Oppositional Defiant Disorder, Research Paper Example

Etiology and history of oppositional defiant disorder, ODD

The actual cause of oppositional defiant disorder, ODD, has not actually been identified but a combination of biological, social factors,  psychological, inherited and environmental factors are closely associated with ODD as contributing causes years (Esther & Lourdes, 2011). With respect to genetic factors, the natural disposition, the temperament as well as neurobiological factors affect the functioning of the nerves as well as the brain hence increasing the possibility of ODD occurrence. As far as the environmental issues that contribute to ODD occurrence, the issues of parenting that engross neglect, harsh and inconsistent discipline, abuse and poor supervision are potential contributors of ODD (Nock, Kazdin, Hiripi & Kessler, 2007).

The occurrence of oppositional defiant disorder is most prevalent in families that have a background of Attention Deficit Hyperactivity Disorder, ADHD, attention-deficit or hyperactivity disorder, learning disabilities, disorders associated with substance use as well as mood disorders that may include bipolar disorder as well as depression years (Esther & Lourdes, 2011). Most of the ODD victims may go an extra mile of developing conduct disorder which is an extreme case of behavior disorder. Research has been done on brain imaging that have indicated subtle disparities in the section of the brain that controls reasoning, control of impulses and judgment among the children who have been affected by ODD. Likewise, results from psychological studies have indicated a difficulty in the accurate identification as well as interpretation of social cues among peers for the children who have been associated with aggressive behavior. Aggressive children perceive and associate hostile intent to neutral circumstances. The childrens who fall victim to oppositional defiant disorder may also develop the habit of generating limited options to problem solution and have high expectations for reward to the aggressive responses that are inherent in them. The absence of parental supervision and a consistent structure for discipline, exposure to violence from the community and abuse are other critical factors that have so far been linked to oppositional defiant disorder proliferation.

DSM-III was the primary tool that was used to give a definition to oppositional defiant disorder in 1980. ODD was consequently introduced as an independent disorder open to study, most of which have predominantly engrossed participation of male subjects. This has continuously raised doubts about the relevance and applicability of the diagnostic criteria to females (Keenan, Coyne & Lahey, 2008). Additionally, some questions have emerged concerning adoption of criteria that is gender specific as well as a set threshold in the trials. The intentions of application of DSM V was redefinition of oppositional defiant disorder through putting emphasis on a unrelenting blueprint of irritable as well as angry mood coupled with vindictive behavior instead of the focusing on the hostile, defiant as well as negativistic behavior that was associated with DSM-IV. Despite the implication of irritability by DSM-IV in this context, DSM-V has gone an extra mile by incorporating three symptom clusters which include ‘angry or irritable mood’ that has been defined in terms of loses temper, is touchy or easily annoyed by others as well as being  angry/resentful (Keenan, Coyne & Lahey, 2008). The implication of this development is achievement of higher echelons of understanding of oppositional defiant disorder that is attributed to the research considered to be clinically relevant.

A remarkable feature in oppositional defiant disorder among children engrosses displaying a continuous pattern of hostile, uncooperative, defiant as well as annoying behavior towards individuals in authority. The behavior of such a child leads to the disruption of the normal activities in the daily schedule of the child in family as well as school settings.

The prevalence of the symptoms of oppositional defiant disorder was to a large extent determined by the sex of the victim. The symptoms were found to be more frequent in boys than girls were which included deliberate annoying people and blaming others. Boys were also found to be more impaired as compared to girls in school, community as well as behavior toward others domains. Girls were associated with higher scores in moods and emotions, self-harmful behavior as well as thinking. Most of the boys suffering from oppositional defiant disorder were often expelled from school and involved with police compared to oppositional girls (Esther & Lourdes, 2011).

Statistical data pertaining to the prevalence of the disorder

Oppositional defiant disorder has been identified as a common problem that has frequently been diagnosed as a mental health issue that affects children. The most notable feature in oppositional defiant disorder is a persistent developmental prototype of disobedient, negativistic, defiant as well as hostile behavior that targets figures in authority. It has been ranked as the most prevalent behavioral disorder in childhood. The recorded data indicates that, approximately 10.2% of entire children population is likely to suffer from oppositional defiant disorder at a stage in their childhood. Additional statistics indicate that the prevalence is likely to be higher in boys as compared to girls. While 11% is the percentage of the oppositional defiant disorder cases that has been documented in boys, only 9% has been associated with girls. The debate on the actual rates of oppositional defiant disorder occurrence is still in progress although it is estimated that the disorder affects the range of 2 to 16% of all the children. The condition was initially associated with boys only but further research has linked girls to this disorder. However, girls who are oppositional defiant disorder victims of oppositional defiant disorder usually display a divergent behavioral pattern as compared to boys. Oppositional defiant disorder clinical condition for boys and girls has disparities in terms of symptomatology, severity, associated impairment as well as comorbidity all important for intervention in ODD. In boys, oppositional defiant disorder symptoms entail deliberately blaming others and annoying other people. In girls on the other hand, oppositional defiant disorder symptoms include depression, anxiety disorders as well as internalization signs such as depression, anxiety as well as somatic complaints. Therefore, therapeutic approaches for oppositional defiant disorder require different elements among boys and girls affected by oppositional defiant disorder. The most recent findings in oppositional defiant disorder indicate that, both boys and girls are affected equally.

However, according to Goez, Back-Bennet & Zelnik, (2007), the prevalence of ODD is in the range of 4 to 8 % in the entire population with boys being associated with higher susceptibility as compared to girls. The suggested reasons behind such differences are linked to disparities in socialization couple with biological factors.

Environmental factors are also linked to the proliferation of oppositional defiant disorder. Such factors include conflicts between the child and the parent and negative practices of parenting which may be consequential to antisocial behaviors (Goez, Back-Bennet & Zelnik, 2007).

Factors associated with mental illnesses as well as substance abuse within the family history coupled with inconsistencies in discipline as well as dysfunctionality of the family system are equally critical contributors of oppositional defiant disorder. Parents who prove to be less effective in offering full security to their children hence loosening parental attachments also contributes to the development of oppositional defiant disorder. In most cases, a low level of internalization of the parent as well as societal standards is evident among the children with problems in their behavioral conduct (Goez, Back-Bennet & Zelnik, 2007). The existence of weal attachment to their parents is a potential cause of engaging in substance abuse and delinquency behavior. The level of instability in the family and stress also pays a critical role in oppositional defiant disorder development. Families of poor socioeconomic status commonly encounter problems in parenting and cases of inconsistency in discipline as well as poor parental monitoring are common. This consequently sets a pace aggression along with antisocial behavior that are potential precursors for oppositional defiant disorder.

Problems associated with externalization are also linked with significantly high frequency among the youth of minority status which consequently results to economic hardship, limited opportunities of employment as well as residing in neighborhoods associated with high risks (Goez, Back-Bennet & Zelnik, 2007).

Diagnostic criteria of the disorder – DSM V

The process of determining the presence of oppositional defiant disorder among children requires a comprehensive psychological assessment to be conducted by a mental health care provider. The critical factors to be included during the assessment include the overall health of the child, the intensity as well as the frequency of the behavior of the child, the behavior of the child across varied relationships as well as settings and potential presence of other disorders that are related to mental, learning as well as communication issues of the child (Nock, Kazdin, Hiripi & Kessler, 2007).

The definition of oppositional defiant disorder based on DSM V is “a behavioral pattern that engrosses angry/irritable mood, argumentative/defiant actions, or vindictiveness that can last a minimum of 6 months as verified by at least four signs from any of the categories and demonstrated during contact with at least one person who is not a sibling”. The children who suffer from oppositional defiant disorder do not show aggressiveness to other people as well as animals unlike the situation of the children suffering from conduct disorder. They also never cause destructions to property and never involved in deceit and theft (Nock, Kazdin, Hiripi & Kessler, 2007). Diagnostic criteria designed for a child suffering from oppositional defiant disorder cannot therefore be applicable to a conduct disorder case.

DSM-IV-TR is the current replacement of DSM V being the 4^th revision of this manual that is responsible for diagnosis. According to the DSM-IV-TR, meeting the set diagnostic threshold for oppositional defiant disorder requires an expression of at least four of the possible eight symptoms that are associated with the disorder. Additionally, the requirements of DSM-IV-TR requires a perpetuation of the signs for a time period exceeding six months while being considered to surpass the normal behavior of the child. The applicable symptoms in this regard engross the following:

• Active compliance negation with the requests of the majority or the rules that have been supported by consensus.
• Deliberate performance of actions that cause annoyance to other people
• Resentful as well as angry to other people
• Frequent arguments
• Blaming other people for mistakes done
• Frequent loss of temper
• Revenge seeker
• Easily annoyed as well as touchy.

According to the criteria in DSM IV-TR, the important consideration engrosses a prototype of hostile, negativistic as well as defiant behavior that persists for not less than six months with at least four of the following observations (Esther & Lourdes, 2011).

• Frequent loss of temper
• Frequent argument with adults
• Frequently active defiance and refusal of compliance with the rules and requests of adults
• Frequently and deliberately annoying other people
• Frequently blaming other people for individual misbehavior as well as mistakes
• Frequently annoyed by other individuals and being touchy
• Frequently resentful as well as angry
• Frequently vindictive or spiteful

It is critical to note that the criterion is only valid on condition of occurrence of such behaviors more frequently as compared to typically observable in upright people in a similar developmental level and age. The behavioral disturbance must result to clinically noteworthy impairment with respect to academic, social as well as occupational functioning. Such behaviors are only valid if they are not associated with Psychotic and Mood Disorder. The criterion is also not applicable in a situation of Conduct Disorder, Antisocial Personality Disorder as well as for persons over the age of 18 years (Esther & Lourdes, 2011).

How does oppositional defiant disorder affect cognitive development, social development and emotional development throughout various developmental stages?

The early stages of life of an individual are associated with inimitable opportunities of establishing a good foundation for a healthy process of development (Esther & Lourdes, 2011). However, the occurrence of oppositional defiant disorder erodes the gains associated with this stage. This stage is also associated with great chances of growth as well as vulnerability. According to the research conducted pertaining early childhood, great emphasis has been placed on the preliminary five years of the life of a child on social-emotional development. An experience of oppositional defiant disorder is a potential cause of impairment of cognitive development, social development and emotional development of the child. A significant percentage of children are affected by social-emotional problems during a period of the first five years which have negative implications on their functioning, cognitive development, social development and emotional development. Available statistics indicate that boys are more vulnerable than girls especially with the occurrence of defiant disorder affect cognitive.

As a result, it is the responsibility of parents as well as caregivers to support the healthy development of the child. The prevalence of defiant disorder affect cognitive has unfavorable effects on the ability of the parent to support the healthy development of the child and may be a significant contributor to behavioral problems in the early years of a child development (Esther & Lourdes, 2011).

Educational impact of oppositional defiant disorder

In most cases, students suffering from oppositional defiant disorder constantly dispute the class rules and fail to work on assignments. They are also constantly involved in fighting as well as arguments with other students and in some cases, with their teachers. The effects of this occurrence are impairment in academic as well as social functioning of the child. Repeated arguments as well as limit testing are consequential to a stressful environment in the classroom. Oppositional defiant disorder is attributed to stress as well as frustration attributed to the deaths of parents, their divorce, disharmony within the family and family loss (Nock, Kazdin, Hiripi & Kessler, 2007). Oppositional defiant disorder may sometimes manifest as a means of addressing issues of depression and the consequence of inconsistent rules as well as behavior standards. This is therefore the reason behind the negative effects of oppositional defiant disorder on academic performance of the child in class. The responsibility of a teacher in the management of students behaviors attributed to oppositional defiant disorder involves addressing particular issues as well as particular adaptations for individual students. Teachers strive to minimize classroom disruptions due to oppositional defiant disorder (Goez, Back-Bennet & Zelnik, 2007). The students affected by oppositional defiant disorder are known for creation of power struggles. The teacher must therefore be wise to avoid situations of verbal exchanges through a concise statement of the position he or she holds. The classroom rules bust also be clearly established and nonnegotiable issues must be stated precisely. For instructors to effectively address the problems associated with program disruption by students suffering from oppositional defiant disorder, clear daily schedules must be laid down and any positive response from such students must be praised (Goez, Back-Bennet & Zelnik, 2007). Any comments that are likely to provoke an argument must be avoided.

The children who suffer from oppositional defiant disorder at schools age are characteristically defiant to their teachers as well as adults and also show a significant degree of aggression towards peers (Goez, Back-Bennet & Zelnik, 2007). Their development in school is marked by rejection from their peers as a result of their aggressiveness as well as underprivileged social skills. They are therefore prone to poor interpretation of the behaviors of their peers as being hostile and are commonly poor in resolving potential social conflicts (Goez, Back-Bennet & Zelnik, 2007). As a result of poor social skills, they are unable to acknowledge their role in resolving conflicts and blame others instead.

Treatment options for oppositional defiant disorder

The effective treatment for oppositional defiant disorder must take in to account medication as well as psychological programs. The critical psychological interventions engross individual as well as family therapies and treatment of associated conditions that include anxiety, ADHD and depression  (Goez, Back-Bennet & Zelnik, 2007).

The individual approach to treatment of oppositional defiant disorder involves training in problem solving skills as well as family intervention that specifically addresses the needs of the child. Behavioral based interventions are also applicable that focuses on the age of the child as well as assisting the child in the acquisition of new skills for solving problems. The home dased interventions involve training the child on techniques of effective discipline as age-appropriate supervision.

Intervention can also be based on the school in which cases much emphasis placed on training as well as education of the child. In this case, it is recommended that home based intervention, school based interventions as well as individual therapy are executed in combination so that the school age children can benefit from these treatments (Goez, Back-Bennet & Zelnik, 2007).

References

Esther, T. & Lourdes, E., (2011). “Sex differences in oppositional defiant disorder”. Psicothema Vol. 23, no 4, pp. 666-671.

Goez ,H., Back-Bennet, O, & Zelnik N. (2007). “Differential stimulant response on attention in children with comorbid anxiety and oppositional defiant disorder”. J Child Neurol 22:   538- 44.

Keenan, K., Coyne, C. & Lahey, B. (2008). Should relational aggression be included in DSM-  V? J Am Acad Child Adolesc Psychiatry 47(1): 86-93.

Nock, M, Kazdin, A, Hiripi, E. & Kessler, R, (2007). Lifetime prevalence, correlates, and persistence of oppositional defiant disorder: results from the National Comorbidity Survey Replication. Journal of Child Psychology and Psychiatry  48(7): 703-13.