As defined by ICD-10, mental disorder is a general term which implies the existence of clinically recognizable set of symptoms or behaviors associated with the interference of a person’s functioning (First et al, 2004). It includes a range of cognitive, emotional and behavioral disorders that interferes with both the life and productivity of an individual. According to DSM-IV-TR, for any disease or condition to be regarded as a metal disorder, it must have a manifestation of behavioral, psychological or biological dysfunction in the said individual. This paper will look at Opposition Defiant Disorder as an example of a mental disorder.
The Opposition Defiant Disorder
Opposition Defiant Disorder (ODD) is a recurrent pattern of negativistic, defiant, disobedient and hostile behavior by children or adolescents towards adults or authority figures. In order to be diagnosed as suffering from the disorder, such behaviors must occur for a period not less than six months. According to DSMIV-TR, the behavior qualifying the disorder should not have as a result of a change in one’s mood or any psychotic disorder. This disorder is common among children especially from the age of eight years old. However, studies have shown that the disorder is increasingly becoming common among the adolescent teens.
The disorder is characterized by angry and hostile behaviors that exceed the normal level of misbehavior. Though it may be challenging to differentiate such behaviors from the normal misbehavior, the fact that the sufferers of the disorder display a consistent pattern of uncooperative, defiant, hostile, and annoying behaviors toward people in authority makes it easily noticed. It can also be noticed by observing any form of disruption of the child's normal daily activities both at home and at school.
Causes/etiology of Oppositional Defiant Disorder
Though there is no definite cause of underpinning the disorder, its etiology is believed to be multi-factorial. That is to say that the disorder results from a number of causes related to developmental, biological, genetics and psychological factors.
More researches done in the recent years have linked the disorder to biological processes. By April 2008, a study published by BMC Psychiatry found an association between chemicals in the Brain and ODD. They also found out that there is genetic link in the causal factors. The study found a reasonable ground to link the disease to some given chemicals in the brain. The same findings were supported by another group of researchers from the University of Southern California. They equally found out a strong link between genetics and the disorder. These studies revealed that many children and teens with the disorder also have close family members with the same disorder or certain other mental illnesses. This suggests that the vulnerability to develop ODD may be inherited.
Some studies have also suggested that the disorder may be caused by defects or injuries of the specific parts of the brain. Still another group of scientists have argued that there is enough evidence to link ODD to abnormal amounts of neurotransmitters. These cells enable communication between the brain nerve cells. Whenever the chemicals have defects or are out of balance, the communication in the brain may be adversely affected. This can be a potential cause of ODD.
The developmental theorists have linked the occurrence of the disorder to incomplete emotional and psychological development by the sufferers. This means that the sufferers may suffer limitations or developmental delays in their ability to process thoughts and feelings. They are therefore faced with challenges during the latter stages of their lives when they are faced with much difficult situations. Their ability to cope with the stresses of life may be very low leading to serious problems like depression and anxiety which later develop into ODD.
Psychological theorists have hypothesized that such factors as temperament have a strong relationship to the disorder. According to research, the occurrence is rampant during the early childhood stages especially when parents put unduly restrictiveness or pressure on their children. The information released by AACAP has shown that the sufferer’s brain especially the part enabling them to reason, and control the impulse is always affected. According to various psychologists, this is why children with the disorder are not finding it easy identifying social cues from peers. The result is misinterpretation of interactions which fuels their temperament and blame game. The sufferers thus often see hostile intent even where none exists. This in turn affects their ability to manage stressors and to socialize.
A link has also been found between the kind of environment in which one is brought up and the possibility of the occurrence of the ODD. Such factors include dysfunctional family life, a family history of mental illness and substance abuse. Another factor which is of great importance here is inconsistent discipline by parents. Noting that the defiant behaviors relating to the disorder can be learnt and that the child looks to those around him/her as the models, a child in such an environment can easily slowly contact the disorder. AACAP has stated that lack of structure, inconsistent discipline practices, and exposure to abuse or violence are potential causes of the disorder.
Symptoms of the Disorder
It is usually challenging to identify the difference between a strong willed or emotional child and one with the disorder. This is because to an extent, the oppositional behaviors are expected at certain stages of a child's development. However, it is argued that if such oppositional behaviors goes beyond six months and are clearly disruptive to the family or school environment then the child would possible be suffering from the disorder.
Generally ODD is characterized by behaviors such as negativity, defiance, disobedience and often hostile behavior towards adults and authority figures. Such behaviors might cause the child to regularly and consistently show symptoms which are useful indicators of the disorder. The symptoms include losing one’s temper, involving oneself in argument with adults with an ill motive and actively defying the rules set by adults. The sufferers of the disorder also deliberately do things that will annoy other people as well as blaming others for the mistakes they have done. The negativistic and defiant behaviors are expressed by such behaviors as consistent stubbornness and unwillingness to compromise.
Manifestations of the disorder are best expressed when the patient is at home. It is therefore better to observe the progress of the suspected individuals’ behavior in the home setting and not at school or in the larger community. It is also advisable for the researches to study the victims during their interaction with adults or their peers especially those who are well known to them. Apart from these usual symptoms, the disorder often occurs along with other behavioral and mental health problems. These include the Attention-Deficit/Hyperactive Disorder (ADHD), Anxiety Disorder and the Depression Disorder. Others like the Learning Disorder and Substance Abuse Disorders may also be common with the sufferer.
The Prevalence of Oppositional Defiant Disorder
Generally it is believed that sixteen percent of any given population suffers from the disorder. Studies have shown that around one in every ten children under the age of 12 years are thought to have ODD. The probability is always higher for boys than for girls by two to one. As stated above, it is common for the sufferers of the disorder to also be diagnosed with ADHD. Studies have shown that between 35 and 50 percent of those with ADHD also has Oppositional Defiance Disorder.
Studies have also shown that the disease is common among the school age children affecting around 20 percent. However, such percentages differ depending on a person’s definition of what a normal childhood behavior and a defiant behavior is. Such definitions vary across races, cultures, and even gender. The behaviors related to the disorder usually starts to manifest at the age of 8 though sometimes it may start even much earlier during the preschool years.
The Current Theories/Approaches to the Treatment of Oppositional Defiant Disorder
Treatment for ODD majorly focuses on therapy and training because medications are not the primary treatment. The types of therapy that are normally used to prevent or treat the disorder include parent training, individual and family therapy, cognitive behavioral therapy, and social skills training. It must however be noted that any successful treatment requires the cooperation of those close to the patient. Early intervention and treatment is recommended to avoid the situation of the children from getting worse especially in their later stages of life (Matthys & Lochman, 2010).
Parenting Training Programs
Formal training programs have been designed to equip the parents with necessary strategies of managing their children and adolescents’ behavior. Parents are taught more positive and less frustrating ways of parenting to ensure that they do not frustrate the patients further. The training specifically focuses on the useful approaches to dealing with both the children and the adolescents with ODD. Parents are also taught how to negotiate with their children while also improving their children’s behavior through such techniques as positive reinforcement. The trainings enable the parents to establish more effective and consistent discipline methods.
The first approach includes the individual and family therapy. The individual therapy seeks to provide the victims of the disorder with forums in which they can explore their feelings and behaviors with a neutral therapist. The individual therapy also seeks to equip the sufferers with the necessary anger management skills. This enables the defiant individual to slowly correct their defying behavior. The patients are also equipped with skills that are useful in finding solutions to the usual problems facing them as well as enabling them to improve on their interpersonal relations. During the therapy, medications for depression and anxiety may also be given if deemed fit by the therapist.
Family therapy is recommended to help address the problems related to family interactions. The therapy specifically seek to modify the way the family is structured, the strategies employed by the family in handling difficulties and the ways in which parents reward mistakes. The program may also address stress related issues affecting children and adolescents with ODD. In case of a child, the therapist may recommend Parent Child Interaction Therapy (PCIT). This approach equips the parents with more effective parenting techniques which help improves the quality of the parent child relationship.
The second approach is the cognitive-behavioral training which is also called cognitive problem solving training. The main goal of the therapist here is to help patients control their aggression. This enable them change their social behavior. The patients are rewarded for any transformation in behavior to encourage them to change further. Studies have shown that cognitive therapy can help the patients of the disorder to improve on their level of self control, self guidance and problem solving strategies. The approach utilizes collaborative problem solving in which the parent works together with the child to come up with the solutions that work for both of them.
The third approach is the social skills training. It is usually done together with therapy to make the process more effective in helping the sufferers change their behaviors. It also involves the use reinforcement strategies such as behavior rewards to help a teenager to learn and maintain positive behaviors. Such trainings should be provided in the sufferers’ natural environment to help them apply what they learn directly to their lives.
A part from these trainings, parents have also been advised to: give effective time-outs with their children, avoid power struggles with them, they should also remain calm and unemotional even in the face of opposition by the sufferers. Parents should also offer acceptable choices to their children by giving them certain amount autonomy. It is also recommended for parents to have certain activities that they do together with their children. Parents must live knowing that they are their children’s role model.
The last approach to the treatment of the disorder is medication. This approach is only recommended when the symptoms of the disorder occur alongside other conditions. The conditions that may warrant treatment approach include the presence of ADHD, anxiety and/or depression. This is because there is no medication for treating symptoms of ODD. Medication can therefore only be ministered when there is another emotional or behavioral disorder accompanying the ODD.
In conclusion, it is clear that more research need to be done to establish the causes, prevention and treatment of the disorder. As things stand an individual may develop to a worse condition without the knowledge of the people around him or her. With the current increase of those contacting the disease, the situation should never be allowed to remain the same.