Early-Onset Oppositional Defiant Disorder

Oppositional defiant disorder (ODD) is included in a group called disruptive behavior disorders. The more serious diagnosis of conduct disorder is also a disruptive behavior disorder. Conduct disorder is separated into childhood-onset (before age 10) and adolescent-onset, but ODD does not share that differentiation. ODD is diagnosed any time during childhood or adolescence.

Definition

• ODD involves a long-term pattern of disruptive behavior that is rebellious, defiant and angry. Children with ODD often lose their tempers, argue with adults, refuse to comply with rules or requests, and are frequently angry, resentful and vindictive. They may be easily annoyed, yet frequently attempt to annoy others. They also tend to blame others for their own mistakes. The key is to distinguish ODD from typical "terrible2s" or adolescent behavior, so the symptoms must exist for at least six months, occur more frequently and be more severe than what would be considered normal for other children the same age.

Diagnosis

• The first step is to rule-out any physical causes or other psychological disorders that have similar behaviors. Attention disorders, learning disorders, other conduct disorders and anxiety may co-exist with ODD, so they must also be considered in the evaluation. While an assessment may begin with a family physician, the expertise of a mental-health professional will be needed to gather the right information from teachers and family members and then assess the symptoms for an accurate diagnosis.

Treatment

• There aren't any medications to treat ODD; however, medications that are appropriate for co-existing disorders such as attention-deficit hyperactivity disorder may be prescribed. Treatment for ODD consists primarily of therapy and education. One of the most important pieces is parent training, not because parents are doing anything wrong but because they need to learn how to manage the child's behavior and other types of discipline that will be more effective. This is critical because oppositional behavior followed by parental punishment quickly evolves into a negative cycle that feeds more disruptive behavior. Parents need new tools to help build the positive and break this downward cycle.

  Family therapy to support communication and help resolve conflicts may also be necessary. The child with ODD will also benefit from cognitive- and social-skills training. Cognitive-based therapy teaches how to recognize negative thought patterns and new ways to manage difficult situations. Social skills training helps to remediate a history of negative interaction with peers and teaches the basics of social interaction.

Age Differences

• Even though the ODD diagnosis does not differentiate according to age of onset, there are some age-related differences. Younger children are more likely to exhibit behaviors that are classically oppositional and defiant. For this reason, parents often wait for them to grow out of a perceived phase before seeking help. Older children tend to express ODD in behaviors such as stealing and fighting. As children with ODD progress through school, they will begin to show open defiance toward teachers and resort to physical aggression with peers.

Outcomes

• It is helpful to think of ODD as being "early-onset" because it is usually diagnosed by age 8 and early treatment helps stop the momentum of the negative cycle. Parents need to be prepared to work with their child for at least three months---sometimes years---but the outcome is worth the effort. According to the American Academy of Child and Adolescent Psychiatry, 67 percent of those who receive consistent treatment will be free of ODD symptoms after three years.