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Oppositional Defiance Disorder

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Of late there is a change in the child's behavior, making hue and cry of even petty issues. The child seems to be in a defiant mood always - A strict 'no' to anything and everything, certain amount of physical violence too. The ballet teacher, sports coach, schoolteacher - have all shared their individual opinion.

Looking at it intently, you can notice that the child's behavior is unusually different with those in authority. The aftermath is becoming contagious. Certain amount of strain is seeping into relationships. What is happening to your child? Should you understand these tantrums as mere signs of growing up? Will things smoothen in due course of time?


Feeling hopeless and helpless can in no way ease the situation. If empowered with information you are well equipped to take proactive steps. Find clues to early detection and understand causes. Check who to approach for help and how to choose suitable treatment options to bring back the child on the road to normalcy.


Oppositional defiance disorder

Children at a tender age of two, teens and adolescents can have oppositional defiance disorder. In younger children, oppositional defiance disorder is more common in boys than in girls. But as the children age, the possibility is almost equal in boys and in girls. Oppositional defiance disorder is the toughest behavior disorder.

Those with oppositional defiance disorder usually have other behavioral problems such as attention-deficit/hyperactivity disorder, learning disabilities, mood disorder (depression) and anxiety disorders. More critical cases may lead to developing a serious behavior disorder called conduct disorder.


Almost all children have their moments. Most of the time they detest being told what to do or ought to do. During these times, depending on their age, they exhibit their unwillingness differently. Some argue or talk back, some cry, some throw tantrums, some shy away - different forms of showing defiance. However, if the child seems to show defiance always, it could be a health syndrome.

A defiant attitude, uncooperative and hostile behavior for more than six months towards any authority figure signals presence of a problem; more so if the behavior has an effect on the child's family, social and academic life. Understanding oppositional defiance disorder holds the key to prompt evaluation and diagnosis.


Oppositional defiance disorder causes


Medical experts are yet to zero in on a single cause for oppositional defiance disorder. Extensive research on the subject has revealed that it can be a combination of biological, genetic and environmental factors.


Biological factor: Alterations in the neurotransmitter activity of the brain are linked to oppositional defiance disorder. Neurotransmitters are made from amino acids, which in turn are obtained from protein in food. Neurotransmitters are brain chemicals. The chemicals facilitate nerve cells in the brain to communicate with each other.

High or low results in shift in moods and changes the way we think. Messages may not make it through the brain. The afflicted individuals may continue to argue, there may be nil fear for punishment, comprehension power may diminish, may shy away from socialization etc. Thus it can lead to psychiatric conditions and mental health problems.


Genetic factor: There is enough data that suggests that oppositional defiance disorder may run in families. In many cases, both children and teens diagnosed with oppositional defiance disorder have had close family members suffering from mental illnesses. Mental health professionals opine that the vulnerability to develop oppositional defiance disorder is high in such cases.


Environmental factor: Home or school, the environment plays a pivotal role in development of oppositional defiance disorder. A child or teen with an imbalance in neurotransmitter levels or who is vulnerable to develop due to genetic reasons is at a high risk of developing oppositional defiance disorder if the environment is not conducive enough. Few environmental factors that contribute are poor parenting skills, domestic violence, physical abuse, sexual abuse, uncaring parents, poverty or low standard of living, substance abuse by parents.


The three factors apart, a group of medical experts have pin pointed two theories as possible causes for oppositional defiance disorder.


Developmental theory: If these children with oppositional defiance disorder are persistent or adamant, it is due to incomplete development. The children do not outgrow their toddler years. Stuck in the 2-3 year old stage they exhibit the same child defiance and are unable to comprehend or be receptive to reasoning.


Learning theory: According to this theory, the child develops the disorder in response to ineffective parenting skills. Right from the formative years the child is exposed to negative techniques, for example harsh or inconsistent discipline. As a result, the child may learn and develop a disobedient behavior.


Oppositional defiance disorder symptoms


It is indeed a challenging task to discriminate between a strong-willed child or teen and one with oppositional defiance disorder. Gone are the days when children and teens respected and regarded words of parents, teachers or elders sans questioning. Children today like to reason out and voice out their individual thoughts on any given subject. The thin line lies in the degree and frequency of aggressive, adamant, defiant, relentless behavior.


Compare the child with children of same age group and gender. Check if there is a disturbance in behavior and how often it occurs. Look if it interferes with family, social and academic or organizational functioning. If it persists for at least 6 months, and if a minimum of four of the following are present, it signals the presence of oppositional defiance disorder.


  • Loses temper too often
  • Develops an aggressive behavior
  • Argues with adults or people in authority
  • Inconsiderate towards requests from adults
  • Plays blame game for his or her behavior
  • Resorts to deliberately annoying people
  • A touch me not or lacks sportive spirit
  • Often angry and feels agitated
  • Refuses to obey rules
  • Excessively stubborn
  • Exhibits temper tantrums often
  • Finds hard to maintain healthy friendships
  • Faces academic or occupational problems
  • Is revengeful


Diagnosis

Before long, acknowledge the necessity to seek help from experts. Aim for early detection and save time. Earlier the diagnosis, better are the chances of reversing its effects. Unlike other health conditions, there are no blood tests done for diagnosing the disorder. Even your child's pediatrician can provide a referral and direct you to concerned health specialists. Psychiatrists, mental health professionals, child psychologists or child behavioral expert are all equipped to undertake a systematic diagnostic evaluation.


At this stage, health professionals look for other disorders, which may be present such as attention-deficit hyperactive disorder, learning disabilities, mood disorders and anxiety disorders. Proper treatment of oppositional defiance disorder may not be possible without treating the other disorders. Talk to the health care provider to understand the factor that has influenced the disorder.


Well before seeking an appointment, do some extensive homework. Equip with detailed information on the subject. Try and speak to parents who have treated their children. Before fixing an appointment with the health care provider, gather information about the person you are supposed to meet. Check their expertise level on the subject and know career profile.

Talk to your child. It is necessary to keep them informed of the steps being taken. Talk to other family members in order to ensure that the child gets good family support. These can make you feel absolutely confident that indeed it is the right path to restore your child's self-esteem.


Tackling oppositional defiance disorder

Varied treatment options are available. There is no single treatment that can work well for all those affected. Treatment is case specific. It is individualized after considering the family background, environmental factors, biological factors, health condition, available resources, and the degree of the problem, gender, and age.


Therapy combined with medications show significant improvement. The aim is to reduce, decrease or eliminate all that which signals a defiant behavior, in order of severity. At the end of a successful treatment the individual should be able to tread the normal path of life like others of their age and gender.


Counseling: Individual counseling and family counseling are integral part of treatment. Parents are taught specific parenting skills and techniques that positively contribute to managing the child or teen. Health professionals encourage and often stress the importance of strengthening the parent-child bonding.

They counsel parents to make them realize how a slight lethargic attitude can negatively contribute to the issue. Likewise, periodical assessment of the child or teen is shared with parents. Parents are informed about the intended future course of treatment and the role to be played by the parents.


Psychosocial treatment: The parents are taught specific techniques to handle the child's defiance.


Parent management training: The aim of the training is to change the way parents and child have been interacting. Parents are encouraged to appreciate the child's positive behavior and subject the child to mild negative consequences for negative behavior. Certain modifications in lifestyle, eating habits, handling o sensitive issues that impact the child are also suggested.


Psychotherapy: Psychotherapy involves alleviating psychological distress through talking rather than through medications. The child, teen or adult is taught cognitive-behavioral approaches. It improves their problem solving skills, communication skills, control impulsive behavior and better manage anger.


How to help?

It could be your child, niece or nephew, friend or neighbor who is affected with oppositional defiance disorder. If you wish to contribute to speedy recovery, here are some useful easy-to practice tips.


  • Check if medications are taken regularly.
  • Appointments with experts are kept.
  • Checklists, advice of health professionals are followed.
  • Check if the child or teen gets enough rest/sleep.
  • Be courteous with the child.
  • Never criticize, ill-treat or look down.
  • Discuss advantages of obeying rules.
  • Talk why listening to authority figures are helpful
  • Play with the child or spend quality time with teen
  • Engage in activities that make him/her happy

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