ODD, is a milder form, and sometimes a precursor to conduct disorder. In contrast to
children with conduct disorder, the behavior of children with ODD does not involve
serious violations of others' rights. It does, however, impair the child's family,
academic and social functioning.
Children with ODD show extreme levels of argumentativeness, disobedience,
stubbornness, negativity, and provocation of others. While such behavior can be true of
most children at some point of their lives, this diagnosis is warranted only for the few
children (3-4%) whose symptoms persist over months or years, occur across many
situations, and result in pronounced impairment in their functioning in home, school, and
peer settings. These children's anger is usually directed at authority figures. These
children are more willing to lose a privilege than to lose a battle, so discipline by
withholding privileges often has no effect on their behavior. It is the oppositional
struggle which becomes the reality in this child's mind, and this struggle, unlike the
typical lower level defiance seen in many children, basically takes over the child's life
and relationships with others. For example, while "temper tantrums" are common among
children, frequent and very prolonged temper tantrums (3-4 hours) often characterize
children with ODD.
Conduct disorder
Children with conduct disorder, CD, are those children who show persistent and serious
patterns of misbehavior. Not only may they indulge in frequent temper tantrums like ODD
children, but they may violate the rights of others (stealing, vandalism, and
aggression). These children are actively aggressive towards people (fighting with
siblings and peers, sexually aggressive) and/or animals (engage in animal torture),
commit vandalism, lie and steal from persons outside the home, and seriously violate
society's moral codes.
Children who are diagnosed with CD and who have a higher IQ are easier to treat, but
are more imaginative and creative in acting out and evading detection. Some youngsters
who have conduct disorder may have a learning disability and lower average verbal skills.
These kids have low self-esteem, become impatient easily, and seem reckless and
accident-prone. Unfortunately, children and adolescents with CD do not show remorse
unless it is to lessen their punishment. In fact, they enjoy telling about what they have
done.
WHAT CAUSES ODD and CD?
More research needs to be done into the causes of both ODD and CD. However, a genetic
vulnerability, especially combined with environmental "triggers" (family histories of
disruptive behavior disorder, antisocial personality disorder, mood disorders, or
substance abuse; permissive, neglectful, harsh or inconsistent parenting; and poverty)
seem to be causes for some children. With CD, studies have also shown that both identical
twins are more likely to have conduct disorder than fraternal twins. Adoption studies
have shown that the risk increases when both adoptive and biological parents have conduct
disorder (antisocial personality disorder in adults).
Lastly, studies have indicated that impairment in frontal lobe and low serotonin
levels may also be factors in causing CD.
DIAGNOSIS
After interviewing the child, family, teachers, etc., the mental health practitioner
should study the course of the child's development, especially through school records.
Particular attention should be paid to any oppositional or aggressive behavior that is
not age appropriate.
ODD.
For a diagnosis of ODD, a pattern of negative hostile defiant behavior which has
persisted for at least six months must be established. Such behavior would include
frequent episodes in which the child:
- loses his/her temper
- argues with adults
- actively defies or fails to comply with adult rules
- intentionally annoys people
- blames others for their own mistakes/misbehavior
- touchy or easily annoyed
- angry or resentful
- spiteful or vengeful
As a result of the behaviors listed above, the child shows significant impairment in
social and academic functioning. It must also be confirmed that the behavior has not
occurred in the course of psychotic or mood disorder.
CD.
To make a diagnosis of conduct disorder, it must be established that the child has shown
at least three major symptoms in the last three months with one of the symptoms having
occurred in the last six months. These symptoms must have occurred in various settings.
The behavior must cause significant impairment in the child's social or academic
life.
The symptoms of conduct disorder include:
- aggression toward people/animals
- destruction of property
- deceitfulness/theft
- serious violation of age-appropriate rules
Conduct disorder usually occurs with another disorder, so the mental health specialist
will also look for other co-occurring disorders, such as Attention Deficit/Hyperactivity
Disorder (this occurs in 25% of children with conduct disorder).
Books for Further Reading
Bodenhamer, G. Parent in Control. Fireside: 1995.
Bodenhamer, G. Back in Control. Prentice Hall: 1992.
Greene, RW. The Explosive Child: A New Approach for Understanding and Parenting
Easily Frustrated, 'Chronically Inflexible' Children. Harpercollins: 1998.
Horne AM, Sayger TV. Treating Conduct and Oppositional Defiant Disorder in
Children. Allyn & Bacon: 1992.
Hendren RL. Disruptive Behavior Disorders in Children and Adolescents.
(Review of Psychiatry Series, Vol. 18, No. 2) American Psychiatric Press: 1999.
Koplewicz, HS. It's Nobody's Fault: New Hope and Help for Difficult Children and
Their Parents. Random House: 1994.
Phelan, TW. 1-2-3 Magic. Child Management: 1996.
Riley, DA. The Defiant Child: A Parent's Guide to ODD. Taylor Pub: 1997.
Samenow, SE. Before It's Too Late. Times Books: 1999.
Scientific Publications
Comings DE, et al. "Comparison of the role of dopamine, serotonin, and noradrenaline
genes in ADHD, ODD and conduct disorder: multivariate regression analysis of 20 genes."
Clin Genet. 2000 Mar; 57(3): 178-96.
Donovan SJ, Stewart JW, et al. "Divalproex Treatment for Youth With Explosive Temper
and Mood Lability: A Double-Blind, Placebo-Controlled Crossover Design." Am J
Psychiatry. 2000 May 1; 157(5): 818-820.
Toupin J, Dery M, et al. "Cognitive and familial contributions to conduct disorder in
children." J Child Psychol Psychiatry. 2000 Mar; 41(3): 333-44.
Rueter MA, Chao W, Conger RD. "The effect of systematic variation in retrospective
conduct disorder reports on antisocial personality disorder diagnoses." J Consult
Clin Psychol. 2000 Apr; 68(2): 307-12.
For further research: http://www.ncbi.nlm.nih.gov/PubMed/
On the Web
http://www.conductdisorders.com/
http://www.aacap.org
http://www.aacap.org/publications/factsfam/72.htm
http://www.aacap.org/publications/factsfam/conduct.htm
http://www.psych.org/
Support Groups and Organizations
American Academy of Child & Adolescent Psychiatry
3615 Wisconsin Ave., N.W.
Washington, D.C. 20016-3007
voice: 202-966-7300
fax: 202-966-2891
http://www.aacap.org
National Institute of Mental Health
Information Resources and Inquiries Branch
6001 Executive Boulevard
Room 8184, MSC 9663
Bethesda, MD 20892-9663
Telephone: 301-443-4513
FAX: 301-443-4279
TTY: 301-443-8431
FAX4U: 301-443-5158
http://www.nimh.nih.gov
E-mail:
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NAMI The Nation's Voice on Mental Illness
Colonial Place Three
2107 Wilson Blvd., Suite 300
Arlington, VA 22201-3042
Helpline: (800) 950-NAMI (6264)
Tel: 703-524-7600
Fax: 703-524-9094
Website: http://www.nami.org |
