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August 16 2022 12:58 AM ˚
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Oppositional defiant disorder in children

Oppositional defiant disorder
Studies and statistics on oppositional defiant disorder in Jordan and in the Middle East remain a significant gap in literature mainly due to the stigma surrounding mental health conditions. (Photos: Shutterstock)
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Even the best-behaved children will have their moments, when they are difficult to deal with, especially if they are tired, hungry, anxious, or upset. They might talk back, throw tantrums, and defy rules. Such oppositional behavior is considered a normal part of development, especially in children ages 2-3 and in early adolescents. اضافة اعلان

However, some children show a persistent pattern of hostility, irritability, defiance, and uncooperativeness that stands out when compared to other children of the same age and developmental level. When this behavior starts to disrupt the child’s family, social, and academic life, he/she may have oppositional defiant disorder (ODD).

The typical age of onset of ODD is 8. Symptoms usually remain stable until the age of 10, then typically, but not always, start declining. ODD is a treatable condition that often may require psychotherapy and parent management training. If ODD is not properly diagnosed and treated, it may persist into adulthood. Almost 30 percent of children with ODD develop a more serious behavioral condition called conduct disorder.
Prevalence of ODD
It is important to acknowledge that there are no perfect sources of data to accurately measure the prevalence of ODD in children, but an estimated global prevalence, detected by all sources, according to The Spanish Journal of Psychiatry, stands at 16.1 percent. Interestingly, the prevalence goes down to around 9.5 percent when the subjects are detected by only one informant, with parents being more able to detect ODD in their children than teachers. The range of prevalence varies because some children are misdiagnosed and many teenagers are often underdiagnosed.

A 2018 study published in The Journal of Child Psychology and Psychiatry showed an 11.7 percent prevalence of behavioral problems amongst Jordanian adolescents. The study also found a correlation between behavioral problems and a lower GPA. Another study, of adolescents in institutional care in Joran, saw an increase in behavioral problems due to family disintegration, maltreatment, or abandonment.

There is a significant gap in literature on studies and statistics on ODD in Jordan and in the Middle East due to the stigma surrounding mental health conditions — especially ones related to behavior — that result in children and adolescents often being underdiagnosed and not receiving sufficient treatment. This is highly tied to the way Jordanian families inaccurately value the community’s perception of them. They believe that their child having any sort of behavioral condition will reflect poorly on their family image and their parenting, so they decide to deal with it themselves, without seeking any kind of professional help. Unfortunately, such fear is not unfounded.

According to a study published in The Journal of Child Psychology and Psychiatry, ODD remains the leading cause of referral to youth mental health services. Many uncertainties surround ODD, mainly due to the fact that it is rarely ever examined as a distinct psychiatric disorder. ODD is usually comorbid with at least one other mental health condition. The most common conditions present alongside ODD are attention-deficit hyperactivity disorder (ADHD), anxiety disorders, learning difficulties, mood disorders, and impulse control disorders. It is believed that around 40 percent of children with ADHD are diagnosed with ODD as well.

Who does ODD affect?
There is no specific known cause for ODD. However, researchers believe in two main theories, developmental and learning, that put certain children at a higher risk of developing ODD. The developmental theory suggests that the problem begins when children are toddlers and, as they grow, they have trouble learning to become independent from a parent or a person they were emotionally attached to. As for the learning theory, it suggests that the negative symptoms of ODD are learned attitudes. Children mirror the effects of negative reinforcement methods used by parents, which exacerbate their ODD behavior, which allow them to get what they always want: attention and reaction from parents and others.

Oppositional defiant disorder is a condition in which a child displays a pattern of uncooperative, defiant and angry behavior toward people in authority. 

Other risk factors include a history of child abuse or neglect, and exposure to violence, which result in children with ODD being more aggressive, hostile, and vindictive. Family issues such as mood disorders, substance abuse, financial problems, divorce, and other destabilizing factors are prominent risk factors as well. Parents who are inconsistent with their discipline methods also put their children at a higher risk of increased ODD symptoms.

Genetics also plays and important role. Researchers also found biological factors that link ODD to issues with certain neurotransmitters, leading to off-balanced chemicals and messages not making it through the brain correctly. Results of a 2017 study released in The Journal of Family Psychology show that the genetic influence of ODD becomes more prominent as maternal involvement decreases. 

What does ODD look like?

Symptoms of ODD are usually most visible at home and at school, but are also noticeable in multiple other settings. Signs and symptoms can be grouped into three main categories: anger and irritability, argumentative and defiant behavior, and vindictiveness. Children with ODD are likely to lose their temper easily and have frequent outbursts of anger and resentment toward a parent, teacher, or others. They may come off as touchy and/or disrespectful. They are very easily annoyed by others and are irritated by the most miniscule things.

Children with ODD are likely to excessively argue with authority figures and refuse to comply with rules and requests. This can be especially difficult in a classroom environment, as it can easily disrupt the class ecosystem and cause tension between the child with ODD and teachers, who will find it difficult to contain them or even reason with them. A child with ODD may deliberately pick fights with other students then proceed to blame them for their own mistakes and refuse to apologize.

Vindictiveness is another important sign of ODD diagnosis, as children with ODD tend to be spiteful and constantly seek revenge. They may say mean and hateful things when they are angry or upset.

In terms of gender differences, the prevalence of ODD is significantly higher in boys than in girls, with one study published in The Journal of Abnormal Child Psychology showing results of a 1.59:1 prevalence ratio. Boys with ODD tend to have more leeway, especially in Middle Eastern cultures, to externalize their aggressive behavior and display more symptoms of deliberately annoying others; they show a greater functional impairment in school and the wider community context.

It is important to take ODD signs and symptoms seriously and not pass them off as “boys being boys”, as they may cause serious harm to those around the child, and, more importantly, to the child himself.

Treatment and diagnosis of ODD
An ODD diagnosis means that a child must have had at least four of the symptoms described in the DSM-5 for a period of at least six months. Such symptoms must clearly disrupt a child’s daily functioning. After a child psychologist or psychiatrist uses interviews and assessment tools to evaluate a child, he should also rely on reports from the child’s parents, siblings, and teachers to get a full understanding of the child’s behavior. Since ODD may be taken for other mental health conditions, it is important to be transparent with your mental health professional with regards to the child’s behavior and history of symptoms.

Treatment for ODD will vary based on multiple factors, such as the child’s age, the severity of symptoms, the ability to tolerate and cooperate with specific therapies and whether the child has other mental health conditions such as ADHD. So far, there is no approved medication for ODD treatment, but a child psychiatrist may prescribe certain medication to treat other conditions, such as ADHD, OCD or depression, which can contribute to helping decrease ODD symptoms. Treatment may consist of a combination of parent management training, psychotherapy, and school-based interventions.

Parent management training is a vital tool in treating ODD because it provides parents with strategies on how to change their child’s behavior at home by utilizing positive reinforcement to drive out unwanted behaviors. It also helps them identify factors in their home life that may contribute to worsening aggressive behavior.

Psychotherapy such as cognitive behavioral therapy-based anger management has shown to successfully teach children with ODD problem-solving skills, perspective-taking and adopting healthier thinking patterns and behavior.

It is important for schools to adopt tools and strategies to help teachers improve a child with ODD classroom behavior, show them how to follow classroom rules and teach them acceptable social interaction.

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