Garcia, Christelle Guiang, Abegail Jerez, Rizzia Oppositional Defiant Behavior

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Garcia, Christelle Guiang, Abegail Jerez, Rizzia Oppositional Defiant Behavior

Description
Oppositional defiant disorder (ODD) is a diagnosis described by the Diagnostic and Statistical Manual of Mental Disorders (DSM) as an ongoing pattern of anger guided disobedience, hostilely defiant behavior toward authority figures which goes beyond the bounds of normal childhood behavior. Children suffering from this disorder may appear very stubborn and often angry.

Manifestations
The child displays signs of ODD instead of normal moodiness if the behaviors:

Are persistent Have lasted at least six months Are clearly disruptive to the family and home or school environment

The following are behaviors associated with ODD:


Negativity Defiance Disobedience Hostility directed toward authority figures

Causes
There's no known clear cause of oppositional defiant disorder. Contributing causes may be a combination of inherited and environmental factors, including:

A child's natural disposition

Limitations or developmental delays in a child's ability to process thoughts and feelings Lack of supervision Inconsistent or harsh discipline Abuse or neglect An imbalance of certain brain chemicals, such as serotonin

Risk factors
ODD is a complex problem involving a variety of influences, circumstances and genetic components. There's no single factor that causes ODD. Possible risk factors include:

Being abused or neglected Harsh or inconsistent discipline Lack of supervision Lack of positive parental involvement Having parents with a severely troubled marriage Parents with a history of ADHD, oppositional defiant disorder or conduct problems Financial problems in the family Family instability such as occurs with divorce, multiple moves, or changing schools or child care providers frequently

Diagnostic Criteria
DSM IV - TR A. A pattern of negativistic, hostile, and defiant behavior lasting at least 6 months, during which four (or more) of the following are present: (1) often loses temper (2) often argues with adults

(3) often actively defies or refuses to comply with adults' requests or rules (4) often deliberately annoys people (5) often blames others for his or her mistakes or misbehavior (6) is often touchy or easily annoyed by others (7) is often angry and resentful (8) is often spiteful or vindictive Note: Consider a criterion met only if the behavior occurs more frequently than is typically observed in individuals of comparable age and developmental level. B. The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning. C. The behaviors do not occur exclusively during the course of a Psychotic or Mood Disorder. D. Criteria are not met for Conduct Disorder, and, if the individual is age 18 years or older, criteria are not met for Antisocial Personality Disorder.

Management
Treatment for ODD is determined based on many factors, including the child's age, the severity of symptoms, and the child's ability to participate in and tolerate specific therapies. Treatment usually consists of a combination of the following:

Psychotherapy : Psychotherapy (a type of counseling) is aimed at helping the child develop more effective coping and problem-solving skills, and ways to express and control anger. A type of therapy called cognitivebehavioral therapy aims to reshape the child's thinking (cognition) to improve behavior. Family therapy may be used to help improve family interactions and communication among family members. A specialized therapy technique called parent management training (PMT) teaches parents ways to positively alter their child's behavior. Behavior management plans also often involve developing contracts between

parent and child that identify rewards for positive behaviors and consequences (punishments) for negative behaviors.

Psychosocial treatments: One of the key factors in the development and maintenance of the negative behaviors associated with ODD symptoms is reinforcement, whether intentional or not, of the unwanted behaviors. The most effective way of treating disruptive behavior disorders is behavioral therapies. Behavioral therapy for children and adolescents focuses primarily on how to prevent problematic thoughts or behaviors from accidentally getting reinforced unknowingly within a young person's environment. Positive reinforcement often unintentionally contributes to an increase in the frequency of ODD behaviors. Behavior therapies can be applied to a wide range of psychological symptoms among children, adolescents, and adults with ODD. Behavior therapists encourage children and adolescents to try new behaviors and not to allow unwanted reinforcement to dictate the ways in which they act. Furthermore, therapists may work with parents to discontinue ways in which they are unintentionally reinforcing unwanted behaviors.

Medication : While there is no medication formally approved to treat ODD, various drugs may be used to treat some of its distressing symptoms, as well as any other mental illnesses that may be present, such as ADHD or depression.

Nursing Management 1. Promote clients ability to engage in satisfying relationships with family members and peer group. 2. Facilitate parents development of effective means of coping with and interventions for their childs behavioral symptoms. 3. Participate in the development of a comprehensive, ongoing treatment approach using family and community resources.

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