To meet DSM criteria, certain factors must be taken into account. First, the defiance must interfere with the Aspergers youngster’s ability to function in school, home, or the community. Second, the defiance cannot be the result of another disorder, such as the more serious conduct disorder, depression, anxiety, or a sleep disorder. Third, the Aspergers youngster's problem behaviors have been happening for at least six months. The diagnostic criteria for this disorder are as follows:
Diagnostic Criteria:
1. A pattern of negativistic, hostile, and defiant behavior lasting at least 6 months, during which four (or more) of the following are present (Note: consider a criterion met only if the behavior occurs more frequently than is typically observed in individuals of comparable age and developmental level):
1. is often angry and resentful
2. is often spiteful or vindictive
3. is often touchy or easily annoyed by others
4. often actively defies or refuses to comply with adults' requests or rules
5. often argues with adults
6. often blames others for his or her mistakes or misbehavior
7. often deliberately annoys people
8. often loses temper
2. The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.
3. The behaviors do not occur exclusively during the course of a psychotic or mood disorder.
4. 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.
If the youngster meets at least four of these criteria, and they are interfering with the youngster’s ability to function, then he or she technically meets the definition of oppositionally defiant.
Prevalence—
The DSM-IV-TR cites a prevalence of 2-16%, "depending on the nature of the population sample and methods of ascertainment."
Prognosis—
Childhood oppositional defiant disorder is strongly associated with later developing conduct disorder. Untreated, about 52% of kids with OPPOSITIONAL DEFIANT DISORDER will continue to meet the DSM-IV criteria up to three years later and about half of those 52% will progress into Conduct Disorder.
Treatment—
There are a variety of approaches to the treatment of oppositional defiant disorder, including parent training programs, individual psychotherapy, family therapy, cognitive behavioral therapy, and social skills training. According to the American Academy of Youngster and Adolescent Psychiatry, treatments for OPPOSITIONAL DEFIANT DISORDER are tailored specifically to the individual Aspergers youngster, and different treatments are used for pre-schoolers and adolescents.
An approach developed by Mark Hutten, M.A. uses a parent training model and begins by focusing on positive approaches to increase compliant behaviors. Only later in the program are methods introduced to extinguish negative or noncompliant behaviors.
One other type of treatment of this disorder is the prescription of risperidone.
The exact cause of OPPOSITIONAL DEFIANT DISORDER is not known, but it is believed that a combination of biological, genetic and environmental factors may contribute to the condition.
• Biological: Some studies suggest that defects in or injuries to certain areas of the brain can lead to serious behavioral problems in kids. In addition, OPPOSITIONAL DEFIANT DISORDER has been linked to abnormal amounts of special chemicals in the brain called neurotransmitters. Neurotransmitters help nerve cells in the brain communicate with each other. If these chemicals are out of balance or not working properly, messages may not make it through the brain correctly, leading to symptoms of OPPOSITIONAL DEFIANT DISORDER, and other mental illnesses. Further, many kids and adolescents with OPPOSITIONAL DEFIANT DISORDER also have other mental illnesses, such as ADHD, learning disorders, depression or an anxiety disorder, which may contribute to their behavior problems.
• Environmental: Factors such as a dysfunctional family life, a family history of mental illnesses and/or substance abuse, and inconsistent discipline by parents may contribute to the development of behavior disorders.
• Genetics: Many kids and adolescents with OPPOSITIONAL DEFIANT DISORDER have close family members with mental illnesses, including mood disorders, anxiety disorders and personality disorders. This suggests that a vulnerability to develop OPPOSITIONAL DEFIANT DISORDER may be inherited.
Although it may not be possible to prevent OPPOSITIONAL DEFIANT DISORDER, recognizing and acting on symptoms when they first appear can minimize distress to the kid and family, and prevent many of the problems associated with the illness. Family members also can learn steps to take if signs of relapse (return of symptoms) appear. In addition, providing a nurturing, supportive and consistent home environment with a balance of love and discipline may help reduce symptoms and prevent episodes of defiant behavior.
My Aspergers Child: Parenting Aspergers Children with ODD