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Oppositional and Aggressive Behaviors

Children and adolescents frequently exhibit oppositional behaviors as they develop. Every parent is familiar with the toddler who is enchanted with the word “no” or the adolescent who pushes for a later curfew. Such responses are part of developing autonomy and independence. Some children and adolescents, however, experience periods of turbulence that are significantly disruptive and that may affect functioning. These are the children and adolescents may have aggressive/oppositional problem., oppositional defiant disorder (ODD), or conduct disorder (CD).

Some key facts:

• It is estimated that 5.5% of US children have behavioral problems of aggressive nature (Offord et al., 1991)
• Of all the risk factors for conduct disorder (CD), age at onset of oppositional and aggressive behaviors seems to be the most important. Children who display antisocial and aggressive behaviors during elementary school are at the highest risk for conduct related problems as adults (Eddy, 1996; Loeber,1988; Patterson et al., 1989).
• Among children and adolescents with CD, 40-70 % also exhibit attention deficit hyperactivity disorder (ADHD) (Essau and Petermann, 1997; Hinshaw, 1993; Loney, 1987). Children and adolescents with CD are also more likely to exhibit anxiety and depression than children and adolescents without CD (Essau and Petermann, 1997; Zoccolillo, 1992).
• Learning disorders, ADHD, mild mental retardation, seizure disorders, schizophrenia, mood disorders, dissociative disorders, and even dissociative identity disorder (multiple personality) may at some time in childhood or adolescence manifest themselves as oppositional and aggressive behaviors (Lewis, 1996).
• Adolescents with CD are at higher risk for suicidal behaviors and suicidal completions than adolescents without CD (American Psychiatric Association, 1994,2000; Renaud et al., 1999).
• Physically abused children and adolescents are more likely to become seriously delinquent and violent juveniles (Lewis, 1996)

Description of symptoms

Adapted from DSM-PC

Early childhood

May frequently shout at, hit, bite, or punch others

Middle childhood

• May deliberately annoy others
• May argue for long periods
• May get into fights intermittently at school or in the neighborhood
• May swear or use bad language in inappropriate settings

Adolescence

• May argue; may vehemently defy requests
• May use obscene language or gestures frequently
• May occasionally hit others
• May exhibit inappropriately suggestive or aggressive sexual behaviors

Children and adolescents with oppositional defiant disorder(ODD) conduct disorder(CD) will have significant difficulties across areas of interactions with others at home, at school, and in the community as well as in the home.

Helpful interventions

Help is ideally to begin as soon as a disorder is identified, continued through adolescence, and address the child’s or adolescent’s functioning in areas of family life, relationships with peers, and school (Haggeler et al., 1998; Kazdin, 1993; Webster-Stratton, 1998).

For family, safety is the first priority in dealing with aggressive/oppositional problems and disorders.

Parents are encouraged to seek help through resources, references from community or from school. In developing behavioral plans for children and adolescents family support is crucial.

Family therapy may be an option along with individual therapy. A trained mental health therapist can help families reach positive outcomes. Early interventions are the keys to favorable outcomes for child/adolescent and family.