Tuesday, November 24, 2009

Oppositional-Defiant Disorder in Children

Oppositional-Defiant Disorder in Children


An all too common problem in our children is Oppositional-Defiant Disorder: This diagnosis is not given to children over 18 years of age, or to those who qualify for a more problematic diagnosis of Conduct Disorder (discussed preveiously).

Oppositional-defiant disordered children are disobedient, hostile, defiant, and negative toward authority figures. They fight compliance with instructions or requests and they are stubborn and will not compromise with adults or friends. They often test limits and do things to purposefully annoy others. These children show frequent hostility to authority figures and peers by arguing with and, in other ways, deliberately annoying them. They also purposefully break the rules that they are reasonably expected to follow. Oppositional-defiant children are often angry, resentful, spiteful and vindictive. Generally, their aggression remains at the verbal level and any physical aggression, if it occurs, remains mild to moderate in nature.

The oppositional and defiant behaviors displayed by these children are often focused intensively upon those who they are closest to (at home with parents and siblings), but they can also be directed at anyone who sets rules or limits upon their behavior. Psychologists and other therapists may not see a child’s oppositional-defiant behavior in their office (even with the parents present) but it will be abundantly present at home and sometimes elsewhere too. A child’s oppositional-defiant behavior may or may not be in evidence at school.

Rates of Oppositional-Defiant Disorder have been estimated to be from 2 to 16%, depending upon the populations sampled and the measures used.

Over the past 40 years, I have been called into schools to consult with teachers and principals to help with student’s behavior problems. I am convinced that oppositional-defiant rates have increased substantially. Rates of occurrence are higher for males before puberty, but are more equal between males and females after puberty is reached. Even so, males tend to be more confrontational than females.

These children may also show other psychological disorders such as ADHD, depression, anxiety, or learning and communication disorders.

Case Study

One adolescent male was born and raised in a family where the father was exceedingly demanding upon him. His mother was permissive and protective towards the boy and there was almost constant conflict between she and her resentful and compulsively demanding husband over the boys disciplinary issues. The boy was very bright and got good grades at school, but the father insisted upon all A’s stating that he was not living up to his potential. The boy’s behavior at school was exemplary and he was in various clubs and athletics. However, at home, he was manipulative and demanding of money, car privileges, and excessive freedom. His father almost always said “no” to these demands and his mother almost always countermanded the father’s judgement. The adolescent’s tactics involved angry, insulting and disrespectful behavior, and noncompliance with the requests of both of his parents. But, he was most likely to focus his blustery and unrelenting tantrum-like demands upon his mother. This was especially likely when his father was not at home. The mother frequently gave-in to her son’s demands. As you might guess, this rewarded the boy’s behavior and set the occasion for the next round of arguments between the mother and father. This adolescent’s oppositional-defiant characteristics appeared to be born of his parents polarized disunity, his resulting ability to further split and alienate them from each other, the ensuing conflict between the parents, and the family chaos that resulted. The adolescent was therefore in a better position to divide and conquer his parents authority in the future.

Suspected Causes

Oppositional-Defiant Disorder is more prevalent in families that have had many different care-givers and where inconsistent, harsh, abusive or neglectful child rearing methods have been used. It is also more likely to be found in homes where at least one parent has had a mood disorder (depression/bipolar), or other similar, perhaps more intense, disruptive disorders

Oppositional Defiant Disorder is more prevalent in males and children who are temperamental and show low self-esteem and low frustration tolerance. This disorder thrives on disorganization and is more common in homes where there have been many care-takers. Im my experience divorce or multiple mates and pregnancies out-of-wedlock frequently set the stage for this kind of chaos. Also, harsh or abusive treatment, irresponsible and neglectful parents, or significant mental illness, is frequently involved in the lives of children who show Oppositional-Defiant Disorder. Sometimes all that is necessary for the development of this problem is a clash between two parenting styles, one very demanding and the other very permissive.

Prevention or early correction

In many cases, parents can prevent these problems, they will recognize the development of this problem early and seek the assistance of an experienced behavior therapist with very good counseling and behavior modification skills. Almost always, with early intervention and treatment, the problem of oppositional defiant behavior in young children can be improved significantly.

Please pass this on to others who may need to know.

God Bless,

Dr. Tom

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