Problem child – or child with a problem?

By Mieke Vlok
11 November 2016

If children are constantly rebellious and nothing is ever their fault, you may wonder whether they’re just naughty. But perhaps they have ODD.

In the 10 years she’d been taking her problem child to doctors and psychologists Stephanie de Kock* had never heard of oppositional defiant disorder (ODD).

But then she spotted something about the condition on the YOU SuperMom website and it seemed to provide quite an accurate description of her 13-year-old son, Stefan*, a child who rebels against authority figures and never accepts responsibility for his behaviour.

Whatever mischief Stefan gets up to, it’s never his fault. “It was a light bulb moment for me,” says Stephanie of Newcastle, KwaZulu-Natal.

“You feel as if you’re waging war daily and it’s encouraging to know there’s a possible reason for your child’s behaviour.’’

Stefan was a quiet, calm baby but by age three he’d started misbehaving, and it got worse every year. He was diagnosed with everything from hyperactivity to bipolar disorder and was on medication with little effect.

Even with strict house rules and punishment, Stephanie and her husband have been unable to control the elder of their two children. He’s aggressive at home and has hit his mother and grandmother. At school he’s constantly in trouble, either because he bullies other children or resists the teachers’ authority.

Read more: Smacking your kid? Here’s why you don’t need to “I have sat in my room ready to phone social services to beg them to just take him away,’’ Stephanie admits. “What am I doing wrong? Why does my child refuse to listen to me?’’ she would constantly ask herself. “Why am I struggling so with a child who’s on every medication under the sun?’’ But after hearing about ODD she has renewed hope that Stefan’s behavioural problems will finally be diagnosed and treated correctly. *Not their real names.

What is oppositional defiant disorder?

The condition was first recognised as a psychiatric disorder in 1980. In DSM-5, the latest edition of the Diagnostic and Statistical Manual of Mental Disorders – the handbook of the American Psychiatric Association (APA) – it falls under a new category of disruptive, impulse-control and conduct disorders and is grouped with conduct disorder and intermittent explosive disorder. Oppositional defiant disorder (ODD) is one of the most common disorders of its type. About three to 11 per cent of children worldwide suffer from it, Cape Town paediatric psychiatrist Dr Zanda Jaquire says. It’s more common in boys than girls, according to Professor Anneke Meyer, a neuro-behavioural scientist at the University of Limpopo.

What causes it?

Experts believe ODD is often the result of a combination of factors rather than having a single cause.

Biological Brain scans of children with the disorder show the frontal lobe of the brain is underdeveloped, neuro-behavioural scientist Professor Anneke Meyer says.

The frontal lobe controls emotional judgment ability, so threats of punishment or promises of reward have no effect on children with ODD.

When adults try to rein in the rebellious behaviour the children become angry and produce so much adrenaline they’re more inclined to fight than take flight, Cape Town paediatric psychiatrist Dr Zanda Jaquire says. That’s why they may become aggressive. Genetics Research has shown that certain mental disorders may be hereditary. Social environment The way in which children are raised can influence whether they develop a mild or serious degree of ODD. In a home where there are social problems such as alcohol abuse, physical abuse, divorce or inconsistency in the behaviour of parents the symptoms and behaviour of these children may be worse, Dr Jaquire says.

What are the symptoms?

Behaviour that points to rage and irritation The children are short-tempered.

Rebelliousness or challenging behaviour They don’t ask for permission from authority figures and struggle to accept responsibility for their behaviour. They often say it isn’t their fault or blame someone else. They’re especially rebellious towards authority figures.

Vengefulness They’re often malicious and bear grudges. Unhappiness Their behaviour makes ODD children tense and causes discontent in the family and at school, psychiatrist Dr Zanda Jaquire says. A negative attitude is common in such children, scientist Professor Anneke Meyer says. Impulsiveness The children act according to how they feel at a particular moment without taking into account the consequences for themselves or others, Cape Town educational psychologist Anel Annandale says.

How is ODD diagnosed?

It may be diagnosed if a child shows symptoms of ODD at least once a week for longer than six months and it’s so serious it occurs in more than one place – at home, at school or in their peer group, Cape Town paediatric psychiatrist Dr Zanda Jaquire says.

A psychiatrist who works in neuroscience or paediatrics should be able to make the correct diagnosis, Dr Jaquire says. A certain type of brain scan, functional magnetic resonance imaging (fMRI), can also show if a child suffers from ODD, neuro-behavioural scientist Professor Anneke Meyer says. For a child to be diagnosed with ODD the behaviour must not be consistent with other conditions such as attention deficit hyperactivity disorder (ADHD), obsessivecompulsive disorder (OCD) or other anxiety disorders, Dr Jaquire says.

How do children with ODD differ from those who are just naughty?

Their symptoms persist for six months or longer, while naughty kids are disobedient sporadically.

They begin displaying behavioural problems when they’re toddlers and they become worse when they reach puberty.

Read more: 3 things you should consider before you become a stay-at-home parent Children with ODD are more inclined to have problems with authority figures than with their peer group. Their bad behaviour is aimed mainly at people. For instance they don’t harm animals.

Can it be treated?

There’s no medication specifically for ODD but there is medication that can help to treat anxiety, lack of concentration and depression, scientist Professor Anneke Meyer says. But the solution never lies with medication alone, psychiatrist Dr Zanda Jaquire says. “A holistic approach must be followed by which the child receives a combination of medication and therapy. If they experience problems at school the issue must be raised there and parents must adapt their parenting style.”

What can I do as a parent?

Parents must be consistent with discipline, scientist Professor Anneke Meyer says. Instead of severely punishing bad behaviour at times then overlooking it at others they must always deal with disobedience in the same way. For instance, the child may not watch TV before they’ve finished their homework.

A trained therapist can help parents to work out how they can introduce a system of predictable and consistent discipline, psychiatrist Dr Zanda Jaquire says.

Read more: ‘I know I’m not supposed to say this – but I wish I had never had my children’

A psychiatrist or psychologist can help parents to identify “negative attention”, which reinforces the bad behaviour and encourages disobedience, and “positive attention”, which combats bad behaviour, psychologist Anel Annandale says.

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