of the behaviors associated with Oppositional Defiant Disorder can also occur because the child is undergoing a transition, is under stress, or is in the midst of a crisis. This makes the behavioral symptoms of Oppositional Defiant Disorder sometimes difficult for parents to distinguish from the stress-related behaviors. In order for a child to be diagnosed with Oppositional Defiant Disorder they have to be extremely negative, hostile, and defiant in a constant pattern for at least 6 months. This behavior also needs to be excessive compared to what is typical for a child at that age and disruptive to the family, school environments and usually directed toward an authority figure. An example of an authority figure would be parents, teachers, principal, or coach. The child also has to exhibit during these six months four or more of the following behavioral symptoms that are associated with Oppositional Defiant Disorder; frequent temper tantrums, excessive arguing with adults, aggressively refusing to comply with requests and rules, often questioning the rules, deliberately annoying and upsetting others, often touchy or annoyed by others, blaming others for their mistakes, frequent outbursts of anger and resentment, or often spiteful or vindictive. Also, the disruption must cause significant amount of damage to the child’s academic, occupational or social functioning and cannot occur only during a Psychotic or Mood Disorder episode. Lastly, the child cannot be diagnosed with Oppositional Defiant Disorder if they meet criteria for Conduct Disorder, if the individual is eighteen years of age or older or meet criteria for Antisocial Personality Disorder.
My best friend has a son with Oppositional Defiant Disorder. His name is Radon. Radon is ten years old and attends the fifth grade. Radon’s day usually starts out with arguing about what he can and cannot bring to school. His mother and his teacher have now made out a written list of what these things are. Radon was bringing a computer to school and telling his teacher that his mother said it was alright. At first his teacher wondered about this, but Radon seemed so believable. Then Radon brought a little knife. That led to a real understanding between the teacher and Radon’s mother.
Radon does not go to school on the bus. He gets teased and then retaliates immediately. Since it is impossible to supervise bus rides adequately, his parents and the school gave up and they drive him to school. It is still hard to get him there on time. As the time to leave approaches, he gets slower and slower. Now it is not quite as bad because for every minute he is late he loses a dime from his daily allowance. Once at school, he usually gets into a little pushing with the other kids in those few minutes between his mother’s eyes and the teacher’s. The class work does not go that badly unless he has an episode as his mother put it. Then he will flip desks, swear at the teacher, tear up his work and refuse to do anything for the rest of the day. The reasons for his outbursts seem so trivial, but to him they are the end of the world. He is not allowed to go to the bathroom by himself and at times this bothers him so he flips his desk. He was told to stop tapping his pencil, so he swore at the teacher. These types of things happen throughout the day according to his mother.
Recess is still the hardest time for Radon. He tells everyone that he has lots of friends, but his mother says that if you watch what goes on in the lunch room or on the playground; it is hard to figure out who they are. Some kids avoid him, but most would give him a chance if he wasn’t so bossy. The playground supervisor tries to get him involved in a soccer game every day. He isn’t bad at it, but he will not pass the ball, so no one really wants him on his team.
After school is the time that make his mom seriously consider foster care. The home work battle is horrible. He refuses to do work for an hour, then complains, break pencils, and irritate her. This drags thirty minutes of work out to two hours. So, now she hires a tutor. He doesn’t try all of this on the tutor, at least so far. With no home work, he is easier to take. But he still wants to do something with her every minute. Each day he asks her to help him with a model or play a game at about 4:30. Each day she tells him she cannot right now as she is making supper. Each day he screams out that she doesn’t ever do anything with him, slams the door, and goes in the other room and usually turns the TV on very loud. She comes up, tells him to turn it down three times. He doesn’t and is sent to his room. After supper Radon’s dad takes over and they play some games together and usually it goes fine for about an hour. Then it usually ended in screaming. He is then sent to bed and the day starts all over. Since I talked to Radon’s mother about him he has had a very difficult time at school. He is now being home tutored by the after school tutor that he had before. The school has found him to be a threat to the staff and other children. The incidents that lead to this were that he destroyed the principal’s office, threated to kill two staff members, and three children. The mom does not want him put into a school for children with behavioral disorders as she feels it will just make him worse. Radon is now seeing three different people to help with his disorder. One is a social worker, one is a psychiatrist and the other is an anger management specialist. The school continues to work with her and if all goes well he will be transitioned back into the school next year. She still has problems with him at home.
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There are many different theories that try to explain Oppositional Defiant Disorder. There is the psychodynamic theory that interprets the aggressive and defiant behavior as an indication of a deeply-seated feeling of lack of love from the parents, the inability to trust and an absence of understanding. The behavioral theory suggests that Oppositional Defiant Disorder is caused by a dysfunctional family life, lack of parenting and the repeated giving into demands that are reinforced when bad behavior occurs. The biological theory suggests that these behavioral problems in children could be caused by impairments to certain areas of the brain. There is also a link between the amount of certain chemicals in the brain and Oppositional Defiant Disorder. The biological theory suggests that if these chemicals are out of balance, the brain is then not working properly. Then the messages sent may not make it through the brain correctly, leading to symptoms of Oppositional Defiant Disorder. Lastly, cognitive theories state that the child feels hostility in their lives and in turn respond to other with their own hostility.
The first step is to assess the danger the children pose to themselves or others and evaluate the impact that the environment may be having on their continued development. It is important to also evaluate the ability of the child parents to adequately care for them. In some cases, crisis care or residential treatment may need to consider. Treatment for children and adolescents should include multiple avenues. Individual therapy, parent intervention, school intervention, and community based interventions should all be considered. While there are several treatments available to help they have not developed a medication to treat this disorder. There are medications researchers say will help with the symptoms but no properly executed study has been completed. A treatment that is available however, would be Psychotherapy. This is a type of counseling that is aimed at helping the children develop more effective coping and problem-solving skills. There is also family therapy, which may be used to help improve family interactions and communication among family members, as well as parent management training. This teaches parents ways to positively alter their child’s behavior. Lastly, there are behavior management plans. These are an agreement between parents and children that give rewards for positive behaviors and consequences for negative behaviors.
The treatments for Oppositional Defiant Disorder are usually a long-term commitment. It may take a year or more of treatment to see noticeable improvement. It is important for families to continue with treatment even if they see no immediate improvement. If Oppositional Defiant Disorder is not treated or if treatment is abandoned, the child is more likely to develop conduct disorder. The risk of developing conduct disorder is lower in children who are only mildly defiant. It is higher in children who are more defiant and in children who also have Attention Deficit Hyperactivity Disorder. In adults, conduct disorder is called antisocial personality disorder. Children who have untreated Oppositional Defiant Disorder are also at risk for developing passive-aggressive behaviors as adults. Persons with passive-aggressive characteristics tend to see themselves as victims and blame others for their problems.
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