Oppositional defiant disorder

What is oppositional defiant disorder (ODD)?

ODD is one of two potentially serious psychiatric disorders that may be seen in up to 30 to 50 per cent of children with attention deficit disorder (ADD) (although both are separate problems - they aren't caused by ADD). The other condition is conduct disorder (CD).

Both occur mostly in boys, but ODD is more common than CD, appears at an earlier age and is generally less severe. The first signs usually become apparent at about the age the child starts school, about four or five.

In the early stages it can be difficult to diagnose - many children of this age have periods when they're negative, hostile or defiant. However, when this behaviour persists while playmates leave it behind them, the problem may become clearer.

Symptoms

In the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, the criteria for diagnosing ODD are:

• A pattern of negative, hostile and defiant behaviour lasting at least six months during which four or more of the following are present: often loses temper, argues with adults, actively defies adults' requests, deliberately annoys people, blames others, touchy or easily annoyed, angry or resentful or spiteful or vindictive.
• This behaviour causes clinically significant impairment in social, academic or occupational functioning.
• The behaviour doesn't exclusively occur during a psychotic or mood disorder.
• The behaviour doesn't meet the criteria for CD or antisocial personality disorder.

Treatment and recovery

An accurate diagnosis must be made by an expert in child psychiatry. If your child does have ODD, they'll need specialist psychiatric help and advice with regard to schooling. Treatment may include stimulant medication such as Ritalin, but this will depend on several factors such as the specific nature of the problem, the treatment approach taken by the specialists, and whether there's an element of ADD (ADD and ODD often coexist, and it's usually the ADD element of the problem that responds to stimulants).

Treatment also includes behavioural and other psychological therapies, non-stimulant medications and special diets.