Oppositional defiant disorder
Classification & external resources
| ICD-10 |
F91.3 |
| ICD-9 |
313.81 |
Oppositional Defiance Disorder is a largely disputed 'mental illness' characterized by an ongoing pattern of disobedient, hostile, and defiant behavior toward authority figures that goes beyond the bounds of normal childhood behavior.
When a child cannot seem to control his or her anger or frustration, even over what seems to be trivial or simple to others, the child will often react in violent or negative ways to his own feelings.
In its basic form, Oppositional Defiance Disorder has specific criteria, according to the DSM-IV-TR, the diagnostic manual of mental disorders. The defiance must interfere with the child’s ability to function, first of all, either in school, home, or the community. Secondly, the defiance cannot be happening just because of another problem, such as depression, anxiety, or the more serious Conduct Disorder. Third, the child’s problem behaviors have been happening for at least six months. Although these behaviors are quite typical amongst teenagers and children, the diagnostic criteria for this disorder are as follows:
- Losing temper
- Arguing with adults
- Refusing to follow the rules
- Deliberately annoying people
- Blaming others
- Easily annoyed
- Angry and resentful
- Spiteful or even revengeful
If the child meets at least four of these criteria, and they are interfering with the child’s ability to function, then he or she technically meets the definition of Oppositionally Defiant.
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Contents
- 1 Treatment
- 2 Criticism
- 3 See also
- 4 External links
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Treatment
In a clinical setting, typical treatment begins with a careful assessment. Assessment requires that a professional therapist must first of all take a psychological history and develop a family genogram, which is a rough picture of the family, similar to a family tree. This serves to put relationships and resources into perspective. Next, the therapist asks questions and listens to the parent and child describe what is going on with the child. This is known as the presenting problem. Experienced therapists will be interested in exceptions to the problem, or times when the child is not defiant, and why that may be. There will also be questions about parenting style, starting back when the child was a baby, as well as school, typical family schedules and routines, and ways that conflict is managed. The clinician will try to rule out another mental illness first, in order to focus the right amount of energy and direction on treating the defiance. Other questions will help to fill in the background necessary to get started. This initial assessment might take about 30 minutes, but is often longer.
The next step is to lay out a treatment plan. This might take a couple of sessions. There are several effective and research-proven ways to treat defiance, but the most effective and research-driven technique is a combination of Parent Management Training and an individualized Behavioral Modification Plan. Although each family is treated uniquely, there are certain qualities to this approach that are the same. With Parent Management Training, most of the energy and work with the therapist is directed at the parents, emphasizing new ways to manage the child. The Behavioral Modification Plan will outline rules of the home and society. It will also include rewards the child can earn for following the rules, and consequences associated with breaking the rules. In those consequences, there will be specific steps to follow to make sure the child is held accountable, learns from mistakes, and is ultimately successful.
Eventually, there will be progress, until the child understands that following the rules is a necessary part of life. Although it is possible to complete this treatment program alone, success is almost always more likely with the help and close support of a professional clinician experienced in the use of Parent Management Training and behavioral modification. Typical treatment of moderate to severe defiance requires four to five months. Several visits are usually necessary to get background and rule out other concerns, explain the process, answer questions, and get ready. At least one visit is necessary to develop and practice the Behavioral Modification Plan. The intensive treatment that follows usually involves two or three weeks in itself. The “maintenance phase” afterward can last from a month or two to six months, although most families are very happy with the results within six weeks, and termination, the final phase, is just one visit.
Criticism
Some critics have taken the view that at least some behaviour diagnosed as mental illness is in fact a mentally healthy reaction to circumstances of life or unreasonable behavior of parents or other authorities.
See for example
- Drapetomania - a supposed mental disorder suffered by slaves which caused them to want to run away.
- Sluggishly Progressing Schizophrenia, another supposed mental illness, affecting political dissidents in the former Soviet Union.
