Conduct Disorder/Oppositional Defiant Disorder

Oppositional defiant disorder

ODD, is a milder form, and sometimes a precursor to conduct disorder. In contrast to children with conduct disorder, the behavior of children with ODD does not involve serious violations of others' rights. It does, however, impair the child's family, academic and social functioning.

Children with ODD show extreme levels of argumentativeness, disobedience, stubbornness, negativity, and provocation of others. While such behavior can be true of most children at some point of their lives, this diagnosis is warranted only for the few children (3-4%) whose symptoms persist over months or years, occur across many situations, and result in pronounced impairment in their functioning in home, school, and peer settings. These children's anger is usually directed at authority figures. These children are more willing to lose a privilege than to lose a battle, so discipline by withholding privileges often has no effect on their behavior. It is the oppositional struggle which becomes the reality in this child's mind, and this struggle, unlike the typical lower level defiance seen in many children, basically takes over the child's life and relationships with others. For example, while "temper tantrums" are common among children, frequent and very prolonged temper tantrums (3-4 hours) often characterize children with ODD.

Conduct disorder

Children with conduct disorder, CD, are those children who show persistent and serious patterns of misbehavior. Not only may they indulge in frequent temper tantrums like ODD children, but they may violate the rights of others (stealing, vandalism, and aggression). These children are actively aggressive towards people (fighting with siblings and peers, sexually aggressive) and/or animals (engage in animal torture), commit vandalism, lie and steal from persons outside the home, and seriously violate society's moral codes.

Children who are diagnosed with CD and who have a higher IQ are easier to treat, but are more imaginative and creative in acting out and evading detection. Some youngsters who have conduct disorder may have a learning disability and lower average verbal skills. These kids have low self-esteem, become impatient easily, and seem reckless and accident-prone. Unfortunately, children and adolescents with CD do not show remorse unless it is to lessen their punishment. In fact, they enjoy telling about what they have done.

WHAT CAUSES ODD and CD?

More research needs to be done into the causes of both ODD and CD. However, a genetic vulnerability, especially combined with environmental "triggers" (family histories of disruptive behavior disorder, antisocial personality disorder, mood disorders, or substance abuse; permissive, neglectful, harsh or inconsistent parenting; and poverty) seem to be causes for some children. With CD, studies have also shown that both identical twins are more likely to have conduct disorder than fraternal twins. Adoption studies have shown that the risk increases when both adoptive and biological parents have conduct disorder (antisocial personality disorder in adults).

Lastly, studies have indicated that impairment in frontal lobe and low serotonin levels may also be factors in causing CD.

DIAGNOSIS

After interviewing the child, family, teachers, etc., the mental health practitioner should study the course of the child's development, especially through school records. Particular attention should be paid to any oppositional or aggressive behavior that is not age appropriate.

ODD.
For a diagnosis of ODD, a pattern of negative hostile defiant behavior which has persisted for at least six months must be established. Such behavior would include frequent episodes in which the child:

• loses his/her temper
• argues with adults
• actively defies or fails to comply with adult rules
• intentionally annoys people
• blames others for their own mistakes/misbehavior
• touchy or easily annoyed
• angry or resentful
• spiteful or vengeful

As a result of the behaviors listed above, the child shows significant impairment in social and academic functioning. It must also be confirmed that the behavior has not occurred in the course of psychotic or mood disorder.

CD.
To make a diagnosis of conduct disorder, it must be established that the child has shown at least three major symptoms in the last three months with one of the symptoms having occurred in the last six months. These symptoms must have occurred in various settings. The behavior must cause significant impairment in the child's social or academic life.

The symptoms of conduct disorder include:

• aggression toward people/animals
• destruction of property
• deceitfulness/theft
• serious violation of age-appropriate rules

Conduct disorder usually occurs with another disorder, so the mental health specialist will also look for other co-occurring disorders, such as Attention Deficit/Hyperactivity Disorder (this occurs in 25% of children with conduct disorder).