Oppositional Defiant Disorder Treatment
Oppositional Defiant Disorder Treatment
by Anthony Kane, MD
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About a year ago I wrote an article on Oppositional
Defiant Disorder, discussing the condition, symptoms and
treatment options. This article is an update describing what is
new.
Introduction
Oppositional defiant disorder (ODD) is a psychiatric
behavior disorder that is characterized by aggressiveness and a
tendency to purposefully bother and irritate others. These
behaviors cause significant difficulties with family and friends
and at school or work.
Description
Oppositional defiant children show a consistent pattern of
refusing to follow commands or requests by adults. These
children repeatedly lose their temper, argue with adults, and
refuse to comply with rules and directions. They are easily
annoyed and blame others for their mistakes. Children with ODD
show a pattern of stubbornness and frequently test limits, even
in early childhood.
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
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.
1-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.
2-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. 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.
3-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.
4-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.
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 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 by going to our Website
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.
b>Anthony Kane, MD ADD ADHD Advances