TABLE OF CONTENTS
3.Medical and Mental Health Issues
3.1.Possible Medical Issues
3.2.Possible Mental and Emotional Issues
3.3.Possible Cognitive Issues
4.Oppositional Defiance Disorder (ODD)
4.1.Prevalence and Demographics
4.2.1.Attention Deficit/Hyperactivity Disorder (ADHD)
4.3.Symptoms of Oppositional Defiant Disorder
4.4.Treatment for Oppositional Defiant Disorder
5.1.Prevalence and Demographics
5.3.Symptoms of Conduct Disorder
5.3.1.Criteria for a diagnosis of Conduct Disorder
5.3.2.Treatment for Conduct Disorder
6.Treatment for Conduct Disorder
7.Traumatic Experiences as precipitating factors
7.1.Post-Traumatic Stress Disorder (PTSD)
7.3.Treating a traumatized child
9.1.Appendix A – Symptoms of Conduct Disorder
9.2.Appendix B – Diagnostic Criteria for Conduct Disorder (DSM-IV-TR)
It may be accepted that at some point in a child’s life, they will display oppositional and defiant behaviour (Riley, 1997). When do the occasional rule-breaking, the sulking and whining, and the fits and tantrums become a cause for concern?
In the course of this paper I will seek to clearly define the characteristics of oppositional defiant disorder and its more severe cousin, conduct disorder. I will expound on the areas of symptoms, causes and co-morbidity, and delve into the appropriate treatment and potential for rehabilitation of a child or teenager who may be suffering with either of these disorders.
Oppositional defiant disorder (ODD) can be characterized by a hostile, negative and argumentative behaviour pattern (Sue, Sue & Sue, 1997). It is common place for these children to lose their temper and argue with adults, refusing their requests. A child who is suffering with ODD will refuse to take responsibility for his actions and his behaviour is an “exaggerated attempt” to show the parent or authority figure that they have no control over him (Riley, 1997). Rutherford and Nickerson (2010) believe that defiant behaviour among children and teenagers is becoming more prevalent.
Conduct disorder (CD) can be characterized by repetitive and persistent social behaviour that violates the rights of others, or violates norms and rules that are appropriate for their age (McIntosh & Livingston, 2008). Conduct disorder includes behaviour such as bullying, lying, cheating, fighting, destruction of property, arson, assault, rape, truancy and cruelty to animals and people (Sue et al., 1997). It is quite evident that conduct disorder is a more severe behavioural condition than oppositional defiant disorder.
If the characteristics of both disorders mentioned here seem rather similar, they should. Is it reasonably to assume that there is some kind of connection between them?
According to the American Psychiatric Association (1993), the behaviour associated with oppositional defiant disorder does not involve the more serious violations of the rights of others in the manner in which it is displayed in conduct disorder. The characteristics do seem to overlap, and for this reason it is noted that it is difficult to separate oppositional defiant disorder from milder forms of conduct disorder and the normal developmental difficulties that can occur in children and adolescents (Paternite, Loney, & Roberts, 1995).
Sue, Sue & Sue (1997) note that oppositional defiant disorder is often found to precede the development of conduct disorder. It is common place to find that an adolescent who suffers with conduct disorder often stems from a history of oppositional defiant behaviour in childhood (McIntosh & Livingston, 2008). Conduct disorder can be viewed as more serious that oppositional defiant disorder, but it would seem that ODD escalates during childhood and manifests as CD in adolescence. While an adolescent with conduct disorder behaves and acts in a negative manner; an adolescent with oppositional defiant disorder, talks in a negative way. As a point of caution, McIntosh & Livingston (2008) note that in some cases, the conduct disorder can begin in childhood; as such, it would be unwise to view ODD as a childhood disorder and CD as a disorder found solely among adolescents. As such, two types of conduct disorder are recognized: (1) childhood onset type and (2) adolescent onset type (Tolan & Thomas, 1995).
Interrelatedness of behaviours associated with ODD and CD
illustration not visible in this excerpt
Schematically, the concentric circles indicate how the characteristic behaviour escalates outwards from defiant behaviour, and how behaviour associated with ‘normal’ oppositional behaviour and ODD are found in children who suffer with conduct disorder. The underlying distinction between ODD and CD is one of severity.
If there exists an interrelatedness among oppositional behaviour, ODD and CD; it could be presumed that there exists causal factors that push a child from the realm of defiant behaviour to defiant disorder and on into conduct disorder. Oppositional defiant disorder is associated with parent-child conflicts and the espousing of unreasonable beliefs, along with negative family interactions (Barkley, Anastopoulous, Guevremont, & Fletcher, 1992).
It would seem that a child’s behaviour is determined by both a natural and an environmental factor (Rutherford & Nickerson, 2010). The specific causes of ODD are still relatively unknown, but parents of children with ODD indicate that their child has always had a level of rigidity and demanding that was not evident in the siblings of the ODD child (McIntosh & Livingston, 2008). It was concluded by Patterson (1986), that the specific factors that may influence the development of antisocial behaviour were: a lack of parental monitoring, inconsistent disciplinary practices, failure to use positive management techniques, and failure to teach the skills necessary for academic success.
Conduct disorder is a little more involved, and many factors can contribute to the development of CD, including; brain damage, child abuse, genetic vulnerability, school performance and other traumatic life events (McIntosh & Livingston, 2008). Children with conduct disorder seem to have parents who also exhibited conduct problems when they were younger. This might suggest that a genetic component exists in the development of CD. It has been suggested that conduct disorder does indeed have a genetic and a psychosocial component, as such social environmental factors will impact on the development of the adolescent.
The social environmental influences that could compound the behavioural problems of the child include the following:
- Early maternal rejection
- Separation from parents
- Early institutionalization
- Family neglect
- Abuse of violence
- Parental mental illness
- Parental marital discord
- Large family size
(McIntosh & Livingston, 2008)
In addition to these, there are physical risk factors that might cause conduct disorder. These include the following:
- Neurological damage caused by birth complications or low birth weight
- Attention-deficit/hyperactivity disorder
- Fearlessness and stimulation-seeking behaviour
- Learning impairments
- Autonomic underarousal
- Insensitivity to physical pain and punishment
(McIntosh & Livingston, 2008)
The child experiencing both social deprivation and a neurological condition is probably most susceptible to developing conduct disorder.
3. Medical and Mental Health Issues
Having noted the interrelatedness of oppositional defiant disorder and conduct disorder, it is important to note that defiant behaviour may be caused by a number of medical and mental issues. It would be wise as a parent, to take note of other possible triggers for the irritable, aggressive and unpredictable behaviour of your child. If a medical or mental health issues is identifiable in the child it may be a cause that is easily alleviated; alternatively, bringing this to the attention of the child’s physician will only add value to gaining help for your child.
3.1 Possible Medical Issues
Children and adults alike are dependent on ‘good quality’ sleep to function optimally during the course of the day. If your child is not getting a good nights sleep it can impact on their ability to function normally and can result in behavioural problems. Changes in the child’s sleep patterns can be indicative of feelings of depression or possibly drug use by the child. Changes in sleep patterns can manifest as an increased need for sleep or a drastic reduction in the amount of sleep required. With the onset of puberty it is common to find teens requiring more sleep than they usually do and having problems getting themselves out of bed in the morning and staying up very late into the evening.
Diabetes (Type 1 and Type 2) causes low blood sugar levels in the child and will manifest as irritable, grumpy and aggressive behaviour. While it is acknowledged that Type 1 diabetes is unavoidable, resulting from an autoimmune disease, Type 2 diabetes is a metabolic disease that is seen in children who are sedentary or obese and this can be addressed. Type 2 diabetes is common in all age groups, but Type 1 diabetes is more commonly seen in children.
Childhood allergies can cause strange behaviour in a child, particularly noted after meals. Changes in your child’s behaviour could be the result of allergies to gluten for example and as such, rather easily alleviated. If you suspect that your child may be suffering with allergies it would be advisable to seek an allergy screening test for the child.
Changes in the hormonal levels in the child, particularly during growth spurts can cause aggressive or other symptomatic behaviour. A pediatric specialist would be able to screen the child and identify the need for some form of hormonal therapy.
Certain conditions may be impossible to alleviate, but awareness can help in reducing some of the undesirable symptoms. Head injuries or abnormal development of the brain, causing damage to the brain and nervous system are beyond the control of the parent or child; often resulting from genetic factors. The use of drugs, tobacco or alcohol by the mother during pregnancy can also cause the child to display aggressive and dangerous behaviour; this can escalate into unprotected sex, bullying, fighting with peers and problems with the authorities.
3.2 Possible Mental and Emotional Issues
At this point, I would like to emphasize that children and teenagers who display oppositional behaviour are more often than not bright, creative and vigorous individuals (Riley, 1997).
The dilemma when discussing mental and emotional complications revolves around the “chicken or the egg” syndrome; are depression and anxiety disorders the result of defiant behaviour or are they the cause of the defiant behaviour. The jury is still out on this debate.