Oppositional Defiant Disorder

ODD is a behavioural disorder, usually diagnosed in childhood, that is characterised by uncooperative, defiant, negative, irritable and annoying behaviours towards parents, peers, teachers and other authority figures.  Many children, particularly adolescents, can be oppositional.  However the oppositionality of ODD persists despite reasonable parenting strategies.  The most concerning form is that of early onset which can occur even in preschool years.  It puts very considerable pressure on the families.

Many children, especially when they are tired, upset or hungry tend to disobey, argue with parents or defy authority. However in children and adolescents with ODD these symptoms occur more frequently and interfere with learning and social relationships.

Symptoms may include;

• ·         Frequent temper tantrums
• ·         Excessive arguments with adults
• ·         Refusal to comply with adult requests
• ·         Always questioning rules; refusal to follow rules
• ·         Behaviour intended to annoy or upset others
• ·         Blaming others for his/her behaviours or mistakes
• ·         It is never their fault!
• ·         Easily annoyed by others
• ·         Frequently has an angry attitude
• ·         Speaking harshly or unkindly
• ·         Seeking revenge

 It is often very difficult to tease out the extent of ODD symptoms in relations to possible autistic spectrum difficulties and even emotional volatility or bipolar disorder with mood instability.  This warrants very careful assessment and sometimes these conditions may coexist together.

The cause of ODD is not known.  However while different professional groups tend to have differing viewpoints, there is increasing recognition that oppositional defiant disorder of early onset almost certainly has a biological component.  Studies show that the majority of children with early-onset ODD have underlying ADHD and/or autistic spectrum disorder.

Only about 10% of cases are ODD alone.  The high prevalence of associated ADHD has led some authors to consider that there should be a form of ADHD diagnosed as the oppositional form of ADHD.  Almost certainly the early onset form is not due to environmental influences alone but it does cause  difficulties and significant family dysfunction.

ODD is reported to affect between 2 and 16% of children and adolescents in the general population. It is more common in boys than girls.  Studies show that at least 40% of children with ADHD have coexisting oppositional defiant disorder. On LANC’s own audit this figure rose to 50%.

A detailed history, clinical observation and sometimes, psychological testing contribute to the diagnosis.  ODD is a clinical diagnosis and the diagnosis is reached by discussing with parents whether or not the child meets criteria for ODD, how long the symptoms have been present and whether or not they have failed to respond to reasonable parenting support.

This will be determined by the age, extent of symptoms, expectations, opinions and preference but they may include; Individual Psychotherapy, Family Therapy, Peer Group Therapy, or Medication:

•  Parenting strategies must be looked at carefully.  The key principles for parenting a child with ODD are on the LANC behaviour modification handout/link.
•  Medication may have a very important role in the management of children with particularly the early onset of oppositional defiant disorder.  Frequently when the underlying ADHD is treated the oppositionality improves.  However if this is not the case an experienced clinician may sometimes need to consider adding either Clonidine or Risperidone to help mellow the oppositional symptoms.