Last week we looked at conduct disorder as a neurodevelopmental disorder that affects many children and adolescents globally. It involves disruptive behavior that is characterized by anger, lack of impulse control, aggressive towards others and animals, being prone to property damage, theft and deceit.
Oppositional defiant disorder (ODD), is also listed in the Diagnostic and Statistical Manual (DSM-5) as a disruptive behavioral disorder. ODD is defined as “ a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness.” ODD behavior is typically targeted towards teachers, parents, caregivers, and other authority figures. Also, ODD seems to have a closer link with ADHD than conduct disorder and ODD does not share these same behavioral characteristics as conduct disorder. Other conditions such as learning disorders and language disorders can be predicted in children or people with ODD.
ODD is a separate disorder that affects males in a 2:1 ratio to females. Most of the early studies were done on predominately male subjects. Yet, ODD is one of the most prevalent conditions among young children and adolescence.
The most predominant persistent behaviors of ODD include:
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irritability
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anger
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vindictive
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hostile
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defiant
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resentful
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negativistic
Signs and Symptoms
Some of the early signs of ODD are:
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disobedience and defiance towards authority figures
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frequent temper tantrums
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refusing to follow the rules
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excessive arguing with adults
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getting easily agitated
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an angry attitude
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purposely upsetting people
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having a vindictive manner
Children begin showing symptoms of ODD around 6-8 years of age. Symptoms can last through the teenage years.
Oppositional defiant disorder has a 1%-11% prevalence with an average of 3.3% among children worldwide. In western cultures, ODD has a sex ratio difference where as in other cultures it is not as significant. Some of the reasons for this could be that the test subjects were mostly male, had lower socio-economic status (which are a factor) and were underdiagnosed.
The Diagnostic and Statistical Manual (DSM-IVTR) states that a person must show 4 out of 8 signs and symptoms to meet the criteria threshold for oppositional defiant disorder. These symptoms include:
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easily annoyed and touchy
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losses temper often
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regularly argues with authority figures or adults
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frequently deliberately annoys others
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actively defies and refuses to comply with rules and requests from authority figures
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frequently angry and resentful
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often blames others for their mistakes and misbehavior
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been spiteful and vindictive at east twice over the last six months
The bad behaviors become persistent and lead to problems in school and other social venues.
Most scientists believe the reasons for developing ODD are a complex result of a combination of environmental and genetic factors.
Genetic Factors
In twin and adoption studies in females and males indicate heredity plays a part in causation for the anti-social behaviors 50% or more of the time. ODD tends to run in families with a history of substance abuse disorders, mood disorders and ADHD. Leading researchers tend to believe that the predisposition to ODD may be linked to genetics.
There is a gene variant found that encodes the neurotransmitter metabolizing enzyme monoamine oxidase-A (MAOA). This directly relates to the neural systems that regulate aggression and behavior when someone is involved in a threatening situation.
Brain imaging demonstrate these patterns and identify their role by the arousal within the areas associated with aggression response.
Birth Complications and Prenatal Factors
Many studies suggest that birth and pregnancy complications are related to the development of ODD and other conduct behavioral disorders. Research indicates that substance use before birth has been associated with the development of conduct and disruptive disorders as well as ODD.
Factors that increase the risk in the development of ODD include:
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Malnutrition
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protein deficiency
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lead poisoning or exposure to lead
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alcohol or drug use during pregnancy
Neurobiological Factors
Through the use of brain imaging studies, scientists have viewed that deficits and injuries to particular neural networks can lead to serious behavioral issues like ODD, in children.
Neuroimaging studies have identified functional and structural abnormalities in children with conduct disorders. The areas most affected are the amygdala, prefrontal cortex, insula and the anterior cingulate along with the interconnecting regions.
Children with ODD have been shown to have hypofunction of the brain areas responsible for reasoning, judgement and impulse control.
ODD children are believed to have an overactive behavioral activation system (BAS) and an underactive behavioral inhibition system (BIS). The BAS stimulates a response to signals of reward and non-punishment. While the BIS produces anxiety and inhibits the ongoing behavior during innate threatening events.
Social and Cognitive Factors
Children with ODD have difficulties with controlling their emotions. 40% of boys and 25% of girls with persistent conduct problems display behavioral deficits that include, immature forms of thinking (egocentrism), lack of verbal regulation for their behavior and cognitive distortions, like misinterpreting a harmless act as a hostile one.
Children learn primarily through observational and social learning. ODD children have a limited amount of social knowledge, formed by a lack of personal experience, which shapes how they should respond, process information and solve problems.
The information a child absorbs and then responds to in a social setting, either in an appropriate manner or not tells a great deal of the health of their cognitive abilities. It has been shown that social and cognitive impairment as a result of ODD will result in a negative impact on friendships and social events.
Children with ODD can benefit greatly from modeling behavior to help modify and strengthen cognition and reinforce good behavior.
Environmental Factors
Poor parental practices and chronic parent-child conflict may lead to anti-social behavior including ODD. Establishing a weak bond to a child may lead children to associate with substance abuse and delinquency.
Environmental factors that contribute to the development of ODD include:
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Family history of mental illness
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substance abuse disorders
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dysfunctional family life
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inconsistent parental discipline
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high ratio of family conflict
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lack of adequate or appropriate adjustment to situations
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family instability and stress
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school factors like peer network and teacher response to discipline
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low socio-economic status
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parental neglect and not being involved
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lack of supervision
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physical and emotional abuse at home
Externalizing problems associated with ODD are reported to be found more in minority- status youths likely because of economic hardships, high-risk inner city neighborhoods and limited meaningful job opportunities.
Management
Most approaches to the treatment of ODD are specific to each child and can include a combination of: medication, psychotherapy, family therapy, parent management training, cognitive behavioral therapy, neurofeedback therapy and social training skills.
Medication treatment in managing oppositional defiant disorder include: mood stabilizers, anti-psychotics, and stimulants.
Individual interventions focus on each specific child and include: assertive training, anger control/ stress inoculation, problem-solving skills training programs and self-monitoring skills.
Parent and family treatment has been shown to be effective and have strong influences on a child. It involves teaching a child skills, in a non-directive manner as wells as parent-directed involvement through coaching. This type of treatment is best suited for elementary-aged children.
Neurofeedback therapy centers on the brainwave activity of the amygdala, prefrontal cortex, insula and anterior cingulate regions of the brain. Where the problem occurs and it uses EEG biofeedback to influence positive changes throughout these regions of the brain. Neurofeedback therapy has been used for years to help shape good behavior by establishing better brainwave communication in neural centers that are responsible for the symptoms.
Oppositional defiant disorder is a neurodevelopmental behavioral disorder that negatively affects the amygdala, prefrontal cortex, anterior cingulate areas of the brain. Children with ODD will display aggressive and disruptive behaviors and can often misinterpret social scenarios. They will not feel remorse for any wrongdoing and blame others for their actions. ODD can lead to delinquency, property damage, theft and a disregard for authority figures. The best plans for management for ODD in children include parent-child training programs, neurofeedback therapy and other psycho-cognitive behavioral therapies. The best long-term outcomes are a result of early detection and the implementation of a combination of therapies tailored made for each child.
-A Balanced Brain is a Better Brain-