Oppositional defiant disorder (ODD) is often comorbid with other psychiatric disorders in childhood. Its association with ADHD & conduct disorder has been well studied. Recent studies suggest that children with ODD have substantial comorbidity with anxiety & depressive disorders pic.twitter.com/4lXWuMaydZ
December 21, 2022— ADHD SNAP (@SNAP4ADHD)

In the last post, we saw how:

Children with Oppositional defiant disorder tend to oppose authority.
Children with conduct disorder tend to suffer from different comorbidities one of which is ADHD.
Conduct disorder can be dealt with at home.

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Welcome to Medic Vibes, where we discuss mental health disorders and make sense of them. Dr Ebingo Kigigha is a medical doctor (aspiring psychiatrist) and creative person (illustration and music). This has been our routine for four consecutive months. This month will be dedicated to Conduct disorder. In the first month, we discussed Depression, and in the subsequent month, anxiety. We just finished with Eating disorders.

In this post, we are looking at Twitter posts. To learn more just keep scrolling down. You can also skip to the key point of the post if you which or go to the conclusion to get the summary.

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Alternative diagnosis of Oppositional Defiant Disorder

Oppositional behaviour can be normal behaviour depending on the age that is being considered and this has to be differentiated when considering oppositional behavioural disorder. There is no difference between oppositional behaviour and disruptive mood behaviour when you consider the time range and the anger. The Diagnostic and Statistical Manual (DSM) states that oppositional defiant disorder cannot be diagnosed when a person has disruptive dysregulation disorder.

If Oppositional defiant disorder happens in response to stress it should be taken as an adjustment disorder. If also this behavioural pattern is seen in a person with conduct disorder, schizophrenia, or mood disorder then oppositional defiant disorder should not be made.
On the other hand, if a child has ADHD or some other cognitive disorder, the disruptive mood disorder can be made as these conditions occur together.
A diagnosis of Oppositional defiant behaviour is usually made depending on the severity, frequency and chronicity of the behaviour. Some children get diagnosed with Oppositional defiant behaviour for several years and later are found to be suffering from conduct disorders. Some who have studied the two conditions consider them to be variants of themselves. Those who meet the criteria for oppositional defiant disorder usually can not fit into the criteria for conduct disorders and 25% of those who do meet the criteria don’t as the years go by.

Oppositional disorders usually continue to conduct disorders when there is very clear aggressive behaviour. The types of Oppositional defiant disorder that progress to this type are the angry and the vindictive type. It is very possible also for two types of oppositional defiant disorder to exist at the same time. The types of oppositional defiant disorder that do not progress to conduct disorder are less aggressive and do not have as many antisocial features.
It is also common to find children who have oppositional defiant disorder and ADHD before the age of 12.
Children who develop conduct disorders start most times with oppositional defiant disorder.

The course of Oppositional Defiant Disorder

The way this condition progresses depends on how serious the condition is and how they respond to therapy. One in four of these patients does not meet the criteria for this disorder as time goes by. If this condition goes on untreated there is a higher chance of the disorder giving rise to mood disorders, conduct disorders and substance abuse disorders.
If the patient will get better it is typically the case that they have a better family dynamic and they do not give the behavioural pattern of the child all their attention.

Children from families with psychopathology such as antisocial personality behaviour and substance abuse tend to suffer from oppositional defiant disorder when compared to people generally. There is an additional risk if the child is not from an orderly family or one that has constant feuds.

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Conduct disorders and Antisocial behavior (Reaction)

Image by storyset on Freepik

According to the National Library of Medicine in a review of prominent literature on conduct disorder and antisocial behaviour written by the National Institute for Health and Care Excellence, they explain that conduct disorders are very common in children and adolescents. In prevalence studies done between 1999 and 2004, they found that it was seen in 5% of the studies subject of children and adolescents
Those who are affected by this condition have difficulty throughout life and this condition may be complicated by several other conditions.

A study by the Office of National Statistics showed that children were 3 to 4 times more likely to fall into lower social classes. Their 2004 study showed that 40% of those who were on child protection programs and had been abused had a conduct disorder.
In conduct disorders, there are frequent episodes of antisocial behaviour such as aggressive or oppositional defiant behaviour and this leads to unexpected behaviour for the child’s age.
The World Health Organization classified conduct disorders into socialised conduct disorder, unsocialised conduct disorder, conduct disorder confined to family and oppositional defiant disorder.
The main difference between oppositional defiant disorder and the other types of conduct disorder is the severity and magnitude of the antisocial pattern. To diagnose antisocial behaviour the person needs to commit more than one criminal act. Oppositional defiant disorder is also seen mostly in children who are older than 10 years while the other types of conduct disorders are seen more commonly among children older than 11.
The number of children with conduct disorders increases as the considered age increases but they are more common in boys than in girls, almost 2 fold even.
Conduct disorders tend to happen with other mental health conditions. ADHD appears to be the most common comorbidity seen in this condition in some studies 40% prevalence has been seen.
There is a higher risk of criminal behaviour in children who have conduct disorder and half of these patients grow up to have antisocial behaviour.
Ethnicity is also a factor that affects the prevalence of antisocial behaviour as Asians have a lower incidence of antisocial behaviour than their African counterparts in the UK.
Those who have conduct disorders usually do not do well in school and in adolescence, they tend to participate in drug abuse and fault the law. In their adult life, their poor educational status leads to poorer work availability and they continue down the line of faulting the law. They also tend to develop other mental health problems.

One of the most common reasons why a child may be referred to see a mental health specialist is because of Conduct disorders. They are also a considerable amount of burden for those who do health work. These patients also need special needs for their education and the justice system has to make adjustments.

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Treatment of oppositional behaviour disorder

There are many options and interventions available for those who have conduct disorder. These are parenting programs that are for younger children and intervention methods that are multifaceted for older children.
A nurse-family partnership can also help with some of these cases and it is evaluated in the UK as an intervention method.

Questions

What did you learn about Conditional disorders?

Conclusion

There are many conditions to can be considered in children with the oppositional defiant disorder.
Children with the oppositional defiant disorder can progress to having antisocial behavioural disorder
In the UK there are different effective treatments for conduct disorders and many are in the works.

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