Juhi, is a 7 year old girl, hailing from a well-to-do and well educated family. Since her early childhood, Juhi has been a difficult child. It would always take more than one round of instructions to get Juhi to follow and act according to what was being said. She would also argue back with her parents whenever she was told something, along with a tendency since early childhood, to get angry at the drop of the hat. However, things have gone beyond the level of tolerance for Juhi’s parents. At home, Juhi has started directly disobeying everything that is told to her by her parents. If even the slightest thing does happen without her consent or will, Juhi starts throwing and destroying whatever she gets at hand, irrespective of how precious it may be. Even after her temper tantrums calm down, there is not a speck of remorse to be seen in Juhi. 3 days back, Juhi’s parents had been called by her school principal. Juhi had knocked down a bottle of paint of her friend’s desk. On being asked to clean it up by the teacher, Juhi had looked into the teacher’s eyes and informed that she would not. On being insisted upon, Juhi took another bottle of paint from her friend’s desk and threw it on the teacher’s face. Not stopping at that, she picked up the mobile phone of her teacher and slammed it against the window, thus crashing both the phone and the window. When asked for an explanation about her behaviour, Juhi reported that had her teacher not insisted that clean up and apologise, none of these things would have happened.

When Juhi was brought in for her consultation by her parents, it was apparent that Juhi had what is commonly known as Oppositional Defiant Disorder, along with a few symptoms of Conduct Disorder. Oppositional Defiant Disorder (ODD) is one of the disorders under the umbrella of Disruptive Behaviour Disorder (DBD), where as the name implies, the manifesting symptoms cause significant distress and disturbance in the lives of the patients as well as the caregivers, mostly the parents and teachers.

The most common behaviors that children and adolescents with ODD show are:

  • Defiance
  • Spitefulness
  • Negativity
  • Hostility and verbal aggression

So, a lot of children do present as being difficult. How then can the parents distinguish between age appropriate difficult behaviour and the presence of ODD in a child? Following are some pointers in this direction:
Children with ODD show an ongoing pattern of extreme negativity, hostility, and defiance that:

  • Is constant
  • Lasts at least 6 months
  • Is excessive compared with what is usual for the child’s age
  • Is disruptive to the family and the school
  • Is usually directed toward an authority figure (parents, teachers, principal, coach)

The following behavioral symptoms are associated with ODD:

  • Frequent temper tantrums
  • Excessive arguments with adults
  • Actively refusing to comply with requests and rules
  • Often questioning rules
  • Deliberately annoying and upsetting others
  • Often touchy or annoyed by others
  • Blaming others for their mistakes
  • Frequent outbursts of anger and resentment
  • Spiteful attitude and revenge seeking

Treatment for ODD usually consists of a combination of the following:

  1. Parent-Management Training Programs and Family Therapy to teach parents and other family members how to manage the child’s behavior. Parents, family members, and other caregivers are taught techniques in positive reinforcement and ways to discipline more effectively.
  2. Cognitive Problem-Solving Skills Training to reduce inappropriate behaviors by teaching the child positive ways of responding to stressful situations. Children with ODD often only know of negative ways of interpreting and responding to real-life situations. Cognitive problem solving skills training teaches them how to see situations and respond appropriately.
  3. Social-Skills Programs and School-Based Programs to teach children and adolescents how to relate more positively to peers and ways to improve their school work. These therapies are most successful when they are conducted in a natural environment, such as at the school or in a social group.
  4. Medication may be necessary to help control some of the more distressing symptoms of ODD as well as the symptoms of coexisting conditions, such as ADHD, anxiety, and mood disorders. However, medication alone is not a treatment for ODD.

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