Oppositional Defiant Disorder & Conduct Disorder

Oppositional Defiant Disorder (ODD) and Conduct Disorder are emotional disorders most often characterized by behavioral symptoms.

ODD typically has two different obvious sets of problems--excessive aggressiveness and a pattern of bothering and irritating others on purpose.  It is normal for children to be oppositional from time to time, especially when they are tired, hungry, or upset.  They may argue, talk back, disobey or defy parents, teachers, or other adults.  Oppositional behavior is normally exhibited during the "terrible twos" and during the teen years.  However, a child with ODD is extremely oppositional.  These children are openly hostile, very uncooperative and often, on purpose, does the opposite of what is asked.  This ongoing pattern of uncooperative, defiant behavior interferes with the child's day-to-day functioning.  Other symptoms may include frequent anger and resentment, seeking revenge when punished or scolded, deliberate annoying behaviors, frequent temper tantrums, excessive arguing with authority figures, verbal meanness and hatefulness when upset, and blaming others constantly for their own problems.

A less obvious problem associated with ODD is that these kids are often growing up too fast, carrying adult emotional responsibilities. As a result, these children do not accept parenting interventions as other children do. They may be skilled at "pushing the buttons" of adults and may demand equal rights and relationships from adults. They will be empowered by the process of an argument, rather than the outcome; in other words, the argument is often more important than what is being argued about. Children with ODD have no insight into their behavior.  As a result, they quickly come to the conclusion that everyone is being mean to them.  They feel they are not doing anything wrong. 

If the disorder progresses, parents and teachers may react negatively to the child.  Parents find themselves having a hard time loving their own child and teachers find it hard to like this child.  Children with ODD usually end up feeling rejected at home and at school.  This causes children with ODD to feel more anger and be more vengeful.

Treatment of ODD can be complicated.  If the child is displaying any high-risk behaviors, those must be addressed first.  Evaluation for medication may be necessary if behaviors include uncontrollable aggression, mood swings, impulsiveness, or explosiveness.  Psychotherapy must include family therapy and teaching parenting skills, so that the adults can learn to respond differently to the child's provocations. Group therapy should be considered for adolescents as they tend to respond to peer interaction.  Therapy should also explore what, if any, adult emotional burdens the child is carrying.  (Examples of these types of burdens include when the child is "promoted" into the role of listener and companion by one parent in the case of a divorce, or when a parent is either physically or emotionally unavailable and the child is largely responsible for taking care of himself.)  Finally, treatment should be coordinated with other social supports and input should be obtained from others involved in the child's life, such as teachers, coaches, family members, or primary care physicians.

Conduct disorder often starts out as untreated or unsuccessfully treated ODD.  The criteria for conduct disorder focuses on a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated.  These behaviors may include bullying, initiating physical fights, using weapons, physical cruelty to people or animals, stealing, forcing another into sexual activity, destruction of property, lying to manipulate others, staying out past curfew repeatedly, running away, and school truancy.   These behaviors cause significant impairment in social, academic, or occupational functioning.

Conduct disorder can start in childhood or adolescence, and if not resolved, may lead to an adult diagnosis of Antisocial Personality Disorder.  Treatment should follow the same criteria as that for Oppositional Defiant Disorder, but may require more intensive interventions.  Many of these children have gotten involved in the legal system due to their behavior, and sometimes treatment is mandated by the court.  Research is torn about the success of residential treatment programs, but many children end up in these facilities or are otherwise placed out of their homes because their parents can no longer manage them. Whatever the situation, parents with conduct disordered children need to have much patience, perserverance, and allow their children to experience the consequences of their behavior so that they will hopefully make positive changes for themselves.

For more information about Oppositional Defiant Disorder and Conduct Disorder, visit http://www.webmd.com/mental-health/oppositional-defiant-disorder or http://www.conductdisorders.com/.