Success with Learning Disabilities Blog

When is "ODD Behavior" not due to Oppositional Defiant Disorder?

Monday, August 07, 2017
A large number of students with developmental disorders have troublesome behaviors, some of which get labeled "Oppositional Defiant Disorder" or ODD.    Boys outnumber girls in this condition and the disruptive, recalcitrant, even violent behavior occurs in middle childhood as well as adolescence.   The most common co-morbidity with this condition is attention deficit disorder (ADD) and the most severe outcome in later life is substance abuse.   A common environmental factor in these argumentative, angry, even vindictive children is interrupted or dysfunctional parenting, but even in well-structured families, these behaviors may occur. 

However, other biological factors may induce behaviors superficially resembling ODD. Recognize that the behavior in ODD is voluntary making behavioral therapy an appropriate treatment option. Biologically-induced behavioral syndrome have a greater probability that a medication used wisely and safely may help attenuate the behavior without just obtunding the student because they act on the biological source for the behavior. 

Alternate considerations for acting out behaviors include: 

Intellectual limitation - students who cannot comprehend the environment or express their lack of appreciation of the circumstance around them are oftentimes resistant. Clarifying what their intellectual potential is and its limitations may explain why the behavior has occurred. Restructuring the approach to the child as well as sometimes medications can be helpful. 

Language disability - just like the above students, those with a specific language disorder cannot comprehend what is being said or asked of them or who cannot explain their behaviors are apt to be misinterpreted as though it is voluntary refusal to cooperate. Anxiety  states  - students  who  are  anxious  act  out  impulsively  and  reactively  without consideration of the consequences and are overly defensive. Easing their general anxiety and patient direction may improve their cooperation. 

Bipolar mood disorder - some behaviors are out of control because the behavior source is out of control whether physiologic or biochemical. Bipolar disorder individuals may act out impulsively, irrationally and angrily, sometimes without provocation. Medical management is a necessity. 

Physiologic brain instability - as may occur in some seizure disorders or migraine headaches. This is an important subgroup of individuals who often times get mislabeled even as a bipolar disorder when they have a brain physiological dysfunction that causes them to be overly reactive. An EEG (electroencephalogram) can clarify  whether or not that physiological dysfunction is present and offer more specific treatment to minimize the risk that the behaviors will occur. 

Obsessive compulsive personality disorder - this is perhaps the most common condition we have encountered among our students with developmental disorders.  These students are oftentimes bright, highly literate, quite verbal, get along with adults better than they do with their peers. Their behaviors are involuntary and they are inflexible from their fixed notions of what is right and what is wrong.  They cannot get along with their peers because they make the rules for the games and if the other kids do not obey them, they are in serious trouble.  Among the behaviors these students may demonstrate are lip biting, nail biting, cheek chewing, stereotypic movements may occur, mannerisms but not tme tics. Then students have great needs at times for symmetry, so kids will line up even at age 2 or 3, their toys in a perfect line and God help you if you try to change the arrangements of their toys.  The result may be rage since what they are doing is what has got to be done because their obsessive personality structure demands it.   They are rigid, inflexible.  They are argumentative, but they use arguments that are rational and resemble those of an attorney. There are medications that can be specific for this disorder that help minimize the adverse effects on socialization. 

Discerning the cause for such behaviors that interferes with socialization, may be crucial to both social as well as academic success.  The prognosis is better in these biologically determined states than ODD for which treatment is often times ineffective.

I hope these observations help you as parents, teachers, counselors to better recognize these differing behavioral states they may intrude on a student's compliance.