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Oppositional Defiant Disorder (ODD) is a mental illness that mainly occurs during childhood while Antisocial Personality Disorder (APD) is common amongst young adults. However, while the two disorders occur at different stages of life, research has highlighted some underlying factors that link them (Salisbury, 2013; Silberg, Moore, & Rutter, 2015). Conduct Disorder (CD) is a mental disorder amongst teenagers hence the link between ODD and APD. The available research shows that cases of ODD in childhood may progress to CD in adolescence and APD later in adulthood (Salisbury, 2013; Burke, Rowe, & Boylan, 2014). While not all cases of ODD go through this transition process, some underlying factors necessitate the progress. Hostile parenting and poor economic backgrounds are some of the defining factors that ensure the progress from ODD to APD through CD (Silberg et al., 2015). Gender also plays a major role in this process as boys suffering from ODD are more likely to experience APD in adulthood as compared to their female counterparts (Burke et al., 2014).
Oppositional Defiant Disorder (ODD) and Antisocial Personality Disorder (APD) affect one’s behavior and personality towards other persons. The two disorders have overlapping characteristics, which can be confused with each other if not observed keenly. However, the two have some distinctive features that can be used to differentiate them. While ODD sets in during one’s childhood, APD develops in late adolescence or young adulthood. The continuous review of the Diagnostic and Statistical Manual of Mental Disorders (DSM) has allowed the classification of ODD and APD as distinct disorders. According to DSM-IV-TR, ODD is a pattern of “negativistic, defiant, disobedient, and hostile behavior towards authority figures” (Boylan, 2014, p. 8). This pattern should last for at least 6 months and cause substantial suffering to a child’s life. On the other side, APD is an enduring “pattern of personal experience and behavior that deviates noticeably from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to personal distress or impairment” (Salisbury, 2013, p. 6). However, despite the clear differences in definitions and characteristics, ODD and APD link at some point. This paper uses recent literature materials to prove that Conduct Disorder (CD) is the connection between ODD and APD.
As mentioned earlier, the link between ODD and APD is CD. According to Salisbury (2013), the available research indicates that ODD, CD, APD are different developmental stages of psychopathy as opposed to being distinct stand-alone disorders. DSM-I classified personality disorders as Psychopathic Personalities before that label changed to Sociopathic Personality Disorders in DSM-II (Salisbury, 2013). Under the current DSM-IV-TR, such disorders are classified as APD. Research shows that children diagnosed with ODD will have CD in their adolescence and they later develop APD in adulthood (Salisbury, 2013). This observation underscores the perception that these three mental disorders are actually different stages of the same problem as people transition from childhood through adolescence to adulthood (Burke et al., 2014). This paper will view ODD and APD from a developmental perspective with CD being the point of transition.
From ODD to CD
Based on DSM-IV-TR’s definition of ODD, the patterns of defiance towards authority have to persist for over six months (Bendiksen et al., 2014). The six-month duration separates other common defiance behaviors that are common amongst children from ODD. CD is divided into different categories, but the common one is the childhood-onset subset, where the majority of children suffering from ODD proceed to develop CD in adolescence (Burke et al., 2014). A study by the National Comorbidity Survey Replication (NCSR) sought to evaluate childhood disorders using medical information of adults that suffer from different mental sicknesses. The study established that children who suffered from ODD progressed to CD in adolescence and APD in adulthood (Lindhiem, Bennett, Hipwell, & Pardini, 2015). However, not all children suffering from ODD progress to CD as some may heal while others develop different mental disorders later in life. Nevertheless, clinical research shows rates of over 96% for comorbidity between ODD and CD in childhood (Burke et al., 2014).
The assertion that ODD and CD are developmental stages of APD implies shared risk factors. The general risk factors for antisocial disorders include psychological, familial, neurological, and individual factors coupled with family issues especially the parenting aspect (Lindhiem et al., 2015). Studies have established more similarities in risk factors for ODD and CD than differences (Burke et al., 2014). The only outstanding difference between the two is the gender aspect. Apparently, boys are more likely to suffer from CD as compared to girls (Burke et al., 2014). On the other hand, both boys and girls show almost similar rates of ODD.
The psychological risk factors for CD and ODD have the same impact on boys and girls (Burke et al., 2014). The same pattern is common for family and environmental causes of mental disorders. Studies on hereditary risk factors for ODD and CD show substantial evidence that the two are related based on genetic patterns (Barry, Golmaryami, Rivera-Hudson, & Frick, 2013). However, researchers have differed on the hereditability and etiological causes of these two disorders. One study concluded that ODD and CD were manifestations of the same underlying genetic information (Burke et al., 2014). Another research showed that the strong correlation between the genetic information pointing to the two disorders does not necessarily mean that the underlying familial factors are precursors of the same problem (Lin & Gau, 2017).
As noted earlier, some ODD cases do not progress to CD. Studies have singled out the common predictors of the progression of ODD to CD (Burke et al., 2014). For instance, ODD cases characterized with constant physical fighting progresses to CD in most cases. Additionally, children who suffer from ODD due to risk factors associated with family instability tend to develop CD later in their adolescence (Burke et al., 2014). Similarly, environmental risks, hostile parenting, and poverty are high in ODD/CD comorbid cases. Therefore, it suffices to conclude that ODD cases caused by hostile parenting and poverty place the disorder in the developmental continuum of CD later in life.
CD – APD
Studying the origins of mental disorders in adults allows psychiatrists to handle the arising issues from an evidence-based approach. Similarly, child psychiatrists can have a long-term view of the outcomes of childhood disorders. According to a study by Corff and Toupin (2014), the majority of adults with APD have cases of CD as teenagers. However, not all teenagers with CD progress to APD in adulthood. Salisbury (2013) posits that one of the ways of diagnosing APD in adulthood is the presence of CD in adolescence. This assertion underscores the strong correlation between the two disorders with CD being a precursor of APD. The most outstanding characteristic of the two disorders is the disruptive tendency of disregarding other people’s rights (Corff & Toupin, 2014).
The conclusion that CD is a precursor to APD points to similar underlying factors concerning the two disorders. These factors are normally established in the risk factors. As shown in the ODD/CD comorbidity cases, teenagers suffering from CD due to predisposal to some risk factors are highly likely to experience APD as adults (Salisbury, 2013). One of the outstanding risk factors is gender. According to Salisbury (2013), males suffering from CD are more likely to proceed to APD as compared to their female counterparts. This observation hinges on the view that boys are more likely to be hyperactive as compared to girls (Lin & Gau, 2017).
Family structures also play an important role in the progression of CD to APD. According to Silberg et al. (2015), all CD cases involving troubled families like teenage motherhood and hostile parenting among others progressed to APD in early adulthood. In most cases, teenagers experiencing CD in a broken family will have poor relationships with their parents. As such, they do not get proper guidance and mentorship that is required to navigate the physiological, social, and psychological issues that come with adolescence (Silberg et al., 2015). Consequently, such teenagers will transition to adulthood without addressing the underlying CD issues which ultimately progress to APD.
Criminality is one of the behaviors associated with APD. According to a study by Murray et al. (2015), CD cases involving children from poor socioeconomic backgrounds tend to progress easily to APD. The link between poverty and the progression of CD to APD hinges on the lack of medical attention to address such problems (Murray et al., 2015). If CD is not treated in time, it will most probably progress to APD. As such, CD cases of children from poor economic backgrounds go untreated due to the lack of financial means to seek psychiatric services.
The occurrence of ODD in childhood may progress to CD in adolescence which then turns into APD in adulthood if not treated. Researchers have shown that the connection between ODD and APD is CD (Salisbury, 2013; Murray et al., 2015). As shown in this paper, cases of ODD triggered by hostile parenting and poverty are highly likely to progress to CD. It emerged that hostile parenting does not create room for children suffering from ODD to get proper guidance and counseling from parents as a way of overcoming the disorder. Similarly, children from poor economic backgrounds may not have the privilege of having psychiatric attention due to lack of financial resources. Consequently, such children grow into teenagers where the disorder progresses to CD. The same problems that befall such teenagers as kids continue to affect the possibility of getting medical attention at this stage. However, boys suffering from ODD are more likely to experience CD as compared to girls. The same trend continues in the progression of CD to APD in adulthood. Therefore, it suffices to conclude that CD connects ODD with APD especially in cases where children experience hostile parenting or come from poor economic backgrounds.
Barry, T., Golmaryami, N., Rivera-Hudson, N., & Frick, J. (2013). Evidence-based assessment of conduct disorder: Current considerations and preparation for DSM-5. Professional Psychology: Research and Practice, 44(1), 56-63.
Bendiksen, B., Svensson, E., Aase, H., Reichborn-Kjennerud, T., Friis, S., Myhre, A., & Zeiner, P. (2014). Co-occurrence of ODD and CD in preschool children with symptoms of ADHD. Journal of Attention Disorders, 21(9), 741 – 752.
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