It’s not easy to understand the intricacies of a toddler’s mind and behavior. Behavior and actions are a way of expressing the body’s response to the information it has been fed and has processed and internalized.
Children go through various developmental changes from the fetal stage till the pre-teen age. It’s highly important to understand that though behavioral fluctuations are normal in a growing child, certain actions surpass the label of normality. Child development is an individually experienced process, but behavior, thought processes and actions that inhibit a child’s functionality, pose a danger to them or others, and are a cause of alarm must be viewed under the umbrella of Disruptive Behavior Disorders.
WHAT ARE DISRUPTIVE BEHAVIOR DISORDERS?
How can you discern if a behavior is normal? Simply by observing the child, and gauging the intensity and intentionality of the behavior displayed.
Disruptive behavior is an exaggerated expression of un-cooperation, defiance and hostility. Children with disruptive behavior disorders tend to be physically and verbally aggressive and actively violate another’s rights. They are usually treated by subjecting the child to anger-management therapies, art-therapies and cognitive behavioral therapies alike. Parents are also included in the treatment; they undergo parent management trainings, are educated on how to manage disruption, and are also encouraged to improve their relationship dynamic with their child.
Such behavior can inhibit their performance at school and reduce their sociability. They usually result from factors pertaining to home life and quality of social, emotional and mental aspects.
THE FUMING CHILD: OPPOSITION DEFIANT DISORDER (ODD)
If a child displays a pattern of behavior which is angry, irritable, defiant and argumentative in nature for six months, chances are that this is the onset of ODD (American Psychiatric Association, 2013). Four categories of negative behavior are displayed in front of at least one non-sibling individual for a diagnosis to be considered.
ODD begins to show observable symptoms by the age of late preschool or early elementary school, and can also manifest in early adolescence (Rowe et al., 2010; Canino et al., 2010)). Though researchers have just begun intensive research into the disorder, a review shows that the prevalence of ODD across cultures is 3.3%, while others quote numbers ranging between 1 – 16% (Canino et al., 2010; Loeber et al., 2000). A child’s diagnosis may begin at a family doctor’s clinic and then be taken over by a mental health professional.
The DSM-V Criteria for Oppositional defiant disorder
- In 2013, the Diagnostic and Statistical Manual of Mental Disorders put forth the following checklist of observable behavior:A pattern of irritable and angry moods and defiant behavior displayed for at least 6 months by the age of 6. The moods have been further categorized to pinpoint certain actions
- Argumentative/Defiant Behavior
- Frequent arguments with authoritarian figures
- Active defiance and frequent refusal to comply with authoritative instruction
- Deliberately annoys others
- Assigns blame for own mistakes and misbehavior
- Has been spiteful or vindictive at least twice within 6 months
- Angry/Irritable Mood
- Quick to lose temper
- Easily annoyed
- Angry and resentful
- Argumentative/Defiant Behavior
2. Behavioral disturbances can be attributed to distress within the self or primary social circle (family, friends, colleagues, peer group) and hamper social, educational, occupational and other areas of human functioning
3. The behaviors exist independently of psychotic disorders, substance abuse or depressive episodes.
Rating the Intensity of Symptoms
To further understand a child’s severity of symptoms, the symptoms have been categorized according to intensity:
- Mild – When some of a child’s symptoms are confined to one setting (home, school or playground).
- Moderate – Some of the child’s symptoms are present in at least 2 settings.
- Severe – Some of the child’s symptoms are present in 3 or more settings.
Comorbidity with other Disorders
ODD does share comorbidity with other mental problems. These can be treated alongside ODD and can either bring forth the onset of ODD or can occur after ODD has developed in a child.
ADHD (Attention Deficient Hyperactive Disorder)
ADHD is one of the most common disorders to share comorbidity with ODD. These children and/or adults tend to be more aggressive and display more negative symptoms of ODD. Their academic performances are below average, as compared to those with just ODD. These children tend to have more strained relationships with family and authoritative figures.
Children and adolescents with ODD and anxiety are more likely to be disruptive because they feel more pressure than others. In response to anxiety, they are likely to act out in disruptive and aggressive ways, perform poor executive functioning and misread cues frequently.
Sharing comorbidity with mood disorders (depression or bipolar disorder) can make children susceptible to developing antisocial tendencies. Treatment usually includes CBT and medication to curb symptoms of both disorders.
This can only be understood via formal testing, although the key to understanding comorbidity of ODD and IDs is to see if oppositional behavior goes beyond the child’s intelligence and capacity of intention. These children usually have difficulties in school and display frequent negative behavior.
Sharing comorbidity with language disorders can lead to a misdiagnosis in both the case of ODD and detecting a language disorder. Children may either have problems comprehending and processing instructions which could be misconstrued (in some cases) as defiance.
WHAT CAUSES OPPOSITIONAL DEFIANT DISORDER: FACTORS THAT INFLUENCE THE ONSET
ODD is still fairly new and under scrutiny by large bodies of researchers. However, various factors have been identified that are visible in children and adolescents diagnosed with ODD.
Studies have shown that ODD has a 61% chance of heritability and shared 50% of its genes with Conduct Disorder (Polderman et al., 2015); Krueger et al., 2002).
Studies have also been done to see the effects of the dopaminergic and serotonergic system genes and hormone regulator genes on aggression in such children (Salvatore & Dick, 2016). Parents with a history of ADHD, ODD or CD or any mood/personality disorder can also pass on ODD genes to children.
Explanatory models of ODD usually focus on executive functions and divide them into “hot EF” (motivational, affective and emotional cognitions) and “cool EF’’ (inhibition, planning, working memory, flexibility and top-down functions) factors which determine cognitive performance (Noordermeer et al., 2016; Blair et al., 2016).
Studies have shown reduced volume in the left amygdala, insula and frontal gyrus, anterior insula, anterior cingulate cortex and medial prefrontal cortex, which taxes the hot functions of the executive functions (Noordermeer et al., 2016; Ashburner et al., 2000; Michelli et al., 2005; Whitwell, 2009; Puzzo et al., 2016).
MRI studies have also noted abnormal activations in the amygdala and insula, which affect cool EF functions, and in the left fusiform area. The amygdala and striatum are also implicated with respect to hot EF.
The cortisol stress response for ODD groups shows that these patients have lower cortisol levels, which were associated with internalizing disorders (Laurent et al., 2015). Reduced serotonin was also noticed, which has been long linked with aggression, in turn.
It can also lead to the onset of antisocial personality disorder (Laurent et al., 2015; Stadler et al., 2004; Zepf et al., 2011).
The primary circle, i.e., family, plays a vital role in determining a child’s behaviors and attitudes. Some important family factors include:
- familial psychopathology and genetics
- prenatal risk factors
- disciplinary practices
- maltreatment and neglect
- parental relationship
- family disharmony
- low social class and poverty
Extra familial factors that can also bring the onset of ODD are quality of residential life, peer groups, peer defiance, peer rejection and other life stressors.
TREATMENT FOR OPPOSITIONAL DEFIANT DISORDER
Understanding Oppositional defiant disorder is dependent on a caretaker’s observations of the child. Environmental factors, life quality factors, life experiences, peer groups and factors alike impact a child’s conduct (41).
It’s tricky treating children with pathological behavior problems – you cannot take consent from them as they don’t pose “adult” faculties to make such decisions. The main basis of treating ODD in children and adolescence lies in good parenting practices, healthy attachments, and close and trusted relationships to help counteract deviant behavior.
In the case of ODD, therapies that are being conducted are as follows.
Parental Management Training (PMT)
This model of treatment focuses on parental skills and encourages parents to spend quality time with their child and utilize reinforcement strategies to direct behavior and motivation. Parent-child interaction therapy includes video-based monitoring and feedback to track the progress of parents and their children.
The Triple P model has shown to work effectively with smaller children and even adolescents. Other models of PMT include the Oregon Model, the Kazdin model and the Berkley model (Nathan & Gorman, 2015; Forgatch et al., 2013; Scott et al., 2010)
Functional Family Therapy
This therapy is conducted with the family where a mental health professional helps to improve family functioning to create a better environment for the child diagnosed with ODD. This can be done by educating parents on how to deal with the onset of symptoms, interventions, and understanding the child’s individual psychopathology.
FFT uses peer interviews and interventions via family, school and mental health professionals. The idea of FFT is to holistically address the ODD symptoms and their triggers to help collectively improve a child’s environment.
This can also encourage children to respond better and acclimate to their environment in a healthy and functional manner.
Cognitive Behavioral Therapy
Usually done on older children, CBT has shown effective results. A 2012 study reported that CBT is effective in improving child conduct problems and aiding parents. Group CBT has also shown to decrease symptoms of aggression, and collaborative problem solving has also proven to be an effective treatment for ODD (Goertz-Dorten et al., 2015; Greene et al., 2004).
Anger coping programs, perspective taking, and parental coping programs have all been included in the CBT component of ODD treatment.
Dialectical Behavioral Therapy
This therapy involves accepting one’s feelings and using thoughts to change or modify thought processes. To deal with emotional dysregulation in children with ODD, this therapy has shown effect. It also equips children with coping skills to deal with symptoms independently.
Importance is given to distress, tolerance skills and interpersonal effectiveness.
Used as a last resort, medication can help improve some physical symptoms of ODD in children. Studies have found that fluoxetine (Prozac) has helped to improve ODD symptoms in depressed individuals (Jacobs et al., 2010).
There has also been literature suggesting that using atypical antipsychotics (aripiprazole and risperidone) and mood stabilizers can help manage aggression. Stimulants are also prescribed if a child shares comorbidity with ADHD
DIFFERENTIATING BETWEEN THE GOOD NAUGHTY AND THE BAD NAUGHTY
Children will display innumerable emotions and behaviors through their developmental period well into adolescence. As human beings, environment, social interactions, intimacies, body biochemistry and brain health all play a part in healthy regulation of the self.
As children grow, they experience life with their own perspective. A bad day at Montessori may make your toddler throw away her spaghetti bowl, a break up may make your teenage daughter melancholy or being bullied may impact your child’s anger expression at home. There are always underlying causes of behavior expression and effective and open communication should always be established between a parent and their child.
However, if your child’s behavior begins to drift away from the normative, affects their relationships at home and at school, is vindictive and defiant, then here’s a great directory of licensed therapists to help address your concerns and understand your child a little better.