02/19/04 — Oppositional Defiant Disorder or just behaving badly?

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Oppositional Defiant Disorder or just behaving badly?

By Matt Shaw
Published in News on February 19, 2004 2:02 PM

Hearing that Bruce Moyer, the director of psychological services at Cherry Hospital, was going to talk about "oppositional defiant disorder," a friend of his quipped, "so you're going to be talking about bad kids, right?"

Are people with diabetes bad? Moyer responded.

Children and teens with ODD can be a handful for their parents and teachers, said Moyer. They can be hostile and defiant, quick to lose their tempers, and argumentative. They may seem to seek out things to do to annoy the adults.

But like diabetics, these children didn't choose their condition, he said.

Their behaviors, even if they seem willful, "are driven by a complex interaction of factors," many of which the children are unaware of or cannot control, he said.

The good news is that many people can be successfully treated through a combination of therapy and training, he said.

More than 80 people came to the Wayne County public schools' administration building Wednesday to learn more about the disorder and treatment. The "Lunch and Learn" seminar was sponsored by the Mental Health Association in Wayne County.

Moyer started by listing some of the warning signs: Hostile, defiant behavior; frequent loss of temper; refusal to comply with requests or rules; blaming others for mistakes; and deliberate attempts to annoy or upset others.

"Are we talking about our children or our co-workers?" Moyer joked.

In fact, it's quite normal for everyone to be "oppositional" from time to time, particularly when they're tired, hungry, stressed or upset, he said. And most 2- to 3-year-olds and early adolescents go through these stages as part of their development.

What separates people with oppositional defiant disorder is that they will have a pattern of this behavior, Moyer said. A child may still be in the "terrible twos" when he's 4, for example.

It's been estimated that 5 to 15 percent of all school-age children have the disorder.

It's not known exactly what causes the disorder, Moyer said. Children of people with antisocial behavior seem to be more susceptible, but that has not been proven.

Children with the disorder have a higher incidence of trauma. Some suffered physical or sexual abuse, while others survived assaults, accidents or illnesses.

There seems to be a neurological component to ODD, he said. Many of the affected children seem to have difficulties with the "executive functions" of their brain, which think through problems and make decisions. They have a hard time resisting temptation. They may not know the acceptable ways to get what they want.

It can be difficult to distinguish ODD from attention-deficit hyperactive disorder (ADHD), mood disorders (depression, bipolar disorder) and anxiety disorders. In some cases, ODD coexists with other conditions or substance abuse or both.

It's also possible for a brain tumor to cause many of the ODD symptoms, especially rage and aggression, he added. A thorough physical exam is needed to rule out any chronic or acute medical issue.

There isn't a "magic bullet" that will eliminate ODD, Moyer said.

Depatoke, a mood stabilizer, showed some positive results in a Stanford University study released last year, but more study is needed before any drug is recommended, he said.

Treatment may include a variety of therapy and training, not only for the patients.

Parents need to learn how to manage their children's behavior better. Trainers can help parents prepare plans for how they will respond to any behavior they expect from their children.

Simply having this type of "road map" can reduce a parent's stress, Moyer said.

Parents may also need group therapy. Many feel incompetent, guilty or angry because they have such difficult children, he said. Many need to build their own self-esteem and learn more effective parenting skills.

Often, therapists and trainers need to change the dynamics in a family so that the parents are rewarding good behavior more often than they are punishing bad behavior.

As for the individuals, they often need psychotherapy to develop more effective ways to deal with anger. Individual cognitive-behavioral therapy can assist problem-solving and reduce negative thoughts.

Many times, the children need training in social skills. For example, they do not understand how to negotiate for what they want; that increases frustration, which leads to aggressive behavior.

Parents need to understand that progress can be slow. One parent had a grocery list of complaints about his teen-age son, so Moyer asked him to pick the one or two most aggravating behaviors as a starting point.

Moyer provided these tips for parents, which he obtained from the American Academy of Child and Adolescent Psychiatry:

*Always build on the positives, give the child praise and positive reinforcement when he shows flexibility or cooperation.

*Take a time-out or break if you are about to make the conflict with your child worse, not better. This is good modeling for your child. Support your child if he decides to take a time-out to prevent overreacting.

*Pick your battles. Since the child with ODD has trouble avoiding power struggles, prioritize the things you want your child to do. If you give your child a time-out in his room for misbehavior, don't add time for arguing. Say "your time will start when you go to your room."

*Set up reasonable, age appropriate limits with consequences that can be enforced consistently.

*Maintain interests other than your child with ODD, so that managing your child doesn't take all your time and energy. Try to work with and obtain support from the other adults (teachers, coaches and spouse) dealing with your child.

*Manage your own stress with exercise and relaxation.

*Many children with ODD will respond to the positive parenting techniques. Parents may ask their pediatrician or family physician to refer them to a child and adolescent psychiatrist, who can diagnose and treat ODD and any coexisting psychiatric condition.

More information can be found at www.aacap.org.