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International Journal of Nursing Education and Research 4(4): October -December 2016 ISSN 2347-8640 (Print) www.anvpublication.org 2454-2660 (Online) www.ijneronline.com REVIEW ARTICLE Oppositional Defiant disorder Ms. Ritika Rocque MGM New Bombay College of Nursing, MGM Educational Campus, Plot no ...

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International Journal of Nursing Education and Research 4(4): October -December 2016

ISSN

2347-8640 (Print) 2454-2660 (Online)

www.anvpublication.org www.ijneronline.com

REVIEW ARTICLE

Oppositional Defiant disorder Ms. Ritika Rocque MGM New Bombay College of Nursing, MGM Educational Campus, Plot no 1 & 2, Sector 1, Kamothe, Navi Mumbai -410209. *Corresponding Author’s Email: [email protected]

ABSTRACT: Oppositional defiant disorder (ODD) is a childhood behavioral problem characterized by constant disobedience and hostility. Around one in 10 children under the age of 12 years are thought to have ODD, with boys outnumbering girls by two to one.ODD is one of a group of behavioral disorders known collectively as disruptive behavior disorders, which include conduct disorder (CD) and attention deficit hyperactivity disorder (ADHD). Early intervention and treatment is important, since children with untreated ODD may continue to be difficult and antisocial into their adult years. This can impact on their relationships, career prospects and quality of life. Some children with ODD will develop the more serious conduct disorder (CD), which is characterized by aggressive law-breaking and violent behaviors.

KEYWORDS: Oppositional defiant disorder, children, behaviour, Family Therapy, School-Based Programs INTRODUCTION: Oppositional Defiant Disorder: It is common for children and teenagers to display bouts of irritability, frustration, and disobedience over the course of their growth and development. For example, a 4 year old who throws a tantrum because she has to stop playing; a 13 year old who argues with her mother about going for a movie with friends. Some children and teens have such an inflexible and hostile nature and their behavior can be so uncooperative and defiant that they disrupt the functioning of whole households and classrooms, not to mention their own learning and wellbeing in relationships.

According to the American Psychiatric Association, ODD is characterized by a chronic pattern of negativity, hostility, and non-compliant child behavior that is most often directed toward authority figures and has existed for at least 6 months. Evidence suggests that between 1 and 16% of children and adolescents have ODD.1 However, there is not very much information on the prevalence of ODD in preschool children, and estimates cannot be made.2

Causes of ODD: There is no clear-cut cause of ODD. However, most experts believe that a combination of biological, psychological, and social risk factors play a role in the Definition: Oppositional defiant disorder (ODD) is one of a group of development of the disorder.3 behavioral disorders called disruptive behavior disorders (DBD). These disorders are called this because children Biological Factors: who have these disorders tend to disrupt those around Children and adolescents are more susceptible to them. developing ODD if they have:  A parent with a history of attention-deficit/ hyperactivity disorder (ADHD), ODD, or CD  A parent with a mood disorder (such as depression or bipolar disorder) Received on 18.06.2016 Modified on 10.07.2016  A parent who has a problem with drinking or Accepted on 17.07.2016 © A&V Publications all right reserved substance abuse Int. J. Nur. Edu. and Research. 2016; 4(4): 493-496. DOI: 10.5958/2454-2660.2016.00091.0

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International Journal of Nursing Education and Research 4(4): October -December 2016

 Impairment in the part of the brain responsible for It is not uncommon for children with Attention reasoning, judgment, and impulse control Deficit/Hyperactivity Disorder (AD/HD), depression, or  A brain-chemical imbalance anxiety to display symptoms of ODD.  A mother who smoked during pregnancy  Exposure to toxins Effect on Families & Relationships:  Poor nutrition Parenting a child with ODD can be a tremendous challenge not only because he or she may seem so willing to defy adult authority, but also because Psychological Factors:  A poor relationship with one or more parent intervention strategies that work with most children,  A neglectful or absent parent such as time-outs, removal of privileges, and grounding,  A difficulty or inability to form social relationships often do not work with ODD. Studies actually indicate or process social cues that these children may not respond well to punishments. Other studies have found that children and teens with severe cases of ODD and/or aggression may feel Social Factors: threatened by situations where there are unclear  Poverty messages, rules, or expectations, which can trigger  Chaotic environment hostile reactions. In addition, they often have poor  Abuse frustration tolerance, which only makes it more difficult  Neglect for them to get through situations where they feel  Lack of supervision uncomfortable, threatened, or where they may see little  Uninvolved parents pay-off for their efforts. The result of these factors are  Inconsistent discipline  Family instability (such as divorce or frequent children and teens who seem to be easily annoyed or moves) angered, yet are difficult to soothe and calm. This pattern  of behavior can leave many families feeling powerless, as if they have to “walk on eggshells” out of fear that Signs and Symptoms: Most children argue with parents and defy authority one wrong move can cause a serious tantrum. It can also from time to time, especially when they are tired, leave the child or teen feeling isolated, anxious, and hungry, or upset. Some of the behaviors associated with unsure of herself as others anticipate her irritability and ODD also can arise in children who are undergoing a explosive behavior even before it occurs. They likely transition, who are under stress, or who are in the midst will be aware of any feelings of disappointment and of a crisis. This makes the behavioral symptoms of ODD resentment that other family members feel toward them sometimes difficult for parents to distinguish from due to their oppositional and defiant behavior. expectable stress-related behaviors.4 Children with ODD Unfortunately, it is not enough to help change the show an ongoing pattern of extreme negativity, hostility, behavior. and defiance that: Diagnostic tests: • Is constant While there is no single test that can diagnose ODD, a • Lasts at least 6 months • Is excessive compared with what is usual for the mental health professional can determine whether a child or adolescent has the disorder by assessing the child’s child’s age symptoms and behaviors and by using clinical • Is disruptive to the family and the school • Is usually directed toward an authority figure experience to make a diagnosis. (parents, teachers, principal, coach) The following behavioral symptoms are associated with Gathering Information: A child and adolescent psychiatrist or a qualified mental ODD: health professional usually diagnoses ODD.A mental • Frequent temper tantrums health professional will gather information from parents, • Excessive arguments with adults teachers, and daycare providers as well as from the child. • Actively refusing to comply with requests and rules The mental health professional will determine whether: • Often questioning rules  The behavior is severe • Deliberately annoying and upsetting others  The conflicts are with peers or authority figures • Often touchy or annoyed by others  The behavior is a result of stressful situations within • Blaming others for their mistakes the home • Frequent outbursts of anger and resentment  The child reacts negatively to all authority figures, or • Spiteful attitude and revenge seeking only his or her parents or guardians

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Prevention of ODD: There is research that shows that early-intervention and school-based programs along with individual therapy can help prevent ODD.3

 Medication may be necessary to help control some of the more distressing symptoms of ODD as well as the symptoms of coexisting conditions, such as ADHD, anxiety, and mood disorders. However, medication alone is not a treatment for ODD.

Among preschoolers, the Head Start program has been shown to help children do well in school and prevent delinquency later in life. Head Start is a program of the United States Department of Health and Human Services (US-HHS) that provides education, health, and other services to low-income children and their families. Young children in this program learn social skills and how to resolve conflict and manage anger.5 A home visit to high-risk children also has been shown to help prevent ODD among preschoolers.6 Among adolescents, psychotherapy (talk therapy), social-skills training, vocational training, and help with academics can help reduce disruptive behavior. In addition, school-based programs can be effective in stopping bullying, reducing antisocial behavior, and improving peer relationships. Parent-management training programs have proven effective in preventing ODD among all age groups. These programs teach parents how to develop a nurturing and secure relationship with their child and how to set boundaries for unacceptable behavior.3

Intervention: The key to successful interventions for ODD is parent involvement. It is critical that parents be firm and consistent not only with their discipline strategies, but also with the love and acceptance in their responses to the child. The most effective interventions are considered to be those that emphasize Parent Training, which provide a framework for understanding the nature of ODD in children and teens and help reinforce specific parenting skills, as well as teach creative strategies for managing ODD behavior. Parents who are not able to respond to ODD behavior in a manner that can calm and soothe the child only add fuel to the fire. It is a lot to ask of a parent who is constantly under attack from oppositional behavior to react calmly, and it probably seems impossible if you are feeling demoralized and exasperated. This is why it is often a good idea to seek the help of a mental health professional, such as a marriage and family therapist (MFT), who can not only help you learn strategies to confront this kind of extreme behavior, but also learn ways of coping with the stress of Treatment: There is no one-size-fits-all treatment for children and parenting in the face of such difficult circumstances. adolescents with ODD. The most effective treatment plans are tailored to the needs and behavioral symptoms Parent-Management Training: of each child. Treatment decisions are typically based on Parent management training teaches parents positive a number of different things, including the child’s age, ways to manage their child’s behavior, discipline the severity of the behaviors, and whether the child has a techniques, and age-appropriate supervision. It is the coexisting mental health condition.7 treatment of choice to prevent disruptive childhood behavior for many mental health professionals. This approach embraces the following principles: Types of Treatment: Treatment usually consists of a combination of:  Increased positive parenting practices, such as  Parent-Management Training Programs and Family providing supportive and consistent supervision and Therapy to teach parents and other family members how discipline to manage the child’s behavior. Parents, family  Decreased negative parenting practices, such as the members, and other caregivers are taught techniques in use of harsh punishment and focus on inappropriate positive reinforcement and ways to discipline more behaviors effectively.  Consistent punishment for disruptive behavior  Cognitive Problem-Solving Skills Training to reduce  Predictable, immediate parental response inappropriate behaviors by teaching the child positive ways of responding to stressful situations. Children with Prognosis: ODD often only know of negative ways of interpreting Follow-up studies have found that approximately 67 and responding to real-life situations. Cognitive problem percent of children diagnosed with ODD who received solving skills training teaches them how to see situations treatment will be symptom-free after three years. and respond appropriately. However, studies also show that approximately 30  Social-Skills Programs and School-Based Programs percent of children who were diagnosed with ODD will to teach children and adolescents how to relate more go on to develop CD.5 In all age groups, approximately positively to peers and ways to improve their school 10 percent of children and adolescents diagnosed with work. These therapies are most successful when they are ODD will eventually develop a more lasting personality conducted in a natural environment, such as at the school disorder, such as antisocial personality disorder.8 However, most children and adolescents will improve or in a social group.

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International Journal of Nursing Education and Research 4(4): October -December 2016

over time, especially if they receive treatment. Parents who suspect that their child has a behavioral problem should have their child evaluated. For children who receive treatment, the outlook is very good.

CONCLUSION: Oppositional defiant disorder (ODD) is a childhood behavioral problem characterized by constant disobedience and hostility. Children with ODD will struggle in school and in making and/or keeping friends. It appears a child with Oppositional defiant disorder thrives on deliberately annoying other people. They refuse to take responsibility, blaming others for their mistakes or misbehavior; they are easily annoyed and act with aggression toward peers and adults. They often have trouble academically. Parents with a child suffering from ODD should seek support and help from a professional familiar with this disorder as many times it is misdiagnosed, and left untreated ODD can, and most likely will, progress to the more serious Conduct disorder, substance abuse and severe delinquency. Children afflicted with ODD or Conduct disorder will most likely have trouble feeling empathy and may misread social queues or miss them altogether. He may misinterpret others behavior as hostile or aggressive leading him to act out in response to the aggression with aggression in return. Parents and children will benefit from parental training. Parents and siblings should have patience as the treatment will include the whole family. When one child is disruptive, the entire family feels the effects and everyone suffers the consequences to a degree. The upside to this “disorder” is that it is within a parent’s control to change their child’s behavior and their life.

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Loeber R, Burke JD, Lahey BB, Winters A, Zera M (2000), Oppositional defiant and conduct disorder: a review of the past 10 years, part I. J Am Acad Child Adolesc Psychiatry 39:1468-1484. American Psychiatric Association (1980), Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III). Washington, DC: American Psychiatric Press. Burke JD, Loeber R, Birmaher B (2002), Oppositional defiant and conduct disorder: a review of the past 10 years, part II. J Am Acad Child Adolesc Psychiatry 41:1275-1293. Skovgaard AM, Houmann T, Landorph SL, Christiansen E (2004), Assessment and classification of psychopathology in epidemiological research of children 0Y3 years of age: a review of the literature. Eur Child Adolesc Psychiatry 13:337-346. Connor DF (2002), Aggression and Antisocial Behavior in Children and Adolescents: Research and Treatment. New York: The Guilford Press. Eckenrode J, Ganzel B, Henderson CR, Smith E, Olds DL, Powers J, Cole R, Kitzman H, Sidora K (2000), Preventing child abuse and neglect with a program of nurse home visitation: the limiting effects of domestic violence. JAMA 284:1385-1391. Kazdin AE (2005), Parent Management Training: Treatment for Oppositional, Aggressive, and Antisocial Behavior in Children and Adolescents. New York: Oxford University Press. Rutter M, Giller H, Hagell A (1999), Antisocial behavior by young people. J Am Acad Child Adolesc Psychiatry 38:1320-1321.

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