Child Behavior Problems, Oppositional Defiant Disorder (ODD), and Disruptive Mood Dysregulation Disorder (DMDD)

Children of all ages can present with a variety of behavior problems. From severe temper tantrums, to defiance, or noncompliance with school or house rules, these problems can lead to highly negative and conflictual environments at home or school.

There are sometimes underlying causes to behavior problems and behavioral disorders such as other mental health symptoms and disorders, though this may not always be the case. Some children may appear more temperamentally inclined toward oppositional or argumentative behaviors. Sometimes children and teens have been reinforced and learned that defiance or lack of cooperation helps them avoid tasks they do not like. Others have a thinking style that is more rigid causing difficulties with flexible and cooperative thinking. This type of thinking can worsen when they become upset, angry, or frustrated.

A child or teen may have trouble with anger management for a variety of reasons. There may be underlying causes such as depression or stressful life situations. In other cases, there may appear to be no logical reason behind extreme mood shifts or explosive outbursts. Some children and adolescents have greater difficulty controlling and managing their anger. They may quickly become “flooded” with emotion and have difficulty making good choices when this happens.

Anger management therapy typically involves helping a child identify triggers that lead to anger outbursts and utilizes strategies to help reduce the intensity of moods and make better choices. Children who exhibit patterns of defiance, rule-breaking, and destructive behaviors are at risk and may need parental involvement and treatment to avoid more serious behavioral , legal, and/or psychological problems.

Oppositional Defiant Disorder consists of a pattern of defiance and noncompliance to rules, expectations, and directions that often occurs in different settings. A child or teen with this diagnosis may be more argumentative, disrespectful, and engage in more rule breaking behaviors than other children. The child or teen may be more irritable, lose their temper, cause trouble with others, and exhibit other behavioral problems. These behaviors can be extremely difficult and frustrating for parents to manage as well as create difficulties in school often leading to alternative class or school placements.

Disruptive Mood Dysregulation Disorder is a diagnosis more recently identified and added by the American Psychiatric Association. The diagnosis addresses the oppositional and argumentative behaviors that are the core of Oppositional Defiant Disorder, while additionally including the explosive, aggressive, and destructive behaviors that some children and adolescents exhibit. This diagnosis also includes chronic irritability and agitation as a component of this presentation.

 

Therapy

Individual and family therapy can address some of the problems associated with behavioral difficulties and defiance. Depending on the nature of the behaviors, one type of therapy may be more appropriate than others. Individual therapy can help the child to identify triggers behind their behavior or anger problems as, well as work to increase motivation to cooperate with others. Therapy with these issues will also involve the family to work on effective behavioral management strategies and parenting strategies to reduce negative acting out behaviors and increase compliance.

 

Therapeutic Goals for Children exhibiting defiant, destructive, and angry behaviors typically include:

• Establish an effective behavioral contract in the home with consequences and rewards that increase compliance and change negative behaviors

• Empower parents to take back authority in the home through behavioral planning and the creation of a strategic alliance with the child

• Help the family to avoid power struggles, nagging, name-calling, and other ineffective communication patterns

• Work with the child to explore and gain insight into behaviors and increase motivation for cooperation and healthy decision making

• Educate the child into thinking and calming strategies to reduce and control angry and destructive impulses