1 2 3 žDiagnostic and Statistical Manual of Mental Disorders, 4th ed.: žRecurrent pattern of developmentally inappropriate, negativistic, defiant, and disobedient behavior toward authority figures. 4 žThe DSM-5 attempts to: ž“Redefine ODD by emphasizing a ‘persistent pattern of angry and irritable mood along with vindictive behavior,’ rather than DSM-IV's focus exclusively on ‘negativistic, hostile, and defiant behavior.’ žAlthough DSM-IV implied, but did not mention, irritability, DSM-5 now includes three symptom clusters, one of which is 'angry/irritable mood' —defined as ‘loses temper, is touchy/easily annoyed by others, and is angry/resentful.’ 5 žA diagnosis of ODD is more common among young children manifesting clinically severe levels of disruptive. Considerable evidence suggests that ODD often precedes the development of CD in children (e.g., Burke et al. 2010); thus, many researchers consider ODD and CD to be age-related manifestations of a common syndrome, with CD representing a more severe developmental progression of disruptive behavior (Loeber et al. 2009). 6 7 žThere's no known clear cause of oppositional defiant disorder. Contributing causes may be a combination of inherited and environmental factors, including: žA child's natural disposition žLimitations or developmental delays in a child's ability to process thoughts and feelings žLack of supervision žInconsistent or harsh discipline žAbuse or neglect žAn imbalance of certain brain chemicals, such as serotonin ž 8 žODD prevalence varies depending on the nature of the study population and evaluation methods. ODD Rates were found between 2 and 16%. žThis condition may appear from 3 years of age but often starts at 8 and usually not after adolescence. Before puberty is more common in men than in women, although the gender distribution is equal in adolescence. 9 žThe naysayers symptoms usually appear in the family environment, but with the passage of time may occur in other environments. Its onset is usually gradual, and usually stay over months or years. In a significant proportion of cases, the ODD is an evolutionary history of conduct disorder. 10 žChildren with ODD seem to have worse social skills than those with CD. Children with ODD seem to do better in school. žConduct disorder is the most serious childhood psychiatric disorder. Approximately 6-10% of boys and 2-9% of girls have this disorder. 11 ž Conduct Disorder is defined as a repetitive and persistent pattern of behavior 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. žAggression to people and animals žDestruction of property žDeceitfulness or theft žSerious violations of rules žThe above problem causes significant impairment in social , academic, and occupational functioning. ž ž 12 žCurrently, the research shows that in many respects, CD is a more severe form of ODD. Severe ODD can lead to CD. Milder ODD usually does not. The common thread that separates CD and ODD is safety. žIf a child has CD there are safety concerns. Sometimes it is the personal safety of others in the school, family, or community. Sometimes it is the safety of the possessions of other people in the school, family or community. Often the safety of the child with CD is a great concern. žChildren with ODD are not especially dangerous. If you have a child with CD disorder in your home, most likely you or your things are entirely safe. žIt is the hardest pediatric neuropsychiatric disorder to live with as a sibling, parent, or foster parent. It is worse than any medical disorder in pediatrics. 13 žSigns of ODD generally begin before a child is 8 years old. Sometimes ODD may develop later, but almost always before the early teen years. When ODD behavior develops, the signs tend to begin gradually and then worsen over months or years. 14 žThe child may be displaying signs of ODD instead of normal moodiness if the behaviors: žAre persistent žHave lasted at least six months žAre clearly disruptive to the family and home or school environment ž 15 žThe following are behaviors associated with ODD: ž žNegativity žDefiance žDisobedience žHostility directed toward authority figures ž 16 žThese behaviors might cause the child to regularly and consistently: ž žHave temper tantrums žBe argumentative with adults žRefuse to comply with adult requests or rules žAnnoy other people deliberately žBlame others for mistakes or misbehavior žActs touchy and is easily annoyed ž 17 žThese behaviors might cause the child to regularly and consistently: ž žFeel anger and resentment žBe spiteful or vindictive žAct aggressively toward peers žHave difficulty maintaining friendships žHave academic problems žFeel a lack of self-esteem ž ž 18 žhttps://www.youtube.com/watch?v=08T_dbRgEfg 19 žWhich risk factors or environmental conditions could favor the development of ODD? 20 žPossible risk factors include: žBeing abused or neglected žHarsh or inconsistent discipline žLack of supervision žLack of positive parental involvement žHaving parents with a severely troubled marriage ž 21 žParents with a history of ADHD, oppositional defiant disorder or conduct problems žFinancial problems in the family žFamily instability such as occurs with divorce, multiple moves, or changing schools or child care providers frequently ž 22 žMany children with oppositional defiant disorder have other treatable conditions, such as: žAttention-deficit/hyperactivity disorder (ADHD) žDepression žAnxiety žLearning and communication disorders žIf these conditions are left untreated, managing ODD can be very difficult for the parents, and frustrating for the affected child. Children with oppositional defiant disorder may have trouble in school with teachers and other authority figures and may struggle to make and keep friends. žODD may be a precursor to other, more-severe problems such as conduct disorder, substance abuse and severe delinquency. ž 23 žOppositional defiant disorder often occurs along with other behavioral or mental health problems such as: žAttention-deficit/hyperactivity disorder (ADHD) žAnxiety žDepression žThe symptoms of ODD may be difficult to distinguish from those of other behavioral or mental health problems. ž 24 Parrafillo de debajo hay que decirlo, está en el word žIt is exceptionally rare for a physician to see a child with only ODD. Usually the child has some other neuropsychiatric disorder along with ODD. žODD plus ADHD. If a child comes to a clinic and is diagnosed with ADHD, about 30-40% of the time the child will also have ODD. žODD plus Depression/Anxiety. This is the other common combination with ODD. If you look at children with ODD, probably 15-20% will have problems with their mood and even more are anxious. ž ž ž 25 žOften the depression gets mixed in the midst of dealing with the aggression and defiance. It is common among adolescents who have been oppositional and depressed but no one ever notices the depression until they make a suicide attempt. Looking for depression in ODD youth is very important ž 26 žODD is diagnosed in the same way as many other psychiatric disorders in children. You need to examine the child, talk with the child, talk to the parents, and review the medical history. Sometimes other medical tests are necessary to make sure it is not something else. You always need to check children out for other psychiatric disorders, as it is common the children with ODD will have other problems, too. 27 žTo be diagnosed with oppositional defiant disorder, a child must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment. 28 žOften loses temper žOften argues with adults žOften actively defies or refuses to comply with adults' requests or rules žOften deliberately annoys people žOften blames others for his or her mistakes or misbehavior žIs often touchy or easily annoyed by others ž 29 žIs often angry and resentful žIs often spiteful or vindictive žThese behaviors must be displayed more often than is typical for your child's peers. žIn addition, to be diagnosed with oppositional defiant disorder, a child's disruptive behavior: žMust cause significant problems at work, school or home žMust occur on its own, rather than as part of the course of another mental health problem, such as depression or bipolar disorder žMust not meet the diagnostic criteria for conduct disorder or, if the affected person is older than age 18, antisocial personality disorder ž 30 žIt can be difficult for doctors to sort and exclude other associated disorders — for example, attention-deficit/hyperactivity disorder versus oppositional defiant disorder. These two disorders are commonly diagnosed together. 31 žFirst, there will be some lucky children who outgrow this. About half of children who have ODD as preschoolers will have no psychiatric problems at all by age. ž ž Second, ODD may turn into something else. About 5-10 % of preschoolers with ODD will eventually end up with ADHD and no signs of ODD at all. Other times ODD turns into conduct disorder (CD). This usually happens fairly early. That is, after a 3-4 years of ODD, if it hasn't turned into CD, it won't ever. A history of a biologic parent who was a career criminal, and very severe ODD predicts a child with ODD getting CD. ž 32 ž Third, the child may continue to have ODD without any thing else. However, by the time preschoolers with ODD are 8 years old, only 5% have ODD and nothing else. ž žFourth, They continue to have ODD but add on comorbid anxiety disorders, comorbid ADHD, or comorbid Depressive Disorders. By the time these children are in the end of elementary school, about 25% will have mood or anxiety problems which are disabling. That means that it is very important to watch for signs of mood disorder and anxiety as children with ODD grow older. ž 33 žDrugs for the treatment of ODD are used? žWhy? 34 žIf the child has co-existing conditions, particularly ADHD, medications may help significantly improve symptoms. However, medications alone generally aren't used for ODD unless another disorder co-exists. 35 žIndividual and family therapy. Individual counseling for your child may help him or her learn to manage anger and express his or her feelings more healthfully. žFamily counseling may help improve communication and relationships, and help members of the family learn how to work together. ž 36 žParent-child interaction therapy (PCIT). During PCIT, therapists coach parents while they interact with their children. In one approach, the therapist sits behind a one-way mirror and, using an "ear bug" audio device, guides parents through strategies that reinforce their children's positive behavior. žAs a result, parents learn more-effective parenting techniques, the quality of the parent-child relationship improves and problem behaviors decrease. ž 37 žCognitive problem-solving training. This type of therapy is aimed at helping the child identify and change through patterns that are leading to behavior problems. žCollaborative problem-solving — in parents and child work together to come up with solutions that work for both of them— can help improve ODD-related problems. ž 38 žSocial skills training. The child also might benefit from therapy that will help him or her learn how to interact more positively and effectively with peers. ž 39 žParent training. A mental health provider with experience treating ODD may help parents develop skills that will allow them to parent in a way that's more positive and less frustrating for them and their child. žIn some cases, the child may participate in this type of training with parents, so that everyone in the family develops shared goals for how to handle problems. ž 40 žGive effective timeouts žAvoid power struggles žRemain calm and unemotional in the face of opposition, or take your own timeout, if necessary žRecognize and praise your child's good behaviors and positive characteristics ž 41 žOffer acceptable choices to your child, giving him or her a certain amount of control žEstablish a schedule for the family that includes specific meals that will be eaten at home together, and specific activities one or both parents will do with the child žLimit consequences to those that can be consistently reinforced and if possible, last for a limited amount of time ž 42 43 žWeb sites: žAmerican Academy of Child and Adolescent Psychiatry: Child and adolescent psychiatrist finder žAmerican Academy of Pediatrics ž http://es.slideshare.net/agrusam/trastorno-negativista-desafiante-1315005?next_slideshow=1 žhttp://es.slideshare.net/MarisaRamn/alumnado-con-trastorno-oposicionistadesafiante?related=1 žhttp://es.slideshare.net/NithyaVeganwwwnithya/trastorno-negativista?related=2 žhttp://es.slideshare.net/Juanjosecubillos/trastorno-de-negativismo-desafiante?related=3 žhttp://es.slideshare.net/ENFE3015/conducta-oposicional-desafiante-ppt?related=4 ž 44 Ylenia Álvarez Díaz