Oppositional Defiant Disorder During Childhood-Adolescent

Oppositional Defiant Disorder During Childhood-Adolescent Research Paper
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Childhood defiance is an inevitable phase of a person's growth. It should be noted that many oppositional behaviors manifest in children aged between 18 and 24 months and attain their definitive thresholds by the age of 3 years. The condition manifests as a pathological occurrence that incorporates abnormal levels in terms of severity or continuity, and its prevalence becomes increasingly significant. This implies that the disorder is pathological when not linked to a child's age or developmental conditions. When these behavioral tendencies repeatedly become overwhelming, they are termed oppositional defiant disorder (ODD). ODD constitutes one of the most prevalent clinical problems in adolescents and children. The disorder is classified into the disruptive behavioral disorder category. The paper argues that ODD's symptomatology is categorized into irritable/angry mood, defiant/argumentative behavior, as well as vindictiveness. The etiology includes sociological, psychological, physiological, and developmental constructs that cause the disorder. It is also established that the gold standard interventions for ODD include patient management training (PMT), school-based interventions, and pharmacologic therapy.
Definition of ODD
Based on the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5), Fooladvand et al. (2021) defined ODD as an adverse, constant trend of aggravation, hostility, rebellions, and disobedience against those in positions of influence or power. ODD is a kind of childhood disruptive behavioral tendency that mainly entails issues with controlling one's behaviors and emotions. According to the DSM-5, persistent irritable or angry mood trends, vindictiveness towards others, or defiant or argumentative behavior constitute ODD's primary feature (Aggarwal & Marwaha, 2022).
Psychologists hold that many factors are attributed to the development of ODD's consistent patterns, including learned, biological, and mood factors. Risk factors for aggressive or hostile behavioral tendencies in adolescents include abusive behaviors during childhood, such as sexual abuse, physical abuse, emotional abuse, and negligence, as well as highly rigorous, punishment-based training. In this vein, the American Psychiatric Association's DSM-5 categorizes ODD into three classifications: irritable/angry mood, defiant/argumentative behavior, as well as vindictiveness (Fooladvand et al., 2021). These dimensions are increasingly interrelated, implying its symptomatology can be defined as one diagnostic construct with the categorization simply reiterating the argument that different patterns of clinical manifestations may offer clinically relevant information. This notion is anchored on rationales of various associations between these categorizations as well as other kinds of dysfunction. For instance, the irritable/angry categorization is increasingly linked to mood/anxiety disorders, whereas the headstrong/defiant categorization is closely associated with attention deficit hyperactivity disorder (Hawes, 2014). Again, the vindictive/spiteful dimension is closely linked to callous and insensitive attributes (Greydanus & Dickson, 2022)
Signs and Symptoms
The signs and symptoms of ODD can be explained via the DSM-5 diagnostic criteria. A trend of irritable/angry mood, defiant/argumentative behavioral tendencies, or vindictiveness which lasts for at least six months as supported by a minimum of four clinical manifestations from any of the categories delineated below, as well as demonstrated during interactions with at minimum one person who is not a family member or instead sibling (American Psychiatric Association, 2013). The irritable or angry mood symptomatology includes the adolescent/child typically losing their temper, he or she is easily annoyed or habitually touchy, and becoming increasingly resentful and angry. With respect to defiant/argumentative behavior, at least four of the following symptoms are noted: primarily argues with those in authority, including adults, adolescents, and other children; mostly actively refuses or defies to adhere to requests by those in authority or with rules; mostly annoys others deliberately; and mostly blames other people for her or his misbehavior or mistakes. Regarding vindictiveness, the child or adolescent should have been vindictive or spiteful at least twice within the previous six months. It should be noted that the frequency and persistence of such behavioral tendencies are employed to differentiate a behavior within acceptable limits from one which is increasingly symptomatic. For kids below the age of five years, the behavioral tendency must happen on a great deal of the days for a timescale of six months at a minimum unless otherwise specified. For persons engaged five years and above, the behavior must happen at minimum once a week for a timescale of six months unless specified otherwise (Ogundele, 2018; American Psychiatric Association, 2013). Whereas the frequency criteria offer guidance on the lowest frequency threshold to delineate the symptoms, other factors are also to be considered, including the if the intensity and frequency of the behavioral tendencies are not within the normative range based on the child or adolescent development stage, culture, and gender (American Psychiatric Association, 2013).
In addition, the behavioral disturbance is linked to undesirable health outcomes in the child/adolescent or others within their social environment (for example, peers, siblings, or other family members). The behavioral nuisance also negatively affects the adolescent’s or child’s learning, social interactions, and other crucial dimensions of normal functioning. Furthermore, the behavioral tendencies do not happen completely when the individual is struggling with psychotic, depressive, bipolar disorder, or substance usage problems. The criteria are also not satisfied for disruptive mood dysregulation disorder (Ogundele, 2018; American Psychiatric Association, 2013). With respect to severity, ODD is termed mild when clinical manifestations are limited to a specific setting, moderate when there are at least two contexts, and severe when the manifestations are noted in three or more contexts (Aggarwal & Marwaha, 2022).
ODD clinical manifestations should also be addressed in individuals without the disorder, and several crucial points concerning whether the behaviors constitute ODD manifestations can be derived. First, the diagnostic criteria of four or extra clinical manifestations within six months should be addressed, and second, the frequency and continuity of the symptoms should extend beyond what is termed normal based on culture, sex, or age. In this vein, the signs and symptoms of ODD are typically part of a trend of problems interacting with others (Fooladvand et al., 2021). Moreover, individuals struggling with ODD normally do not view themselves defiant, angry, or disobedient (Fooladvand et al., 2021; Eskander, 2020). Other traits related to ODD diagnosis are that the disorder is increasingly prevalent in adolescents and children from families where there were disruptions in caregiving because of caregiver substitution or in families where the child experienced violence, negligence, or instability (Suwanee, 2019). Symptomatology in ODD patients also relates to family settings, as younger children view their parents or guardians as owners of power. In contrast, adolescents typically view teachers, parents, and other adults are power owners. Nevertheless, the prevalence of symptoms constitutes a strong indicator of the disorder's severity. ODD symptoms could be constrained within a limited locale which is normally called home (Fooladvand et al., 2021). Individuals that show enough clinical manifestations to satisfy the diagnosis criteria, even when they are within the home environment, could be increasingly disadvantaged within their social dimension.
In severe instances, the clinical manifestations present in a wide range of situations. Considering that the symptoms indicate the disorder's severity, the person's behaviors must be evaluated in a wide range of situations. Since those behavioral tendencies are common when interacting with siblings, it is important to observe them when the child interacts with individuals other than his or her siblings. Furthermore, since the clinical manifestations of ODD are typically presented when the child interacts with peers or adults whom they are conversant with, they may not be clearly manifested during a clinical assessment. In chronic thresholds, an individual with ODD usually experiences problems when interacting with others or sustaining interpersonal relationships as well as academic performance. Children struggling with ODD also reject classmates and peers and could be alone and isolated. Despite their level of intelligence, children or adolescents struggling with ODD may demonstrate poor academic competencies due to a lack of effective participation and failure to cooperate with others in the classroom. The poor academic skills could also be attributed to failure to accept assistance from others. These problems contributed to deteriorated self-esteem levels in the child. The child also becomes depressed, presents anger explosions, and is unable to tolerate failure. ODD also predicts diverse compatibility issues (Fooladvand et al., 2021). Compatibility constitutes an alteration in cognitive processes or behavioral tendencies, allowing people to adaptively cope with shifts in their competencies (Fooladvand et al., 2021).
Developmental/Physiological/Psychological/Sociological Factors Underlying ODD Causation
It should be noted that ODD etiology remains increasingly complex and typically emanates from the interplay between psychological, developmental, sociological, and physiological factors. ODD heritability is roughly 50 percent, and significant genetic commonality exists with conduct disorder (CD) (Aggarwal & Marwaha, 2022). Also, genetic implications underlie the link between Attention-deficit/hyperactivity disorder (ADHD) and ODD. Gene-context interactions also prove to be increasingly significant in ODD development. For example, individuals with a low activity threshold of the neurotransmitter-processing enzyme monoamine oxidase A and who experienced abuse in childhood have higher chances of developing hostility and conduct problems in development. In addition, alterations in cortisol thresholds and neuroimaging results (especially of the insula, amygdala, and prefrontal cortex) appeared to play a central part in the development of ODD (Aggarwal & Marwaha, 2022).
Environmental and psychosocial factors also contribute to the development of ODD. Childhood mistreatment and harsh, incoherent parenting are normally noted factors in families with adolescents and children struggling with ODD. Temperamental traits, including poor frustration, impulsivity, irritability, and high emotional reactivity levels, are typically linked to ODD (Pisano & Masi, 2020; Aggarwal & Marwaha, 2022). Whereas not all adolescents and children with ODD demonstrate unemotional and callous behavioral ...