Mental Health Nursing, Psychiatry, Child Health Nursing, Childhood Disorder

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Oppositional Defiant Disorder
Definition
The American Psychiatric
Association’s Diagnostic and
Statistical Manual, Fourth Edition
(DSM IV), defines oppositional defiant
disorder (ODD) as a recurrent pattern
of negativistic, defiant, disobedient,
and hostile behavior toward authority
figures that persists for at least 6
months. ODD is a condition in which
a child displays an ongoing pattern of
uncooperative, defiant, hostile, and
annoying behavior toward people in
authority. The child’s behavior often
disrupts the child’s normal daily
activities, including activities within
the family and at school.
Causes and Risk Factors
The causative factors can be divided into categories, namely:
Biological Factor. Aggressive behavior may be caused by alterations in the
neurotransmitter activity of the brain. Neurotransmitters help nerve cells in the
brain communicate with each other. If these chemicals are out of balance or not
working properly, messages may not make it through the brain correctly, leading
to symptoms of ODD, and other mental illnesses. Also, some studies suggest that
defects in or injuries to certain areas of the brain can lead to serious behavioral
problems in children.
Familial Factor. Familial influences on child development may be genetically
linked, attributed to conflict in the family home or based on parent-child
interactions. Additionally, a parent’s prior aggressive behavior (in childhood) has
been shown to manifest itself in their child at the same age.
Genetics. Many children and teens with ODD have close family members with
mental illnesses, including mood disorders, anxiety disorders, and personality
disorders. This suggests that a vulnerability to develop ODD may be inherited.

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Environmental. Factors such as a dysfunctional family life, a family history of
mental illnesses and/or substance abuse and inconsistent discipline by parents
may contribute to the development of behavior disorders.
Clinical Manifestations
Actively does not follow adults’ requests
Angry and resentful of others
Argues with adults
Blames others for own mistakes
Has few or no friends or has lost friends
Is in constant trouble in school
Loses temper
Spiteful or seeks revenge
Touchy or easily annoyed
Diagnosis
To fit this diagnosis, the pattern must last for at least 6 months and must be characterized
by the frequent occurrence of at least four of the following behaviors: losing temper,
arguing with adults, actively defying or refusing to comply with the requests or rules of
adults, deliberately doing things that will annoy other people, blaming others for his or
her own mistakes or misbehavior, being touchy or easily annoyed by others, being angry
and resentful, or being spiteful or vindictive.
Management of Children with ODD
Behavior management techniques. Use behavior contracts.
Be fair but be firm, give respect to get respect.
Using a consistent approach to discipline and following through with positive
reinforcement of appropriate behaviors. Apply effective contingencies that are
consistent responses to the child’s behavior, following through with appropriate
rewards and consequences when these are needed.