Oppositional Defiant Disorder Treatment

by Anthony Kane, MD

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About a year ago I wrote an article on
Oppositional Defiant Disorder, discussing the condition, symptoms and treatment options. This article is an update describing what is new.

Introduction

Oppositional defiant disorder (ODD) is a psychiatric behavior disorder that is characterized by aggressiveness and a tendency to purposefully bother and irritate others. These behaviors cause significant difficulties with family and friends and at school or work.

Description

Oppositional defiant children show a consistent pattern of refusing to follow commands or requests by adults. These children repeatedly lose their temper, argue with adults, and refuse to comply with rules and directions. They are easily annoyed and blame others for their mistakes. Children with ODD show a pattern of stubbornness and frequently test limits, even in early childhood.

These children can be manipulative and often induce discord in those around them. Commonly they turn attention away from themselves by inciting parents and other family members to fight with one and other.

Behavioral Symptoms
Normal children occasionally have episodes of defiant behavior, particularly during ages of transition such as 2 to 3 or the teenage years where the child uses defiance in an attempt to assert himself. Children who are tired, hungry, or upset may be defiant. Oppositional defiant behavior is a matter of degree and frequency. Children with Oppositional Defiant Disorder display difficult behavior to the extent that it can interfere with learning, school adjustment, and, sometimes, with the child's social relationships.

Common behaviors seen in Oppositional Defiant Disorder include:
-Losing one's temper
-Arguing with adults
-Actively defying requests
-Refusing to follow rules
-Deliberately annoying other people
-Blaming others for one's own mistakes or misbehavior
-Being touchy, easily annoyed
-Being easily angered, resentful, spiteful, or vindictive.
-Speaking harshly, or unkind when upset
-Seeking revenge
-Having frequent temper tantrums

Many parents report that their ODD children were rigid and demanding from an early age.

Diagnosis

The diagnosis of ODD is not always straight forward and needs to be made by a psychiatrist or some other qualified mental health professional after a comprehensive evaluation.

If you feel your child may have ODD, there is a quick
ODD Screening Test

Causes
It is not clear what causes Oppositional Defiant Disorder. There are currently two theories.

The developmental theory suggests that ODD is really a result of incomplete development. For some reason, ODD children never complete the developmental tasks that normal children master during the toddler years. They get stuck in the 2-3 year old defiant stage and never really grow out of it.

The learning theory suggests that Oppositional Defiant Disorder comes as a response to negative interactions. The techniques used by parents and authority figures on these children bring about the oppositional defiant behavior.

Co-morbidity

Oppositional Defiant Disorder usually does not occur alone.

-50-65% of ODD children also have
ADD ADHD
-35% of these children develop some form of affective disorder
-20% have some form of mood disorder, such as
Bipolar Disorder
or anxiety
-15% develop some form of personality disorder
-Many of these children have learning disorders

Any child with Oppositional Defiant Disorder must be evaluated for other disorders as well. If your child has ODD it is imperative to find out what are the co-existing problems. This is the key to treating the condition, as we shall soon discuss.

Prognosis

So what happens to these children? There are four possible paths.

1-Some will grow out of it. Half of the preschoolers that are labeled
ODD are normal by the age of 8. However, in older ODD children,
75% will still fulfill the diagnostic criteria later in life.

2-The ODD may turn into something else. 5-10 % of preschoolers with
ODD have their diagnosis changed from ODD to ADHD. In some
children, the defiant behavior gets worse and these children eventually are diagnosed with
Conduct Disorder. This progression usually happens fairly early. If a child has ODD for 3-4 years and he hasn't developed Conduct Disorder, then he won't ever develop it.

3-The child may continue to have ODD without any thing else. This is
unusual. By the time preschoolers with ODD are 8 years old, only
5% have ODD and nothing else.

4-The child develops other disorders in addition to ODD. This is very
common.

Treatment

Medical Intervention

There have been some recent studies that have examined the effects of certain medications on Oppositional Defiant Disorder. All the research is preliminary and just suggests that certain treatments may help.

One study examined the use of Ritalin to treat children with both ADHD and ODD. This study found that 90% of the children treated with Ritalin no longer had the ODD by the end of the study. The researchers skewed the results a bit because a number of children were dropped from the study because they wouldn't comply with the treatment regimen. Still if these children are included as treatment failures the study still showed a 75% success rate.

There have been two studies examining the effect of
Strattera on children with both ADHD and ODD. One study showed that Strattera helped with ODD, one study showed it did not help.

There was a large Canadian study that showed that Risperdal helped with aggressive behavior in children with below normal intelligence. It did not matter if the child had ADHD or not.

There was study showing that 80% of children with explosive behavior improved when given the mood stabilizer, divalproex.

There was another pilot study examining the use of
Omega-3 oils and vitamin E in ODD children. Both helped the ODD behavior to some degree.

Psychological Intervention
Parent management training is still viewed as the main treatment for Oppositional Defiant Disorder. Our program,
How to Improve Your Child's Behavior which is available online, or some other parent training program is still considered essential if you want to help your child. Also, the younger your child is when you enroll in such a program, the better the results.

Conclusion: Advice to Parents

Currently, there is still far too little research on this very common disorder.

Medically, the most important consideration is to treat other disorders that come along with ODD. Considering that Ritalin may help alleviate the problem in 75-90% of ODD children who have ADHD, and considering that most children with ODD also have some degree of ADHD, I feel that it is very worth your while to try your ODD child on Ritalin unless you know for sure that he does not have ADHD. The other treatments may also be worth a try depending upon the nature of your child.

I feel that using Omega-3 supplements and a vitamin E supplement should be tried in all children. This is because most children are deficient in these nutrients. Even if it does not help with the ODD, it should make your child healthier.

Parent training is still the most effective means of dealing with Oppositional Defiant Disorder. The two main drawbacks of most of these programs are the expense and the availability.

Some practitioners charge $100 or more per visit and considering the program will take several months costs add up. Insurance usually will not pay for such programs. Many parents complain to me that they can not afford the program that their child so desperately needs.

In addition, these programs are not available everywhere. Over the years, numerous parents have told me that where they live there are no programs for Oppositional Defiant Children.

I created How to Improve Your Child's Behavior to address these two problems. It allows parents to help their children regardless of where they live and at a cost that is less than one office visit. Even though it was an experiment to try to administer such a program online and to date no one else is doing this, over the past two years How to Improve Your Child's Behavior has proven time and again to help parents gain control of their defiant children.

Get more information on Oppositional Defiant Disorder- ODD Help by going to our Website

It is tough to live with children who have ODD. However, if you make sure that your child has his other problems addressed and you improve your parenting skills by enrolling in a parent training program, you can do a great deal to improve your child's condition and his future.

b>Anthony Kane, MD
ADD ADHD Advances