6 days ago
#HEALTH: Is your child's defiance a disorder?
ALEX (not his real name) started displaying disruptive behaviour at school when he was 10 years old.
It gradually got worse over the course of a year, with frequent arguments with peers, anger and provocative behaviour, and marked defiance - particularly towards his parents and certain teachers.
At school, he would often skip classes and hide in secluded areas to read comics or sleep, especially when he had lessons with teachers he disliked. At times, he would skip school altogether to play video games at a nearby arcade.
As a result, he received multiple warnings and was even temporarily suspended from school.
Following the recommendation of his school counselor, Alex was finally brought in for a psychiatric assessment.
His home environment was already challenging enough. His parents had longstanding marital conflicts which often resulted in loud arguments and episodes of domestic violence.
During these times, his mother would sometimes leave the house with his two younger sisters, leaving Alex to fend for himself. Alex does not have a positive relationship with either of his parents.
At home, when scolded or shouted at, he often reacts by shouting back, pushing his parents, or damaging household items before storming out.
Eventually, he started sneaking out at night to spend time with older teenagers in the neighbourhood and started experimenting with vaping and smoking.
Alex recently lost his grandfather, who had been a stable and consistent adult in his life and a major source of emotional support. He is grieving the loss deeply, but his emotional needs have largely gone unnoticed by those around him.
Alex presents as an angry and resentful, yet bright and emotionally sensitive boy. He appears misunderstood by many of the adults around him, and his grief and emotional struggles remain unaddressed.
Alex's behaviour is not your usual run-of-the-mill adolescence rebellion, but one that reflects Oppositional Defiant Disorder (ODD) explains Prince Court Medical Centre child and adolescence psychiatrist Dr Norharlina Bahar.
ODD is a behavioural condition marked by a consistent pattern of angry or irritable moods, argumentative or defiant behaviour, and/or vindictiveness lasting at least six months, she explains.
Individuals with ODD often lose their temper, are easily annoyed, and feel resentful. They argue with authority figures, defy rules, refuse to comply, blame others for their mistakes, and may deliberately provoke people.
"Spiteful or vindictive behaviour is also common. These behaviours occur more often than expected for the individual's age, gender, and cultural background, and cause significant problems in social and academic functioning."
AN ONGOING CHALLENGE
Symptoms may be present in only one setting, most commonly at home, adds Dr Norharlina. In more severe cases, symptoms appear across multiple environments.
"Individuals with ODD typically struggle with relationships but often do not recognise their behaviour as problematic, viewing it instead as a justified reaction to perceived unfairness."
It can be challenging to determine whether the behaviour is the root of family problems or a response to external factors such as harsh, inconsistent parenting or a neglectful environment.
ODD is primarily diagnosed in children and adolescents, says Dr Norharlina.
When similar behaviour patterns appear in adults, other conditions, such as personality disorders, may be considered.
Children don't misbehave on purpose, she explains. Their challenging behaviour is often a response to stress, emotional struggles, or difficult environments.
Some defiance is also a normal part of development. While ODD does not have a single known cause, it can run in families, although no specific genetic pattern has been identified.
It usually results from a combination of biological, psychological, and social factors. These may include a family history of mood, behaviour, or substance use disorders.
"Harsh, neglectful, or inconsistent parenting can increase the risk, especially when combined with a strained or distant parent-child relationship," warns Dr Norharlina.
Children exposed to trauma or major life disruptions (such as divorce, loss) may also develop oppositional behaviours as a way of coping.
In addition, living in an unstable or hostile household with ongoing conflict can create a sense of insecurity, further increasing the risk of defiant behaviour.
Difficulties in peer relationships or ongoing challenges in forming healthy friendships can worsen symptoms, especially when combined with family stress.
ODD can occur in families from any background and it often co-occurs with conditions such as AttentionDeficit/Hyperactivity Disorder (ADHD), conduct disorder, anxiety, or mood disorders.
In teenagers, depression or low mood is frequently seen alongside behavioural difficulties.
Generally, ODD affects about 3.3 per cent of children worldwide, says Dr Norharlina.
It is more common in children than in teens and typically begins in early childhood with symptoms becoming less noticeable as children grow older, although some teens may still have symptoms.
IS IT ODD?
A DIAGNOSIS of ODD is made after a comprehensive history, clinical, and psychological evaluation of the child and family. Assessment also includes screening for commonly associated conditions such as ADHD, anxiety, and mood disorders.
But how do we make the distinction between the usual hormone-driven anger issues and rebellion versus ODD?
All children display defiant behaviour at some point, especially when tired or stressed, explains Dr Norharlina.
ODD is in fact normal in toddlers and in early adolescents. However, the behaviour of a child with ODD is much more extreme and disruptive than normal, and occurs much more frequently.
"It is persistent and occurs across many situations and interferes with the child's social, family, and educational life."
A teenager with ODD will exhibit ongoing negative, hostile, and defiant behaviour that interferes with daily life at home, school, and in social settings. It is marked by frequent anger, irritability, arguing, defiance, and vindictiveness toward authority figures.
"They often argue with adults, deliberately annoy others, blame others for their actions, and may act in a spiteful or vindictive way."
If ODD is untreated - especially in more severe cases or when combined with other conditions like Conduct Disorder, ADHD, or mood disorders, the behaviour can escalate over time.
While not all children with ODD become violent, some may develop more serious behavioral issues, including aggression, property destruction, or criminal behavior, particularly during adolescence.
GETTING HELP
Early intervention, consistent structure and support, and appropriate therapy can greatly reduce this risk and improve long-term outcomes.
Since children with ODD often don't recognise that their behaviour is a problem, it is usually the responsibility of parents to seek help, says Dr Norharlina.
A combination of therapies is most effective, she adds. This typically includes behavioural therapy, family therapy, parent training, and in some cases, medication.
The main goals of treatment are to rebuild the parent-child relationship, help parents understand the underlying reasons behind the child's behaviour, and teach them effective strategies for managing it.
"Early intervention is important as starting treatment early greatly increases the chances of preventing ODD from progressing into more serious issues such as conduct disorder, mental health problems, or involvement in criminal behavior," says Dr Norharlina.
With the right help, many teens who are labeled "difficult" or "problematic" can improve significantly and go on to lead healthy, functional lives.
*Having frequent temper tantrums
*Arguing a lot with adults
*Refusing to do what an adult asks
*Always questioning rules and refusing to follow rules
*Doing things to annoy or upset others, including adults
*Blaming others for the child's own misbehaviors or mistakes
*Being easily annoyed by others
*Often having an angry attitude
*Speaking harshly or unkindly
*Seeking revenge or being vindictive
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