More Effects of ODD, Diagnosis and Treatment.
Other effects of ODD on a young person include stress and anxiety as the young person is always getting into one trouble or the other, at home and in the school. At adolescence, young people with ODD are more likely than their peers to experience arrest and serve jail terms as they usually engage in violent behaviours and other activities that put them in conflict with the law, such as physical assault, rape, economic fraud, stealing and armed robbery. The life of a young person, especially an adolescent with ODD is socially and emotionally difficult as he has to battle with rejection from all quarters. This rejection together with personal inadequacies, such as poor academic performance or failure to acquire vocational skills, impact negatively on his self- worth and self esteem. The result is that the young person gets to a point where he feels irrelevant and out of place in the society.
This could lead to frustration, hopelessness, depression, substance use and addiction, suicide ideation , self harming behaviour and suicide. Some young people at this point, may experience a heightened sense of vengeance and engage in extremely violent behaviours, such as murder and terrorism. This is more common among those who have suffered childhood sexual abuse, severe physical abuse, extreme parental neglect and deprivation as well as those who have been publicly humiliated or disowned by their families. This category of young people may feel they have nothing to protect.
Oppositional defiant disorder has been identified as a risk factor for the development of other psychological disorders such as conduct disorder, antisocial personality disorder, substance abuse, social media addiction, addiction to sex and other forms of obsessive compulsive disorder. Adolescents with ODD may suffer psychosomatic symptoms such as diarrhea, insomnia and aches. Generally, the relationship of a young person with ODD is characterised by conflicts due to lack of sensitivity to others’ needs and values. The young person with ODD has no respect for other people’s personal boundaries. These attitudes could have adverse effects on the future family life of the young person, by increasing their susceptibility to failed relationships, dysfunctional marriage, separation and divorce.
As the young person with ODD enters into adulthood, he may lack the confidence to enter into the world of work as he may have failed to obtain the minimum academic requirement or vocational preparedness needed to function effectively in a competitive labour market. Young adults with ODD who are fortunate enough to secure jobs may have a hard time sustaining their jobs due to lack of respect for professional and organisational ethics. They are more likely than others to disrespect their superiors, undermine established protocols, lead agitations and less likely to meet deadlines.
How Prevalent is ODD?
About 10.2 % of the global population of children are said to suffer from ODD while 2%-16% of school age children have been reported to suffer from the disorder. Both boys and girls are affected by ODD though more boys (11%) than girls (9%) struggle with the disorder.
Diagnosis of ODD
Though some experts are of the opinion that there could be genetic or other biological causes of ODD, there has not been and there is currently no known laboratory test that can be used for the diagnosis of ODD. Medical examinations may be conducted to ascertain the existence or extent of ODD related medical conditions such as substance abuse and psychosomatic symptoms.
The diagnosis of ODD itself is based on psychological assessment and evaluation of a child suspected to suffer from ODD. The signs of ODD usually manifest in children before the age of 8. As recommended by the Diagnostic and Statistical Manual of Mental Disorder (DSM) 5th edition, these three conditions must be present before a child can be said to suffer from ODD.
- A consistent behavioural pattern of anger, irritable mood, argumentative behaviour, especially with parents and authority figures, defiant behaviour, vindictiveness. These symptoms must last for at least 6 months and at least, one of the symptoms must be displayed to someone other than family members. Also, the child must have acted spitefully, at least twice within the six month period.
- The behaviour is severe enough to disrupt the child’s normal functioning in terms of learning or interaction and it also causes distress for the child.
- The behaviour is not as a result of substance abuse or other mental health problems. The disorder may be mild ( presenting in only one setting, eg only home or only school). It may be moderate ( presenting in two settings, eg home and school) or severe (presenting in three or more settings)
Do Children Outgrow ODD?
Children do not ordinarily outgrow ODD as a result of biological growth alone. However, positive socialisation can have a positive effect on the disorder. Where the individual does not get help and continues to interact with peers that strengthen the disorder, the disorder could be carried into adulthood.
Treatment of ODD
Just as there is no medical diagnosis of ODD, there is currently no known medical treatment for ODD. Nevertheless, medical interventions may be included in the treatment plan of ODD to ameliorate certain medical conditions that usually result from the disorder, such as stress, depression, anxiety, substance abuse and psychosomatic symptoms.
The core treatment of the disorder itself is hinged on psychotherapy. Psychotherapy procedures for the treatment of ODD include Cognitive Behaviour Therapy ( CBT) focused on :
- helping the child to gain understanding of the problem and change faulty perceptions, such as the perception of being hated.
- helping the child to learn impulse control, anger management and improve problem solving and communication kills so that he/she would be able to express needs and feelings using socially healthy media rather than the use of violence or temper tantrums.
- treating related psychologal problems resulting from the disorder, such as low self-esteem, depression, anxiety substance abuse, social media addiction, addiction to sex or pornography and other obsessive compulsive behaviours.
Psychotherapy is also used to help parents and caregivers of the child to heal from psychological problems they may experience in the course of handling the child, such as stress, anxiety, anger, depression and guilt in some cases.
In addition, therapies, such as parent-child Interactive therapy( PCIT) help to improve the interaction dynamics between the child and the parents.
The treatment of ODD requires parenting training for parents and caregivers of the child, to help them understand the child’s problem and improve their parenting skills, so that they would be able to manage the child more effectively, rather than breaking the child due to frustration.
Individual and group counselling can be used to help young people with ODD and their parents.
What can Parents do to Help a Child with ODD?
- Come to terms with the problem – Accept that the child has a problem and that he/ she needs your help.
- Express your love and acceptance- Let the child be convinced that you love him /her as a person and that it is the behaviour that is the issue. Though young people with ODD usually give the impression that they are not interested in any one’s approval or affection, deep inside them, they yearn for acceptance and love, especially from their significant others.
- Focus on your goal of helping the child.
- Deal with your emotions and face the task. It is true that nothing can be more annoying or humiliating to a parent than being consistently opposed and resisted by one’s own child. In the course of my work, I have seen parents of young people with ODD breakdown and weep while expressing their deep hurts. Some young people with ODD get aggressive to the extent of assaulting their parents verbally or physically. Some go to the extent of stealing and selling their parents’ property in order to raise funds for drugs or just to punish their parents. There is no doubt that the pain caused by one’s child can sit deep. However, if you are going to help this child, you will need to first deal with your hurt, anger and bitterness. If you cannot handle this on your own, it is okay to get psychological help.
- Be optimistic about change- Never write off any child. I have seen children who were written off for bad behaviour change positively and become role models and the corner stones of their families. Be positive about your child’s ability to change and give the child the opportunity to achieve the change.
- Do not expect an automatic change- Remember that unlearning a bad behaviour is never automatic. It takes a gradual process. So, even when your child has commenced the process of therapy, some misbehaviours will surface occasionally. This does not mean that the child is not making efforts to change. Be patient with the child.
- Minimize factors that strengthen the behaviour. One of the things that strengthen ODD in adolescents, is attention from friends and their heroe worship of the young person with ODD, who usually and easily becomes the gang leader. Hence, a change of environment or school is usually recommended in severe cases of ODD, especially while therapy is on going or after therapy.
- Exercise your authority calmly but confidently- Avoid power struggle with your child. Your child will never be your parent no matter what. Even if you think you may have lost your authority along the way, do not betray your fear or struggle with your child to reclaim it. Nothing confuses a young person with ODD more than a calm response when the child expects you to explode. This does not mean that you will allow the misbehaviour to pass. Rather, it means that you are calm enough to decide on the best strategy you will apply in response to the misbehaviour. Pick up courage and take your place as a parent. You don’t have to shout, hit or threaten to disown your child in order to exercise your authority.
- Don’t Stop Caring- Some parents think they can improve their control over a young person with ODD by refusing to care for or provide for the child. This is usually counter productive as the young person at this point, may have established a strong network of support among the peers, who in most cases are usually also young people with questionable behaviours. The refusal of parents to care for young people with ODD makes it easy for them to explore criminal behaviours, such as stealing and armed robbery in order to survive.
- Do not indulge the child- Hold the child accountable for his actions. Set rules and limits with specific consequences. Explain them as well as the consequences of breaking them. Ensure that you follow up on this. Once rules are broken after explanations and warnings, do not allow any room for negotiation. Otherwise, the child will not take you seriously.
- Use healthy techniques rather than destructive punishments to discourage bad behaviour. Some of the healthy techniques include time out and withdrawal of certain privileges. Please, note that food necessary for survival and not a privilege that should be withheld from a child.
- Avoid verbal and physical abuse, public humiliation, locking out the child and threats to disown the child.
- Teach decision making skills – Let the child know that actions have consequences and that some of these consequences are inevitable. For instance, if your 6 years old pours his food on the floor in anger, let him tidy up the mess. Teach the real consequences of wrong behaviours and let them know that these consequences are far more severe than punishment.
- Teach healthy ways of communicating needs, anger and frustration instead of using temper tantrums.
- Teach resilience and problem solving skills so that the child would learn how to handle difficult situations without feeling frustrated easily .
- Establish a warm relationship that encourages dialogue with your child.
- Acknowledge and reinforce positive behaviours. Encourage the child’s efforts towards positive change no matter how insignificant such efforts may seem. This will enhance the child’s self- worth and self-esteem, and also increase his confidence in his ability to change.
- Ignore little mistakes while the child is making effort to Change. Do not make every mistake an issue.
- Get the services of a child psychotherapist.
I will like to conclude by sharing a question my son asked me when he was 6 years old. He had just used the convenience, and when he came out, he asked, ‘mummy, can you run away from your own feces? ‘ Confused about the question, I asked him to explain, and he said, ‘ I felt like running out because the stench was horrible but I had to endure it till I finished.’
Parenting a child, especially an adolescent with ODD could be a messy and an unbearably stinky experience. Yes, you want to run away from it but it remains your ‘mess’ . Hence, the only profitable thing is to complete the process of dealing with the problem. You can’t possibly run away from your child. Some people talk about disowning a child. Is it really possible to disown a child and never have a thought about the child? I guess not. So, instead of disowning a young person with ODD, the parent should accept the problem and face it by helping the child.
Dr. Rosemary Oshiomah Ogedengbe-Child Psychotherapist @ www.raphacounsellingnigeria.com.