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As parents, you may be irritated if your children always disobey your rules, talk back to you, have violent behaviours or even violate social rules. If you have tried change of parenting method but the problems still persist, there may be chances that your children are suffering from Oppositional Defiant Disorder, Conduct Disorder or other child and adolescent mental health problems.
Oppositional Defiant Disorder is a psychiatric disorder in childhood. A pattern of negativistic, hostile, and defiant behaviour lasting at least six months during which four or more of the following are present: often loses temper, often argues with adults, often actively defies or refuses to comply with adults' requests or rules, often deliberately annoys people, often blames others for his or her mistakes or misbehaviour, is often touchy or easily annoyed by others, is often angry and resentful and is often spiteful and vindictive. The disturbances of behaviours cause clinically significant impairment in social, academic, or occupational functioning.
This is a common psychiatric problem in children. Over 5% of children have this, and is more common in boys (Male: female ratio ~ 2:1). There are researches shown that about half of adolescents with aggressive behaviour can trace back to pre-school stages. And if the child displays aggressive behaviour at age 7, there is half chance that he/ she would continue to have this tendency in adolescence. No one knows for certain cause of ODD, but if parents are alcoholic and have been in trouble with the law, their children are almost three times as likely to have ODD. Moreover, poor parental-children relationship, parents’ emotional problem, children’s temperament, their activity level and developmental level, and the peer influence may also increase the chance of ODD.
Conduct disorder is more common in older children and adolescents. In some ways, conduct disorder is a worse version of ODD. They display repetitive and persistent pattern of behaviour in which the basic rights of others or major society rules are violated. At least three of the following criteria must be present in the last 12 months, and at least one criterion must have been present in the last 6 months. The criteria include: aggression to people and animals, often bullies, threatens, or intimidates others, often initiates physical fights, has used a weapon that can cause serious physical harm to others (a bat, brick, broken bottle, knife, gun), physically cruel to animals, physically cruel to people, has stolen while confronting a victim (mugging, purse snatching, extortion, armed robbery), destruction of property, has deliberately engaged in fire setting with the intention of causing serious damage, has deliberately destroyed other's property other than by fire setting, deceitfulness or theft, has broken into someone else's house, building or car, often lies to obtain goods or favours or to avoid work, has stolen items of nontrivial value without confronting a victim (shoplifting, forgery), serious violations of rules, often stays out at night despite parental prohibitions, beginning before 13 years of age, has run away from home overnight at least twice without returning home for a lengthy period, often skips school before age 13. And the above problem causes significant impairment in social, academic, and occupational functioning.
Some of the children with Oppositional Defiant Disorder may deteriorate and result in Conduct Disorder. A proportion of them would have co-morbidities such as attention-deficit/hyperactivity disorder, dyslexia, mood disorders (depression/ anxiety) or other disorders. Some of them may also have tendency of substance abuse or having trouble with the law.
The doctor will perform a psychiatric assessment by gathering history from the children/ adolescents and their parents, doing a mental state examination, or using a special rating scale to formally diagnose Oppositional Defiant Disorder/ Conduct Disorder according to international diagnostic criteria. The treatment aims at improving the relationship between the children/adolescents and their parents, such as parenting skill training, family therapy or individual counselling to the children/adolescents. Medication cannot improve disruptive behaviours directly. However, if the children have other co-morbidities such as attention-deficit/ hyperactivity disorder; or the aggressive behaviours were so severe, medication may be helpful.
(Special thanks to Dr Venus Tam of Institute of Mental Health, Castle Peak Hospital, for authoring this article)
