Oppositional-Defiant Disorder in Children

Oppositional-Defiant Disorder in Children

Symptoms

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
11/24/09

Conduct Disorder In Our Children and Youth

Children diagnosed with conduct disorder show a repetitive and persistent tendency to disrespect and violate the rights of others and to break normal societal rules and also laws. Conduct Disorder may be identified in children before 10 years and up to 18 years of age. It can be diagnosed in individuals older than 18 years, but only if they do not meet the criteria for Antisocial Personality Disorder which I will discuss in a later blog. Briefly, Antisocial Personality Disorder is a life-long disorder that is more severe than Conduct Disorder. The early appearance of Conduct Disorder in a child makes it more likely that the problem will continue into Antisocial Personality disorder in adulthood.

Conduct Disorder may be classified as mild, moderate or severe in nature. Frequently, children with mild cases of this disorder can be helped with therapeutic interventions and the problem may improve with maturity. Severe cases are more likely to continue into adulthood and form a long-term pattern of deeply ingrained antisocial behavior patterns that are highly resistant to change. The majority of our prison populations would be diagnosed as Antisocial Personality Disordered.

The list of actions shown by the children diagnosed with Conduct Disorder can be alarming. A partial list of such behaviors is as follows:

Recklessness and risk-taking
Curfew violations
Truancy from school
Running away from home overnight or longer
Lying, deceiving or “conning” others
Early sexual activity
Tobacco, drug and alcohol use
Bullying, threatening, intimidating and fighting
Using weapons (stones, clubs, knives, guns)
Breaking and entering homes, cars, or other buildings
Cruelty of people and/or animals
Property destruction (vandalism)
Robbery, extortion, mugging, purse snatching (while confronting the victim)
Assault and, rarely, murder

Conduct Disorder has increased in prevalence over several decades and rates are around 6% to 16% for males and 2% to 9% for females.

Suspected Causes

Many very bad childhood experiences appear to be tied to the development of Conduct Disorder. Parents who are drug involved, or have mental disorders of their own are more likely to have conduct disordered children. Research also suggests that the tendency to develop Conduct Disorder behavior patterns is genetically inheritable. Children so diagnosed frequently have experienced traumatic events, poverty, family disorganization, abuse, neglect, and abandonment. They have frequently lived in poverty and grown up around violent peers and adults. Children with a biological or adoptive parent with Anti-social Personality Disorder or a sibling with Conduct Disorder, are themselves at greater risk for developing a conduct disorder.

A Case Study

One 15 year old’s father was in prison for killing someone. The boy had visited his father in prison on numerous occasions and sometimes got phone calls from him. Despite his father’s pleadings to him to do good in school, follow the rules and stay out of trouble, the boy was failing in school, frequently suspended, and had been in a juvenile detention center for threatening and attacking other students. The boy’s mother had lived with several other men in the course of his short life-time and he had experienced drugs, violence, and the physical abuse of his mother and himself repeatedly. After frequently running away from home and being involved with older men and drug abuse, he was placed in a long-term adolescent treatment facility. The boys Conduct Disorder was severe in nature, with an early onset, and it was likely that his behavior patterns would continue into adulthood and then be diagnosed as Antisocial Personality Disorder.

We must find ways to save our infants and children from these incredibly damaging influences. The majority of these human tragedies can be prevented before their contagious effects spread throughout our population. Our current late remediation strategies are failing miserably and are doomed to fail by the very nature of this intractable psychological disability.

America must create bold preventive and very early interventions to avoid the continued escalation of the social havoc that we now experience due to our increasing rates of Conduct Disorders.

If you see the symptoms listed above in your own children, or a Friend or family member complains about them in their children, the best advice is to get professional help as soon as this behavior pattern begins to take shape. I recommend a conference with your family MD and if there are no health issues, an appointment with a psychologist with both counseling and behavior modification skills.

God Bless,

Dr. Tom
11/23/09