MHM Magazine

10 | MENTAL HEALTH MATTERS | 2023 | Issue 4 MHM Oppositional Defiant Disorder (ODD) is described as a severe and persistent, recurrent pattern of negativistic, defiant, disobedient and hostile behavior beginning in childhood or adolescence with a duration of six months or more. Symptoms that are specific to ODD are: irritable or angry mood, argumentative and defiant behaviour, being easily annoyed by others, aggression and vindictiveness, a refusal to comply with rules, the deliberate annoyance of others and blaming others for their own mistakes. It is well established that ODD is a precursor for Conduct Disorder. Conduct Disorder (CD) occurs predominantly amongst male youths. They display at least four of the following behaviours: • Aggression towards others including physical altercations and physical cruelty to animals • The use of a weapon to harm others • The perpetration of a forced sexual act on another • Property destruction by arson or any other means • Criminal acts such as breaking into a property or theft or shoplifting or mugging • Truancy, running away from home and a refusal to comply with the rules set by parents and/or other adults. These individuals also show a lack of remorse, no empathy towards others and seem callous and unconcerned by the nature of their behavior. Callous and unemotional behaviour strongly suggests the potential progression towards Antisocial Personality Disorder or habitual adult criminality. The rate of this progression is as high as fifty percent. For both conditions there is well established co-morbidity and pre- morbidity with Attention Deficit Hyperactivity Disorder (ADHD). ODD is a comorbid diagnosis in 60% of minors with ADHD. The combination of the diagnoses indicates a worse prognosis, earlier age of onset with more functional impairment, increased risk of developing anxiety, depression and progression to conduct disorder and more delinquency than either disorder alone. ADHD is a treatable condition. Therefore, diagnosis and successful treatment of ADHD is critical factor in reducing the potential progression to ODD and CD. Risk factors for the development of ADHD, ODD and CD include: • Antenatal maternal smoking and postnatal adversities • Family history of ADHD, ODD or CD • High levels of family conflict • Parental psychopathology, substance abuse and maladaptive parenting styles including harsh parenting • The absence of fathers/positive male role models • The experience of any form of abuse Specific risk factors contributing towards CD are: • The inability to self-regulate combined with rapid activation of the fear and anger centres as a result of neurological malfunction in the amygdala and the orbito-frontal cortex • Low verbal IQ • Lack of economic opportunity • Frequent unoccupied and unsupervised time • Rejection by more prosocial peers and an association with delinquent peers and the gang system Fifty to seventy percent of referrals to Child and Family units in the Western Cape are for male minors presenting with unmanageable behaviour, extreme impairment in functioning and the creation of significant distress in both patient and family, as a result of this diagnostic combination. This combination of diagnoses tells the sad tale of family structures that have collapsed. Fathers are usually absent; mothers are overwhelmed or are abusing substances and Dr Terri Henderson Psychiatrist ODD AND CONDUCT DISORDER