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Conduct & Oppositional Defiant Disorder

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The Diagnostic and Statistical Manual of Mental Disorder (DSM-IV) categorizes oppositional defiant disorder and conduct disorder in the category of childhood mental disorders, under the subcategory of disruptive behavior disorders. Note that a certain degree of defiant behavior is part of the maturation process that separates children from parents and allows them to build their own personal identity.

Children who are diagnosed with oppositional defiant disorder or conduct disorder have moved beyond the normal, assertive behavior seen in early childhood and adolescence. But when defiance becomes a constant in the child’s relationships – such as at school or with friends and not just at home – and when anger turns to rage, acts of destruction or even violence, normal has metamorphosed into abnormal. At that point, a diagnosis of oppositional defiant or conduct disorder may be appropriate.

What is Oppositional Defiant Disorder?

Asserting your will as a child or an adolescent is a normal and healthy rite of passage as you establish yourself as a person with an individual identity. It is during this time that you set your own standards of behavior and develop your values which, ideally, conform to those of your community and culture. Sometimes, patterns of hostility and a lack of cooperation can get out of hand, expanding to include interactions with associates, authority figures, etc. These behaviors can interfere with your daily function and frustrate your parents, teachers, employers and/or friends. Children with oppositional defiant disorder are often without friends, do poorly or fail in school and/or become depressed or anxious.

Warning signs commonly associated with oppositional defiant disorder include: noncompliance with rules, frequent temper tantrums, spitefulness, irritability, deliberate attempts to upset or annoy those around you and/or a complete refusal to accept any blame or responsibility for mistakes or actions. These behaviors may begin and remain within the home or they seep into other parts of your life. Generally speaking, these interactions are limited to those who are well-known to you such as your parents, siblings and/or peers.

How Common is Oppositional Defiant Disorder?

Studies have set the prevalence of this disorder as high as 16 to 20% among school age children. Although it has been diagnosed in children as young as 3, it usually presents by age 8. Prepubescent boys display signs more often than girls of the same age – a that pattern continues after puberty.

Attention-deficit/hyperactivity disorder (ADHD) and learning and communication disorders are frequently seen in children and young people diagnosed with oppositional defiant disorder.

What Are The Most Effective Forms of Treatment for Oppositional Defiant Disorder?

Treatment for oppositional defiant disorder is essential. Left untreated, the behaviors and attitudes of oppositional defiant disorder can become ingrained and segue into more serious problems such as: conduct disorder or after the age of 18, antisocial personality disorder. Children displaying the signs normally associated with oppositional defiant disorder should be screened for attention-deficit/hyperactivity disorder, learning disorders, depression, bipolar disorder and anxiety.

Individual psychotherapy can help children understand how their behavior is self-destructive and replace their defensive attitude with self-control and true independence. Parents can work with a behavior therapist to learn effective ways to discourage their child’s oppositional conduct and support and reinforce more appropriate behavior.

Suggestions as to ways a parent can help a child with oppositional defiant disorder include:

  • Build on Positive Behaviors (Praise)
  • Take a Time-Out (If the Situation Seems Out-Of-Control)
  • Pick Your Battles
  • Keep Your Child’s Age in Mind
  • Set Up Boundaries
  • Maintain Those Boundaries
  • Do Not Waste Your Time and Energy Explaining or Arguing (State Your Case and Move On)
  • Develop Interests of Your Own
  • Seek and Utilize Support From Other Adults

What is Conduct Disorder?

Conduct disorder can emerge in either childhood or adolescence and can include aggression towards people and animals, the deliberate destruction of property, deceitfulness, theft and truancy. Rules are followed and socially unacceptable behavior becomes the norm. Young people diagnosed with conduct disorder are frequently labeled as delinquent or “bad” by peers, teachers, social service case managers and/or law enforcement officials. Rejection merely adds to the problem and may encourage you to run away from home or seek acceptance in gangs.

There are many theories as to why a child develops conduct disorder. It appears that the home environment plays a significant role in this type of disorder. While a divorce or separation will not cause conduct disorder, constant strife between parents may be a contributory factor, as may be parental substance abuse, dependence on alcohol, sociopathy, neglect and/or abuse. Chaos at home can cause children and teenagers to become anxious, angry and/or disruptive; the attitudes and conduct of poor role models are mimicked.

Damage to the central nervous system may provide a physical component in the disorder’s development. ADHD and extremes in temperament during infancy and early childhood may create a predisposition to conduct disorder.

How is Conduct Disorder Treated?

Treatment for conduct disorder typically includes the use of all resources, at home, in school and within the community and treatment for oppositional defiant disorder includes psychotherapy and in some cases medication. Psychotherapy and change and improve the ways in which you approach problems in your life. Behavioral techniques should be employed at home and at school to encourage socially acceptable behaviors.

Changes in the home environment are essential; rules and consequences for breaking rules must be consistent and enforced. If abuse exists within the family, the child should be removed from the home and placed in a structured and supportive environment.

Under some circumstances, medication is warranted and can be very effective. This is particularly true is if acts of explosive aggression are occurring; in those cases, anti-psychotics and sedative are recommended.

Where Can I Find Additional Information on Oppositional Defiant Disorder and Conduct Disorder?

Several excellent books on oppositional defiant disorder and conduct disorder are available.

These books include:

The Family Intervention Guide to Mental Illness: Recognizing Symptoms & Getting Treatment by Bodie Morey and Kim T. Mueser and Banishing Bad Behavior: Helping Parents Cope with a Child’s Conduct Disorder (Parent, Adolescent and Child Training Skills) by Martin Herbert.

In addition, the American Academy of Child and Adolescent Psychiatry (www.aacap.org) provides a registry of mental health providers in your local area.

References:

American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington, D.C.

Kaplan, H. I. & Sadoc, B. J. (1996). Concise textbook of clinical psychiatry. Baltimore, MD: Williams & Wilkins.

Preston, J. & Johnson, J. (2008). Clinical Psychopharmacology Made Ridiculously Simple. Miami, FL: MedMaster, Inc.