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Handling Adolescents With Oppositional Defiant Disorders

Introduction

Children undergo a series of developmental stages as they grow towards maturity and it is important that parents understand the difference between the normal adolescence behaviors to attempt to disobey rules and authority and the full-blown Oppositional Defiant Disorder. Oppositional Defiant Disorder (ODD) is a behavioral disorder that mostly affects adolescents in their early stages. It is characterized by lack of cooperation, being irritable, showing defiance and having a negative attitude towards parents, teachers and other people with authority over them. They are more troubling to other people than they are troubled themselves (Lahey, 2008).

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According to Kazdin (2006) children with oppositional defiant disorder normally have other associated psychiatric disorders. ODD is a co-morbid mood disorder that is connected with behaviors like hyper-activity, attention-deficit disorder, anxiety and obsessive and compulsive disorders. Such children show a consistent behavior of not following orders or requests by their seniors and this creates adverse effects on the interaction between them and their parents or caretakers. Research has also shown that children with ODD are at risk of developing a long term conduct disorder and parental guidance is necessary to help the parents handle their ODD adolescents and hence prevent the disorder from getting to an adverse stage.

Diagnostic and Developmental issues for ODD patients

Since many of these behavioral disorders are found in normal children, making a diagnosis for ODD may be difficult. The diagnosis can only successfully be carried out by a psychiatrist or any other qualified psychological professional once a comprehensive evaluation has been done. Psychiatrists and other health professionals normally rely on their medical experience, the information given by parents, teachers and other relevant persons and the information they get when they question the children. It may also be difficult to separate ODD with other related disorders like attention-deficit/hyper-activity disorder (ADHD) and doctors have to diagnose them together (Greene, 2004).

According to Kazdin (2006) it is rare for a doctor to treat a child with oppositional defiant disorder alone because the ODD child normally has other psychiatric disorders other than ODD. This tendency for different psychological disorders to manifest together is known as co-morbidity and ODD children are said to have co-morbid mood disorders, which must be treated together with ODD.

Oppositional defiant disorder is normally diagnosed when the child’s (especially teenagers) abnormal behavior exceeds six months. A full medical check-up is carried out to ensure that there is no possibility for other medical problems that may be affecting the child’s behavior. Once a medical examination is undertaken, a psychological evaluation for ODD is then carried out. This includes ruling out the likelihood for the prevalence of a more adverse behavior like the Conduct Disorder (CD). CD is closely related to ODD but besides the disruptive behavior in ODD patients, children suffering from Conduct disorder are physically aggressive and they have a tendency to break laws and abuse the legal rights of other people (Greene, 2004).

The extent of development of ODD behavior in adolescents may be used in diagnosis to define the degree of severity as mild, moderate or extreme.

Characteristic defenses

Adolescent children with ODD are normally very disobedient. They also have a very high temper and are constantly angry, normally creating arguments at all times. Their happiness is in winning arguments even when they know they are on the wrong. It also becomes difficult to try to reason with such children because they perceive it as a way of going on with arguments. On the other hand, children with ODD do not take themselves as being argumentative or disruptive. They tend to defend their behaviors by passing on blame to other people. They can be said to implement a defensive mechanism for their behavior by showing perfectionism and by having a strong desire for proper justice to be taken against those who violate what they consider the right behavior (Lahey, 2008).

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According to Lindahl (1998), young children with ODD are normally very stubborn and tend to cause tantrums over petty issues. Such children are impatient and they have the attitude of not tolerating other people. Older children, especially teenagers tend to provoke other people, especially their adults by being critical and speaking ill of them. They may also bully the other children as they tend to feel superior over everybody else.

Other characteristic behaviors that ODD adolescents possess which act as a defense mechanism include (Lindahl, 1998):

  1. They have a strong desire for control and they will do anything just to have it. They feel they have authority over everyone else both young and old and they will not be ready for any corrections.
  2. They never admit for any negative impact that their behavior causes. They will deny having been the cause of a negative action caused by their misbehavior and they hardly care about the effects their misbehaviors might bring to other people.
  3. They are ever ready to attempt anything and they develop the intention to learn how other people will react from their behaviors. Once they identify the response of people, they use this to create more trouble towards their families and to the society.
  4. They operate on negativity and they tend to be happy whenever they succeed in creating conflict and negative attitudes with other people.

How parenting can cause or prevent Oppositional Defiant Disorder in children

Parents play a significant role in determining the behavior of their children and they are the greatest determinants of the likelihood of the occurrence of an oppositional defiant disorder in their children. According to Greene (2004), there are psycho-social treatment approaches that are used to establish ways in which parenting affects the possibility for the development of oppositional defiant disorders among children. Parent training (PT) models and behavioral family therapy are effectively used to identify the parental discipline techniques that may result in the development of defiance and oppositional behavior among children. Parents are taught skills that will be used to prevent them from encouraging ODD behavior among their children and these include positively participating in bringing up the children as well as using the appropriate means of command to guide their behavior.

Different studies on parenting show that oppositional disorder among children and adolescents is more common where the family structure is significantly out of balance. That is, when there is too large a structure or when it is not enough. An over-structured family system results in an inflexible family that is not ready to adapt to any changes that are coming up. In this kind of family structure, parents become too strict on their growing children and tend to control their entire life without giving their children the freedom to manage their own life. This kind of parenting only creates defiance among children, where they tend to develop oppositional behavior against their parents (Carr, 2009).

According to Carr (2009), a loose or insufficient family structure is also likely to cause problems in the children’s behavior. Children are likely to develop oppositional defiant behavior when their parents fail to provide sufficient structure. That is, if they fail to create reasonable boundaries for their children’s life by establishing any misbehavior as well as ensuring the children bears the consequences for their misbehavior. Parents in this kind of structure normally give in to all the child’s demands in an attempt to please them or to play the role of best parent.

In order to prevent or reduce the level of oppositional defiant behavior among children, parents should ensure that they develop appropriate parenting styles where the parenting or family structure is balanced. They need to ensure that they use their authority to gain respect from their children as well as make the children feel loved and respected (Carr, 2009).

The relationship of the parents is another factor that may promote or prevent oppositional disorder among children. When couples are oppositional or constantly in conflict, they end up having disagreements in respect to parenting and this creates a limit towards enhancing positive behavior in their children. Children who are developing oppositional defiant disorders will most likely tend to create problems for their parents and when the parents have misunderstandings, the problem may be made worse. Parent training programs and counseling are necessary in order to reduce the conflict between parents and create a basis for a united and effective parenting. Parental training models are focused on looking into the cognitive deficiency issues among children that are likely to result in oppositional disorders (Lahey, 2008).

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According to Lahey (2008), infant temperamental behavior is another determinant of the possibility or impossibility of oppositional disorders among children. Lahey relates temperament behavior in infants with parenting and it is argued that children who have a high level of infant fussiness are more likely to develop future behavioral problems. Proper parenting is necessary at the initial stages of the life of a child because it is what determines the behavioral characteristics once the child has grown. Parents ought to develop appropriate techniques of controlling the temperamental behavior of children at their early stages of life in order to overcome the oppositional defiant disorder in teenage life.

Therapeutic techniques that parents can use to handle their ODD children

Carr (2009) argues that parents play an important role in helping ODD children improve on their defiance behavior and learn the ways in which ought to interact with other people. Proper guidance should be provided by experts to help the parents establish therapeutic ways of dealing with their ODD children. Psycho-therapy is a psychiatric treatment that is used by a health professional to enhance interactions between the professional and the affected child and family. It is an effective way towards helping the parents understand and be capable of effectively handling their ODD children. Psycho-therapy also enables parents to modify the behavior of their children and create a positive change.

Another effective way that parents may use to handle their ODD children is by avoiding conflicting issues with the child. Parents who are always argumentative towards their ODD children will only be making the situation worse. Controlling conflicts by trying to change the subject or creating a more useful discussion will work towards controlling a defiant child’s temper. Parents should bring their authoritative right in bringing up their defiant children but they should not use that authority to cause more problems. One of the effective ways of avoiding conflict would be change the subject or to stay calm while trying to support your point (Lindahl, 1998).

According to Hales (1999), utilizing effective consequences for any oppositional behavior may also be used as a therapy towards controlling the behavior of the child. However, this should be carefully implemented because it may act as a basis for more arguments and conflicts. It is important that parents focus on those consequences that do not need the co-operation or support of the defiant children and these consequences need to be clear and if possible, in writing so that arguments do not arise in implementing them on the children.

Once the parents have successfully been able to control the child’s behavior, they should then try to soothe the child to try to bring them back to their role as children and to restore the authority of the parents. ODD children tend to consider themselves at the same level with their parents and with all the conflicts going on, they may feel not loved and may tend to cause more harm to themselves and to their families. Soothing defiant children makes them feel loved and appreciated and it is an effective way of ensuring that the negative behavior has fully been controlled (Hales, 1999).

Resistances in therapy

Kadzin (2006) argues that developing an Evidence-based Treatment is important while carrying out a psycho-therapy research. It helps identify the effectiveness of the therapy administered on ODD patients. Some patients are normally resistant to therapy and they may result in having a more serious disruptive disorder if appropriate treatment is not carried out. More severe cases of oppositional defiant disorder may not respond well to therapeutic treatment and would require more specialized training. Cases of conduct disorders or complexities may need to be given more specialized attention other than therapy from the parents or the children’s caretakers.

Resistance in treatment may also arise in the case where the parents are also experiencing dysfunctional problems. Parents should work towards helping their defiant children adapt well to therapy, but when they are also psychologically affected by their children’s behavior, then the therapy might not be effective on the children and they are likely to develop resistance to treatment (Kadzin, 2006).

Prognostic indicators

Hales (1999) argues that treating an oppositional defiance disorder is a long term strategy and it requires a lot of patience until when the child is totally cured. Parents and family members need to persistently follow mediation even when there are no signs of development because the psychological healing process is not instant. If treatment is stopped, there is likelihood that the child might develop more severe disorders like the conduct disorder or Attention-deficit/Hyper-activity disorder. The possibility of developing conduct disorder among ODD patients is higher in adolescents than in infants since in most cases, young children are only mildly defiant while adolescents have fully developed the negative defiance attitude that is likely to result in conduct disorder.

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According to Greene (2004) Conduct disorder in adults is also referred to as antisocial personality disorder (ASD), because the adults tend to develop a personality drawback and they avoid interacting with other people. On the other hand, ODD children who do not undergo treatment in due time are likely to develop personality drawbacks like adults. They may become antisocial and may feel victimized because of their behavior. They may also tend to blame other people for their problems and hence creating conflicts with anyone who get in their way.

Lahey (2008) notes that there are four possible outcomes for treating ODD children and these are:

  1. Some children will fully recover. Most infants normally recover from ODD by the age of eight. In adolescents however, majority (almost 75% of the patients) are likely to suffer from the disorder later in life.
  2. The condition may turn to something else all together. It has been noted that up to 10% of ODD infants normally have their diagnosis changing to ADHD in future and the situation may even get worse to the extent of the Conduct Disorder. However, if an infant has had ODD for more than three years without any signs of CD, there is a likelihood that the Conduct Disorder will never occur.
  3. An ODD infant may live with the condition without having any other disorder. This is however not common and among the ODD patients, study has shown that only 5% survive without another condition occurring.
  4. An ODD infant develops other more severe conditions like ADHD or Conduct Disorder.

Appropriate treatment

Treatment of Oppositional Defiant Disorder is directed to both the child and the parents. Treatment aims at helping the child to feel protected, appreciated and secure and also to train them towards appropriate behavior. On the other hand, parents need to know the appropriate way to set structural limits and how to handle a child who does not respect the limits. Through treatment, parents also learn how to encourage positive behavior in their children (Kadzin 2006).

According to Kadzin (2006), parents who had ODD children received Parent Management Training (PMT) and Problem-solving Skills Training (PSST) as a means of treatment towards their ODD children and this enhanced the parenting skills that would help the children develop positive behavior. Treatment would be combined with cognitive and behavioral techniques to train the parents to solve problems resulting from the behaviors of the defiant children.

It is also important that parents identify help towards providing solutions to problems that may be creating a gap between them and their children. These problems may be alcoholism or drug abuse, depression and other stress-related problems or financial difficulties. In some cases, it may be necessary to seek legal assistance especially where one parent would need to obtain support from the other in cases where there is divorce or separation (Lindahl, 1998).

Lindahl (1998) argues that behavioral therapy is another effective way of treating oppositional defiant disorder and it focuses on changing particular behaviors of the child, without necessarily analyzing the history of the child. This helps the therapist to instill new behaviors to the child to replace those that have been creating problems. As the child develops the new behaviors, she/he will tend to be interested in continuing with these new behaviors rather than going back to the old ones.

Besides the psycho-therapy treatment, medical treatment may also be necessary. It is in fact known to be the key towards treating ODD patients. Anxious or depressed children would need to be given medication to control their condition. On the other hand, severe cases of ODD need immediate medical attention to prevent the condition from getting out of hand (Greene, 2004).

Empirical research

Empirical research shows that different techniques have been used to curb this defiant condition among children and adolescents and with the different studies carried out, it is clear that this condition is an issue of great concern. Oppositional defiant disorder is said to be identified in approximately 6% of all children in the United States of America. It is more prevalent in those families belonging to the lower socio-economic status. Approximately 8% of children from low-income earning families were diagnosed with the defiant disorder (Hales, 1999).

According to Hales (1999), the disorder takes effect mainly when the child is about six years old and at this age, boys are more affected than the girls. However, during adolescence, both males and females are equally likely to be diagnosed with the disorder. It is also estimated that about one-third of the total number of children diagnosed with attention-deficit/hyperactivity disorder (ADHD) also have oppositional defiant disorder. On the other hand, children suffering from ODD also experience depression or anxiety.

Conclusion

In conclusion, it is clear that ODD is a serious condition that is likely to affect every child and unless proper preventive measures are taken, the child may suffer from other more damaging psychological problems. Proper parenting is very important while bringing up both infants and adolescent children and it is the key towards overcoming oppositional defiant disorders. Early diagnosis is also necessary to prevent the condition from getting out of control and any signs of depression among children must be addressed in due time so that the society can overcome the high cases of ODD.

Bibliography

Carr, A. (2009). The Effectiveness of Family Therapy and Systemic Interventions for Child-Focused Problems: Journal of Family Therapy.

Greene, R., Ablon, J., et al. (2004). Effectiveness of Collaborative Problem Solving in Affectively Dysregulated Children With Oppositional-Defiant Disorder: Initial Findings: Journal of Consulting and Clinical Psychology.

Hales, R, Yudofsky, J. and Talbott, A. (1999) Textbook of Psychiatry: Washington DC; American Psychiatric Press.

Kazdin, A. and Whitley, M. (2006). Co-morbidity, Case Complexity and Effects of Evidence-Based Treatment for Children Referred for Disruptive Behavior. Journal of Consulting and Clinical Psychology.

Lahey, B., van Hulle, et al. (2008). Temperament and Parenting during the First Year of Life Predict Future Child Conduct Problems: Journal of Abnormal Child Psychology.

Lindahl, K. (1998). Family Process Variables and Children’s Disruptive Behavioral Problems: Journal of Family Psychology.

Loeber, R. (2000). Oppositional defiant and conduct disorder: a review of the past 10 years: Part one: Journal of the American Academy of Child and Adolescent Psychiatry.

Masi, G., Milone, A., et al. (2008). Co-Morbidity of Conduct Disorder and Bipolar Disorder in Clinically Referred Children and Adolescents. Journal of Child and Adolescent Psychopharmacology.

Pliszka, S. and Carlson, C. (1999). ADHD with Co-morbid Disorders, Clinical Assessment and Management: Guilford Press, New York.

Sadock, B and Sadock, V. (1999) Kaplan & Sadock’s Comprehensive Textbook of Psychology: Philadelphia: Lippincott Williams and Wilkins.

Sells, S. (1998). Treating the Tough Adolescent: A Family-Based, Step-By-Step Guide: Guilford Press, New York.

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