Oppositional defiant disorder

All children are oppositional from time to time. They talk back, disobey, ask “why?”, and argue with or ignore adults. This is developmentally appropriate and part of testing limits and learning.

However, when a child’s oppositional behavior seems more frequent or severe than other children of the same age, or if the behavior starts to interfere with the child’s friendships, school performance, or family relationships, and has lasted for at least six months, it is no longer considered developmentally appropriate.

Oppositional defiant disorder behaviors can include:

• Losing his temper
• Arguing with adults
• Actively defies adults’ requests or rules
• Deliberately annoys people
• Blames others for her mistakes or misbehavior
• Easily annoyed by others
• Appears angry and resentful
• Appears spiteful and vindictive

Treatment and parenting approach

The first step is to see the child’s pediatrician or primary care provider. The American Academy of Child and Adolescent Psychiatry suggests that a treatment plan be created to best treat the needs of each individual child.

Treatment that focuses on helping parents and caregivers learn skills for parenting and managing has been effective in reducing disruptive behavior in children with oppositional defiant disorder. These treatment approaches include education for the parents and behavioral approaches that reinforce positive behavior and provide consequences for negative behavior.

It is important in oppositional defiant disorder that parenting be consistent, clear, and loving. Limit-setting is important. However, treatment or parenting approaches that try to shock or scare children and teens are not effective and may be harmful.

When parents and teachers recognize oppositional defiant disorder behaviors in children, there are steps they can take to help. Parents can learn skills for parenting and managing their children’s behavior. Classroom teachers can employ structured behavioral reinforcement routines in their classrooms.

Conduct disorder

Conduct disorder is a severe disruptive behavior disorder diagnosed when behavior is consistently antisocial and aggressive. Children and teens with conduct disorder behave in destructive ways that violate others’ rights and are not typical among others their age.

Conduct disorder may be present when a pattern of behavior is severe, lasts at least 12 months, and affects a child or teen’s ability to relate to others and function well in daily life.

Conduct disorder may include these behaviors:

• Bullying and threatening others
• Initiating physical fights
• Sexual aggression
• Harming animals
• Using a weapon to harm others
• Deliberate destruction of property
• Deliberate fire-setting
• Breaking into a car, house, or other building
• Stealing
• Lying or deceiving to manipulate others
• Frequently skipping school
• Running away from home or staying out at night despite parents’ rule
• Lack of remorse

The American Academy of Pediatrics recommends that parents consult their child’s doctor if they are concerned about aggressive behavior, especially if a child has caused physical injury to himself or others, or if parents fear for their safety or feel unable to cope with their child’s behavior.

Mulitmodal approach

Research suggests that the most successful interventions for conduct disorder are multimodal, meaning that several approaches are combined to address the various areas of a child’s life and meet his particular needs. A multimodal approach may involve parent education and skill-building, individual and family therapy, and therapy in the school setting. It is important that a treatment program be consistent and long term, as it takes time to learn new behaviors and skills such as problem solving, empathy, and anger management. This treatment is important for the safety and well-being of the child and others. Untreated, conduct disorder can become antisocial personality disorder in adulthood, unless a child has an opportunity to learn new skills and behavior.

Risk factors

The factors that put children at risk for oppositional defiant disorder and conduct disorder are:

• Genetic risk factors
• Poor parenting, such as neglect or discipline that is too harsh or inconsistent
• Physical, sexual, and emotional abuse
• Peer group rejection
• Living in a violent neighborhood or home
• Maternal health, such as smoking, alcohol, or drug use during pregnancy and complications during pregnancy and birth
• Family economic stress
• A family history of disruptive behavior problems