Oppositional Defiant Disorder

Most young children occasionally behave aggressively, refusing to comply with their parents' orders, throwing tantrums, hitting, kicking and biting. When a child displays several of these behaviors consistently—day in and day out—over a period of six months or more, he may have an emotional disorder known as oppositional defiant disorder. This disorder typically appears during the grade school years, but it can begin as early as age three. It affects between 2 and 16 percent of children.

The behavior problems that mark oppositional defiant disorder usually occur at home but also may appear at school. They may be a result of upsetting events in a child's life, or they may indicate a more serious behavior problem which will increase as the child gets older.

WHAT CAUSES OPPOSITIONAL DEFIANT DISORDER?
Defiant behavior is part of a normal and crucial development stage related to the child's attempt to establish self-determination and autonomy. A strong-willed child may run into problems if parents are overly controlling or exert authority arbitrarily. This may lead to a power struggle. The child's normal attempts at autonomy may develop into oppositional defiant disorder to guard against overdependence on the parents.

			• Living with the spirited child

Oppositional behavior can represent a misguided attempt to control the environment, not much different from infants' crying, which brings their parents' response. As they grow up, most children learn socially appropriate ways to get what they want. Some, however, learn only inappropriate methods, becoming demanding, defiant and difficult. Still, other children may display oppositional behavior as a result of feelings of inadequacy stemming from a physical disability or mental retardation.

WHEN SHOULD I SUSPECT OPPOSITIONAL DEFIANT DISORDER?
Almost all children go through phases of ill temper and aggressive assertion of their independence. In fact, a classic example of normal oppositional behavior is the toddler period, during which children stretch their wings and express their growing autonomy from their parents. In oppositional defiant disorder, this expression becomes more intense and lasts longer. Oppositional behavior that occurs at normal developmental stages is of shorter duration and is similar to the behavior of other children the same age.

IS MEDICAL ATTENTION NECESSARY?
Yes. A child with true oppositional defiant disorder usually becomes increasingly hard to mangage at home and at school. In time, it interferes with the development of peer relationships, erodes school performance and lowers the child's self-esteem. In the teen years it may evolve into a more serious behavioral disturbance, such as a conduct disorder or drug or alcohol abuse.

WHAT TREATMENTS ARE AVAILABLE?
Treatment usually consists of therapy with the child and the family. Your pediatrician will be able to refer you to a child psychologist or family therapist. Psychotherapy for children with the disorder focuses on resolving the conflicts related to developing independence and increasing the child's self-esteem. One effective method has been cognitive therapy, which teaches children problem-solving skills and how to see situations from another person's perspective.

Parents also should receive counseling and training in order to change the way they manage the child. Parents can learn to reinforce (reward) positive social behaviors and decrease undesirable behaviors through time-outs, removal of privileges or other consequences.

POSSIBLE SIGNS OF OPPOSITIONAL DEFIANT DISORDER
A child with oppositional defiant behavior will exhibit at least five of these behaviors frequently and consistently over a period of at least six months:

• Losing his temper

• Arguing with adults

• Defying or refusing to comply with rules and instructions from adults

• Annoying others deliberately

• Blaming others for his own problems and mistakes

• Becoming easily annoyed by others

• Being angry and resentful

• Being spiteful or vindictive

Excerpt from THE DISNEY ENCYCLOPEDIA OF BABY & CHILD CARE, © 1995 DSH Communications, Inc. This material is based on current medical research and, to the best of the editors' knowledge and understanding, is accurate and valid. However the reader should not use information contained in this material to alter a medically prescribed regimen or as a form of self-treatment, without seeking the advice of a licensed physician.