Oppositional Defiant Disorder (OCD) Refers

¶ … Oppositional Defiant Disorder (OCD) refers to a spectrum disorder on the low end of all those disorders linked to the general disorder group Conduct Disorder. In a sense ODD is usually classified as rule breaking behaviors that do not necessarily develop into socially inappropriate behaviors, though there is some grey area in this subjective characterization, but the basic historical distinction is that ODD symptoms are more rarely associated with actual physical harm to others. (Loney & Lima, 2003, p. 4) in the Diagnostic and Statistical Manual (DSMR IV) there are fewer subscale distinctions between general CD (previously viewed as more severe) and ODD. The classification then includes two subgroups of CD/ODD, childhood onset and adolescent onset which each have age appropriate opportunity distinctions of symptomology. In childhood onset CD/ODD the individual child exhibits three of fifteen aggressive or rule breaking behaviors with at least one being documented prior to age ten and with symptoms that have been experienced within 12 months and at least one within the past 6 months. The list includes: bullying, fire setting, lying to obtain goods or favors and truancy. Adolescent onset CD/ODD is similar but with the exception that no symptoms were documented prior to age 10. Diagnostic are similar short of the fact that one violation does not have to have occurred in the last 6 months. In addition both childhood and adult onset ODD/CD include non-specific disruptive behaviors as a residual diagnostic category/criteria. (Loney & Lima, 2003, p. 9)

The difficulties of defining and diagnosing ODD as well as other Conduct Disorders in general are many and varied, not the least of which is the subjective nature of the behaviors themselves. While some parents, caretakers or educators could clearly evaluate ODD/CD symptoms in almost the entire population of a class many are reluctant to accept definitive diagnosis, as it tends to follow students and does not always take into consideration that ODD/CD symptoms may very well be associated with a real environmental challenge the child is facing. Some examples of such situations are profound grief, related to loss of friends, family members or even beloved pets or objects (depending on age). Additionally, children are highly sensitive to social conditions and if they change they may exhibit disruptive behavior as a way to seek attention. Some of these same people (parents, caregivers and educators) might also say that there is a clear difference between ODD/CD kids and normal children experiencing temporary or even persistent environmental reactions, as with ODD/CD kids they cannot isolate reason and none can be found. The reality is that diagnosis is subjective as is behavioral recognition, and reluctance to diagnosis is likely wise, as diagnosis of ODD/CD can follow a child forever and impede his or her own self-growth, which could essentially (if they are misdiagnosed) lead them to "normal" variable behavior. Another reason why some are reluctant to allow diagnosis is indicative of the fact that there is a multivariate scale that can be over or under representative of reality, due to the fact that most research and knowledge is based not on a whole sample of the population of children but on a small subset of "clinical" patients. (Avila, Cuenca, Felix, Parcet & Miranda, 2004, p. 295) it is also clear that all researchers and diagnosticians do not agree on diagnostic or behavioral criteria for ODD/CD.

ODD typically occurs in early childhood and is characterized by behaviors such as arguing with adults, losing one's temper, and angry or intentionally annoying behavior. CD often develops later than ODD, in early adolescence, and is characterized by behaviors including stealing, lying, fire setting, truancy from school, and property destruction. Although children with ODD often are diagnosed with CD when they reach adolescence, not all individuals with CD have had a previous diagnosis of ODD (Lahey, McBurnett, (Dick, Viken, Kaprio, Pulkkinen & Rose, 2005, p. 219)

Finally, diagnosis of ODD/CD could be inappropriate if the individual would actually fit better into another category such as ADHD, and therefore would be better treated by the treatment scope of this other disorder. One work specifically isolates a type of treatment that is helpful for ODD or milder CD:

In this book our focus is on supportive-expressive play psychotherapy for a particular kind of patient: the school-aged child who meets the criteria for oppositional defiant disorders and mild or moderately severe conduct disorders (DSM-III-R). There are, however, important qualifications. First, the child must demonstrate some capacity for genuine guilt, remorse, or shame about his stealing, lying, or hurting others. Further, he must manifest during the diagnostic evaluation some potential for engaging in a therapeutic alliance; the therapist can best make this judgment by reflecting on the child's willingness to come and interact with her at some level, albeit a negative one. Finally, parental and school cooperation with the treatment plan should be available. We have conceptualized SEPP for children in the spectrum of conduct disorders. This specific approach has not been tried systematically with other patient populations. (Kernberg & Chazan, 1991, p. 24)

Under the ise of qualifications one can see that children must be a of a particular character to seriously gain from the type of treatment suggested (supportive-expressive play psychotherapy) and that in many ways these are the "best case scenario" children, i.e. those who make emotive connections to the people in their environment and feel remorse with regard to their disruptive actions.

Treatment options for children lacking these characteristics seem to be exceedingly difficult, and those who mask these feelings could be hard to spot and easily given up on in treatment. This is especially true of adolescent onset ODD/CD as the nature of the adolescent mind, even with "abnormal" is often associated with limiting culpability, as one does when they are a child by refusing to take accountability for actions, even when guilt is felt. In my opinion this characteristic of guilt should be assumed in many cases as children often gain the ability to lie and manipulate as they age, as a normal aspect of growth and development (for real everyday survival) and therefore should still be given opportunities for treatment options that would normally exclude them based on external assumptions regarding remorse or lack their of. (Kernberg & Chazan, 1991, p. 216)