Abstract
A lot of research has been done in regard to behavioral disorders in general and the oppositional defiant disorder in particular but there seems to be difficulties in understanding the whole concept. This paper gives an in-depth discussion of the oppositional defiant disorder and the aspects associated with it for instance the diagnosis, causes, symptoms, prevention and intervention and treatment.
Various theories and model have been discussed to show the developmental pathways that lead to the development of the disorder. The parties that can influence the development of the oppositional deficient disorder and how they do so have also been illustrated and suggestions of what need to be done in regard to the topic are highlighted.
Introduction
Oppositional defiant disorder is a form of social aggression that is characterized by a number of behaviors; for instance negative attitudes towards aspects, hostility among others. It is a disorder that can be expressed by children from their early ages to adolescent stage and it is more common in boys as compared to the girls.
It is however very difficult to identify the opposition defiant disorder (ODD) in both the children and adolescents since even the well behaved ones can prove to be very difficult to handle depending on situations. Parents could however note of an abnormality if the child or adolescent shows some persistent defiance towards them and other authority figures (Fonagy et al. 2005).
This piece of work gives a detailed discussion of the oppositional defiant disorder giving an insight to the theoretical underpinnings that surround the condition, what others have said about it (literature review) and the way forward. It also shows how school child counselors can be incorporated in the process of dealing with the disorder by altering the developmental pathway that would lead to the development of the diagnosis.
Theoretical Underpinnings
There are several ideologies and theories that have been put forward in an effort to make the understanding of the opposition defiant disorder better. Cherry (2011) discusses the attachment theory in his article, ‘attachment theory’ showing how it is related to ODD. It was brought forward by John bowlby and later developed by Mary Ainsworth. Attachment entails the emotion bond between individuals.
The bonds formed between children and their caregivers from the beginning influences their entire life for instance the bond between mother and child which acts as a source of security to the child hence building up confidence of the child in facing the world. The child seeks comfort, consolation and security from the caregiver and is distressed in case of separation.
There are four main forms of attachments (i.e. secure attachment, avoidant – insecure attachment and ambivalent – insecure attachment and disorganized – insecure attachment) all which have some impacts on the children’s conduct later in their lives.
In secure attachment, a child shows distress incase of separation with the caregiver and happiness when united. The security however gives the child some hopes that even when the caregiver leaves, he or she will be back. The child seeks for comfort and reassurance from the caregivers whenever they are afraid or threatened. An ambivalently attached child on the other hand displays a lot of grief when a parent leaves.
It is a condition that is associated with poor maternal treatment where the parent is usually not available making not dependent on the parent or giver even when in need. It is not very common. The avoidant attachment entails the child avoiding the parents or caregivers and in most cases they treat the parents the same way they do to strangers.
This behavior could develop a result of some instances of neglect or abuse by the caregiver or parent. Research shows that the best attachment is the (secure) attachment. It is therefore evident that poor attachment can lead to the opposition defiant disorder among other problems and should hence be avoided.
Although this disorder could develop as early as the age of two or three years, the school child counselors can be helpful to those who show signs of developing the disorder through learning of the situations that face them in their families and also how they interact with their with other children in school.
The disorder could also be corrected incase it has already formed to avoid major harm or difficulties in future. The counselor liaises with the parents and teachers of the affected children and helps in handling of the children.
The coercion theory is also a theory that can help account for the possible pathways that lead to behavioral problems. The theory was brought forward by Patterson in 1982 and relates different parenting styles to behavioral problems exhibited in children. It is based on the principle of operant conditioning and stresses family relations as the major causes of the development of behavioral difficulties in children.
Negative reinforcement for instance reduces the negative behavior of both the parent and the child. In cases where a parent opts to stop a child’s paroxysm through some reward the tantrums in the child may be heightened due to the positive reinforcement while the parent is negatively reinforced by eliminating the tantrum.
The reciprocal relation is deemed responsible for the negative patterns of interaction in settings where children with behavioral problems exist (Mash and Wolfe 2008).
The theory of genotype-environment effects by Scar also relates to behavioral problems. It operates on the principle that genotypes have a role in shaping experiences. Individuals are argued to form their environments which are usually related in a unique way with their individual differences in regard to their genotypes. There could be the formation of active, passive or evocative genotype environment interactions.
Active outcome is experienced when the genetic characteristics of an individual determine the choice of the environment to be lived in. Passive effects are experienced when the biological parents provide the genes and home environment to a child. Evocative impacts on the other hand entail the responses of others to a child basing on his or her characteristics.
The genetic components and the environment are both responsible in shaping the behavior of a child but the former seem to influence the latter. This is so since parents of the a child with the oppositional defiant disorder exhibit behavioral problems while parents of a child with conduct disorder in most cases have negative parenting behavior and a child may also evoke negative ways of interaction (Bukowski, 2008).
Literature Review
Kane (2004) describes opposition defiant disorder as a psychiatric behavior disorder exhibited in children who show some form of aggressiveness and a predisposition to deliberately bother and infuriate others. It is a disorder whose behavior creates considerable difficulties to those relating with the victims for instance family members, teachers and even friends.
Opposition defiant disorder can be a symptom of conduct disorder which has a genetic component and can also stand by its own.
Some of the symptoms associated with opposition defiant disorder as discussed by Kane are; defying of requests made by others, refusing to comply with rules and regulations, purposely annoying and irritating others, quick to anger and losing temper, switching blames to others following their mistakes, being argumentative even when dealing with adults, having the urge to revenge, speaking in a harsh and disrespectful manner especially when upset, manipulative, stubbornness among others.
The Children’s Hospital of Pittsburg (2008) defines oppositional defiant disorder as a behavioral disorder that exhibit symptoms like negativism, irritation, lack of cooperation, defiance, and annoyance towards authority figures like parents and teachers. The children and adolescents suffering from the oppositional defiant disorder tend to cause trouble and distress to others as a result of their behavioral problems.
According to Clinicaltrials.gov (2005), the diagnosis of oppositional defiant disorder is done by a child psychiatrist or a mental health practitioner although various people for instance teachers and parents can easily note or identify the behavioral disorders.
It however requires the presentation of detailed information on the child’s behavior by the parents, teachers and other involved parties and most importantly psychological testing. Early identification of the behavior problems and intervention, through treatment, could prevent further problems.
It is very essential to treat the ODD early enough to help deal with other mental health problems that are associated with it for instance anxiety disorders, conduct disorder among others which would worsen the condition of this disorder if not taken care of early enough.
Early detection and intervention is essential in disrupting the developmental pathway that would lead to more behavior problems. It also enhances the individuals’ normal growth and development and interpersonal relationships and hence improves their quality of life through avoidance of the problems that would otherwise occur.
Research studies carried out by Craighead and Nemeroff (2004) have shown that although the exact cause of oppositional defiant disorder is not known, there are theories which explain its development. The disorder is believed to start when a child is a toddler.
The children and adolescents who suffer from this disorder are considered to have experienced a difficult time in learning how to separate from their initial attachment, parent or caregiver, and adapting to the general world. Lack of correction of developmental problems during the infant stage could also lead to the bad attitudes exhibited by those suffering from the oppositional defiant disorder.
The learning theory however contrast this by stating that the negativism in the children suffering from ODD is learnt from the way the child is treated by the authority figures, that is, negative reinforcement. The negative reinforcement is deemed to exacerbate the ODD as the child tries to fight back.
The oppositional defiant disorder could also be caused by a combination of biological, that is, the parental genes and environmental factors which include family issues like divorce, death of family members among others. The factors may not necessarily cause ODD but they increase the chances of its development.
Matthys, and Lochman, (2010), provide some interventions on the oppositional defiant disorder among the children and adolescents which are aimed towards managing the disorder. Some of the interventions in preschool and early childhood include; child development project (CDP) which works towards increasing a child’s respect and responsibility hence improving behavior.
It employs principles like cooperative learning that emphasizes working as a unit other than individualism, reading exercises, collaboration of older and younger children in competing activities, community based activities where the parents, teachers, students and other school staff work together among others.
Good behavior game is also applied and works under the principle of increasing the children’s acceptance of authority and compliance with the set rules and regulation. Children are divided into groups where the teams that follow the stipulated rules are highly regarded as opposed to those who break the rules. This enhances communication and partnership hence reducing aggression, shyness and poor behavior.
It also encourages the children to behave in a good manner observing the rules and regulations while at the same time respecting the authority as it is associated with reward rather than punishment. The intervention programs that can be applied for intervention in adolescents include; training on life skills where a life skills training program is designed with an aim of preventing the act of substance abuse among the adolescents.
The students are taught drug resistance skills, social skills and also self management skills. It has proved to be very effective in changing the behavior among the adolescents specifically in reducing the rate of substance abuse which in the long run enhances good behavior as the adolescents can now reason straight. Positive youth development (PYD) is another technique used among the adolescents.
It is an intervention aimed at increasing the adolescents’ personal and social competence through lessons on stress management, improving ones self- esteem, enhancing problem-solving skills, effects of abuse of substances on health, and social skills.
The skills learnt helps the adolescent in solving conflicts among themselves and coping with others, making informed problem solving decisions, and avoiding use of alcohol and other substances. Responding in peaceful and positive ways (RIPP) is also another intervention that teaches problem solving techniques, communication skills and means of attaining achievements.
All these aim at reducing violence behavior among the adolescents. This improves overall behavior of the adolescents and results in reduced chances of punishment in regard to violence related acts, fewer suspensions and reduced number of dropout cases among other benefits.
There is also the existence of the school transitional environment project (STEP) which handles the adaptation skills of the adolescents necessary in the different transitional stages for instance from one grade to another.
This program works under such strategies as reorganizing the social system in learning institutions for example creation of smaller class sizes and organizing the peer groups. It results in high rates of school attendance and achievement and also reduces the number of students’ drop out.
Apart from intervention, there should also be treatment of the oppositional defiant disorder and other general behavioral problems.
Sadock et al (2008) emphasizes on the importance of a parent in the treatment of a child suffering from oppositional defiant disorder. ‘‘the primary treatment of oppositional defiant disorder is family intervention using both direct training of the parents in child management skills and careful assessment of family interactions’’.
The parents should engage in encouraging their children to behave well as opposed to discouraging the bad behavior through praising and rewarding positive behavior and ignoring the negative behaviors.
According to the Children’s Hospital of Pittsburg (2008), treatment is based on the age, overall health and the medical history of an individual, the extent of the disorder in regard to symptoms, tolerance of the individual towards some therapies and medication among other factors.
Different forms of treatment may be administered for instance individual psychotherapy which instills skills like communication skills, problem solving skills, anger management skills among others. Family therapy on the other hand entails improving the situation in homes in regard to handling of the victims.
Peer group therapy can also be offered with an aim of enhancing the social and interpersonal skills of the victims through interaction with others. Medication is usually applied to treatment of oppositional defiant disorder as the last resort for instance where there is the presence of other disorders or behavioral problems which necessitate medication.
Matthys and Lochman (2010), provide some of the ways of treating the oppositional defiant disorder among the children and the adolescents. To the children there should be training on problem solving skills aimed at eliminating antisocial behavior in the children.
Anger coping programme is another technique discussed by Matthys and Lochman and works by reducing aggression and violence among the children. Among the techniques applied in the treatment of the adolescents suffering from ODD on the other hand include teaching on the art of self control which entails aspects like relaxation, assertiveness, self anger monitoring, conflict management and problem solving among others.
According to Lougy, DeRuvo and Rosenthal (2009), the school child counselors are very essential in the correction or management of various disorders that are exhibited by children especially those who have attained the age of going to school.
It is important for the counselors to collaborate with the teachers and parents and help them understand well the scope (social and educational) of the challenges that are associated with the children suffering from oppositional deficient disorder and other disorders.
The counselors should particularly help teachers and other people involved of the special needs that the children with the disorders need as a tool for social and educational intervention.
This is because the teachers may not be familiar with the consequences of the disorders and could find themselves not catering for the specific needs of children and hence affect the child’s performance negatively due to lack of knowledge on the disorders.
Lucero (1999) assert that the teachers and the school child counselors should work together in an effort of handling those who seem to have the oppositional defiant disorder to avoid the worsening of the condition but rather reduce its effects.
For instance; the counselor is able to choose the areas that are most important to be dealt with in the child rather than revolving on the entire child’s misbehavior which may annoy the child making change to be very difficult. They also consult with parents to identify the strategies applied by the parents to manage the behavior. The counselors may apply the strategies at school to allow for consistency.
The counselor has also the ability, through application of the psychology learnt, to involve the child in all plans that aim at changing his or her behavior as opposed to where the child is not involved which is likely to probe rebellion. The counselors are also able to advise the teachers to stay calm to avoid provocation by the children and also as a way of setting good examples to the children.
They also set chances where choices can be made helping the child to feel powerful hence avoid power struggles. They also impact social skills in the children through some training to help the children relate well with their peers hence make their lives better. Appreciating and rewarding good behavior and allowing participation in what the child enjoys also encourage the child to behave well (Wood 1999).
McKinney and Renk (2007), discusses a model, interactional- developmental etiological approach (IDEA) which is a multiple pathway model that accounts for the development of behavior problems based on the fact that the various theories that have been discussed in regard to the development of behavioral problems are inadequate as they do not account for and amalgamate the findings attained, do not show the interaction among the factors that lead to the behavior development and the pathways followed, and do not clearly show how the genetic and environmental factors affect each other.
McKinney however gives the theories some credit as they provide a means of examining the developmental pathways. The IDEA model incorporates a wide range of possible pathways that lead to behavioral problems. There are the genetic factors, dispositional factors, and environmental factors that may be involved in developing the behavioral problems. The factors may either be protective or source of risk.
For instance, parenting may contribute either positively or negatively to a child’s behavior. Positive parenting for instance protects against further development of behavioral problems while negative parenting tend to heighten the chances of worsening the situation. The combination of genetic and environmental factors can produce dispositional factors.
Positive experiences however play a great role in preventing the behavioral problems even where the genetic and biological predispositions exist. According to the model the pathways that lead to development of behavioral problems could be activated at different development stages hence the importance of considering age and gender in studying the development pathways.
The cognitive and social development of an individual also affects the development of behavioral problems. The IDEA model combines the different findings on behavioral problems and shows that there exist unique genetic and environmental etiologies for various behavioral disorders and also the common environmental etiologies that are shared.
Discussion and Future Actions and/Or Directions
The issue of oppositional defiant disorder is very complex and should not be handled by the parents alone but also other practitioners like the counselors, psychologists, doctors, child development experts among others.
It is however curable through application of various therapy, training that aims at improving social interactions for instance in families and also among peers as well as the treatment of the mental health conditions associated with the disorder.
The parents and counselors are the most essential parties that can alter the developmental pathways involved in the development of the oppositional defiant disorder through working with the affected children and adolescents closely and encouraging positive behavior as opposed to concentrating on discouraging the negative behavior exhibited in the children and adolescents suffering from ODD.
The counselors acts as mediators and help both the teachers and parents to appropriately handle the children in a manner that is likely to encourage them avoid bad behavior and adopt positive behavior.
Although there has been much research carried out on the problem of oppositional defiant disorder, there are gaps left in the study and therefore there is a need to fill the information gaps to facilitate the understanding of behavioral problems in general and those exhibited by victims of oppositional defiant disorder.
For instance there should be reliable and standard definitions of all the aspects that relate to behavioral problems for example the characteristics of antisocialism, and major behavior problems to avoid confusion or difficulty in the understanding of the concept like that seen in the classification of ODD where some researchers discusses it as conduct disorder while others differentiate it completely.
The methodology applied in this area should also be consistence to ease understanding and the different related behavioral problems be identified and be well differentiated to allow for proper treatment. It is also important that the various factors associated with the different behavioral problems and their relationships be examined and explained clearly for instance the biological, additive and environmental factors.
The other factors thought to be contributing to the development of the disorders and behavioral problems should also be examined to add to what is already known.
The inconsistencies that exist in the different research findings carried out by different individuals, groups and institutions should be integrated and presented in theories and models to enhance the assimilation of the acknowledge associated with behavioral disorders in general and also in oppositional defiant disorder in particular hence help in dealing with the issues.
The problems presented by an individual should also be uniquely identified and the pathway involved in their development looked into as opposed to generalization especially when it comes to treatment. This is because some form of treatment could be appropriate on one individual and not on the other even if the diagnoses is the same due to differences in the development of the problem.
The children and adolescents suffering from oppositional defiant disorder should be encouraged to be positive by being taught on the benefits of behaving well (Romano, Tremblay, Boulerice, & Swisher, 2005).
Conclusion
From the research, it is evident that the problem of oppositional defiant disorder is real and affects a majority of people causing great behavioral problems even in adulthood especially when the disorder is not dealt with appropriately. It is one of the most notable bases for referral of children and the adolescents and seems difficult and costly to treat.
The children and adolescents are likely to suffer from depressive disorders, engage in criminal activities and also substance abuse. Despite this, there is no specific aspect that has been identified as a cause to the disorder. It is however likely that both the biological or genetics and environmental aspects contribute to the development of the disorder in one way or the other.
Reference List
Bukowski, M.W. (2008). Social and Emotional Development: Methods and models of developmental psychology. London: Taylor and Francis.
Craighead, E.W and Nemeroff, B.C. (2004). The concise Corsini encyclopedia of psychology and behavioral science.3rd Ed. USA: John Wiley and Sons.
Children’s Hospital of Pittsburg. (2008). Oppositional Defiant Disorder. Web.
Cherry, K. (2011). Attachment Theory. Web.
Clinicaltrials.gov. (2005). Prevention of Oppositional Defiant and Conduct Disorders in Preschool Children. Web.
Fonagy, P et al. (2005). What works for whom? A Critical Review of Treatments for Children and Adolescents. New York: Guilford Press.
Kane, A. (2004). Oppositional Defiant Disorder. Web.
Lucero, L. (1999). How to Work with a Child with Oppositional Defiant Disorder. Web.
Lougy, A.R, DeRuvo and Rosenthal, D. (2009). The School Counselor’s Guide to ADHD: What to know and Do to help your students. USA: Corwin Press, 2009.
Mash, J.E and Wolfe A.D. (2008). Abnormal Child Psychology. 4th ed. USA: Cengage Learning.
Matthys, W and Lochman, E.J. (2010). Oppositional Defiant Disorder and Conduct Disorder in Childhood. USA: John Wiley and Sons.
McKinney, C. and Renk, K. (2007). Emerging Research and Theory in the Etiology of Oppositional Defiant Disorder: Current Concerns and Future Directions. International Journal of Behavioral Consultation and Therapy.
Romano, E., Tremblay, R. E., Boulerice, B., & Swisher, R. (2005). Multilevel Correlates of Childhood Physical Aggression and Prosocial Behavior. Journal of Abnormal Child Psychology, 33, 565-578.
Sadock et al. (2008). Kaplan and Sadock’s Concise Textbook Of Child And Adolescent Psychiatry. New York: Lippincott Williams & Wilkins.
Wood, R. (1999). Dysinhibition Syndrome: How to Handle Anger and Rage in Your Child or Spouse. New York: Hope Press.