OT and Pathology: Oppositional Defiant Disorder (ODD)

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Definition

Oppositional Defiant Disorder is defined as a less severe variant of conduct disorder (CD). Conduct disorder is defined as a disorder that gets diagnosed when an individual engages in at least 3 episodes of behavior that violate societal norms within the past 12 months. These norms may include aggression, destruction of property, lying or theft, or violation of rules. Although related to CD, it is diagnostically different because risk problems with the legal system is much lower, school problems tend to be less severe, and prognosis is better over the long term. According to the DSM IV this disorder is diagnosed based on a pattern of hostile or defiant behavior of at least 6 months and causes implications/impairment of function.

ODD Symptoms

According to the DSM IV a child must present at least 4 of the following 8 symptoms for at least 6 months straight to be diagnosed as having ODD. These symptoms include often loses temper, often argues with adults, often actively defies or refuses to comply with adults' requests or rules, often deliberately annoys people, often blames others for his or her mistakes or behaviors, is often touch or easily annoyed by others, is often angry and resentful, or is often spiteful or vindictive.

Other Characteristics

Other characteristics that can be displayed include being non-compliant, having negative attitudues, being irritable, having low self-esteem, creating or having social problems, displaying symptoms of depression or anxiety, difficulty adapting to new environments, or irregular sleeping and eating habits.

Causes

The causes of this disorder are not clearly established, but they are thought to be either caused by environmental factors or a biological/genetic disorder. Environmentally, a person can be greatly influenced is they have negative or changing home environments and/or inconsistent or lack of discipline or harsh discipline. As the disorder is becoming better understood and researched it is becoming more clear that the proximal cause of the disorder is misinterpretation of social situations by in the individual and inappropriate choices of response. Biologically, researchers have found that there may be biological or neurological imbalances. For example, it has been found that some in utero exposures or experiences may contribute to this disorder.

Prevalence

It has been found that ODD is more common is boys than girls and 12 to 16 percent of the population is diagnosed with this disorder. Of this statistic the individuals are 3 times more likely to become teenage parents, have 4 or more siblings, live in a single parent household, live with a blended family, frequently move, or live foster care. This is because these are environments that are more likely to be inconsistent in general or have inconsistent discipline. Another interesting statistic is that 50-65 percent of children with ADHD are diagnosed with ODD later in life.

Social Implications: Friends and School

Because of the inappropriate choices of response due to the misinterpretation of social situations a person with ODD will have difficulty with social situations involving friends and school. Persons with ODD may have limited friendships due to their rigid personalities, difficulty maintaining friendships, and trouble playing with others. This lack of successful interaction can cause frustration, ending with more disruptive behaviors. In school a person with ODD may display disruptive behaviors, difficulty focusing, defiant attitude, suffer academically, and parent-teacher tension. This can ultimately cause the child to do unwell in school and have an increased defiant attitude due to lack of motivation.

Social Implications: Family

Outburts of defiant behavior and easily being set off into frustration can cause many problems within a family. The family may become scared of the child and want to tiptoe around them, afraid to set them off. The constant outbursts and defiance may cause the parents to decrease discipline to avoid the consequences the child displays. Ultimately, these behaviors and its repercussions cause decreased energy in the parents and insufficient attention to the other children. With that said, having a child with ODD causes problems within the whole family unit and interactions between all members.

Implications Later in Life

Children with ODD have statistically been found to be diagnosed with conduct disorder (CD) and violent behaviors later on in adolescence. It has also been associated with anti-social personality disorder. These two things being said, it is extremely important to seek early intervention so that treatment options can be explored before symptoms become worse and effect daily function further.

Best Behavioral Treatments

A whole range of treatment options are available. This includes psychotherapy, behavorial therapy, social learning, cognitive therapy. academic intervention, parent training, and recreational programming. Social learning, parent training, and recreational programming are especially important because they get the individual out and moving while also learning to play with others. Parent training is important because it helps the parent learn strategies to implement at home so they can restore some sort of balance and routine at home. Other behavioral treatments include role playing, reward systems, and video modeling. These treatments can help the child express how they are feeling in a controlled setting and reward them for good behavior, positively reinforcing good actions.

Implications for OT

OTs can work with children with ODD in many ways. First, they can work on channeling negative energy to more positive energy in appropriate activities. In these activities it is important to clearly identify expectations for behavior with reasonable positive or negative outcomes provided. Some activities that may be beneficial are recreational activities. Second, opportunities for appropriate expression of emotion may be helpful to the child. This can be done through providing alternative strategies for emotion expression through art, play, music, etc. A positive experience in this area of intervention can be of great value in building a positive self concept. Third, it is imperitive as an OT to provide parent training. This can be beneficial because it can help parents establish appropriate reinforcement of positive behaviors and to provide negative consequences in the most effective way to minimize behavioral outbursts.

References

1. Bloomquist, M. (1996). Skills training for children with behavior disorders. New York, NY: The Guilfod Press.
2. Bonder, B. (2010). Psychopathy and function. (4th ed.). Thorofare, NJ: Slack Inc.
3. Dowd, T., & Sterba, M. (1998). Treating youth with DSM IV disorders: the role of social skill instruction. Boys Town, NE: Father Flanagan's Boy's Home.
4. Greene, R. (2005). The explosive child. New York, NY: HarperCollins Publishers.

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