Introduction
Good behaviour and character of a child depend upon many factors. While any parent may face a situation when their chid throws a tantrum or shows aggression in public is considered normal, having a thought of a mental disease in a child is very rare. Unfortunately, things become cruelly bad in some children and proper diagnosis and management is very important. ODD is a behavioural disorder that results in defiance and anger against authority. It can affect a person’s work, school, and social life. It is manifested mostly in childhood. Even the most mild-mannered children have occasional outbursts of frustration and disobedience. But a persistent pattern of anger, defiance, and vindictiveness against authority figures could be a sign of oppositional defiant disorder (ODD). ODD affects between 1-16% of school-going children. It is more common in boys than girls. Many children start to show symptoms of ODD between the ages of 6 and 8 years. ODD also occurs in adults. Adults with ODD who were not diagnosed as children often go undiagnosed.
Signs & symptoms
In children and adolescents
ODD most commonly affects children and adolescents. Symptoms of ODD include:
- frequent temper tantrums or episodes of anger
- refusal to obey parents or comply with adult requests
- excessive arguing with adults and authority figures
- always questioning or actively disregarding rules
- behaviour intended to upset, annoy, or irritate others, especially authority figures
- blaming others for their own mistakes
- being easily annoyed
- vindictiveness
- Being spiteful and seeking revenge
- Swearing or using obscene language
- Saying mean and hateful things when upset
In addition, many children with ODD are moody, easily frustrated, and have low self-esteem. They also sometimes may be addicted to alcohol or drugs. It is important to identify substance abuse and ODD separately. None of these symptoms alone points to ODD. There needs to be a pattern of multiple symptoms occurring over a period of at least six months.
In adults
There is some overlap in ODD symptoms between children and adults. Symptoms in adults with ODD include:
- feeling angry at the world
- feeling of being misunderstood or disliked
- strong dislike for authority, including supervisors at work
- identifying as a rebel
- defending themselves aggressively and not being open to feedback
- blaming others for their own mistakes
Causes
There is no proven cause of ODD, but there are theories that can help identify potential causes. It can be a combination of environmental, biological, and psychological factors
Families with a history of Attention deficit hyperactivity disorder (ADHD) show more chances.
Other possible causes include:
- certain personality traits, like being strong-willed
- lack of positive attachment to a parent
- significant stress or unpredictability in the home or daily life
Pathophysiology
Oppositional defiant disorder symptoms are commonly seen initially during preschool years and often precede symptoms of Conduct Disorder. In a large-scale study using retrospective age-of-onset reports, 92.4% of those who met ODD criteria also met criteria for at least one other mental disorder, including mood disorders (45.8%), anxiety disorders (62.3%), impulse control disorders (68.2%) and substance use disorders (47.2%.
ODD is a strong risk factor for the development of Conduct Disorder in boys, with atypical family structure being an important factor. In contrast, ODD does not increase the risk of later development of Conduct Disorder in girls. However, ODD does increase the risk of continued ODD symptoms, depression, and anxiety in girls.
Psychological evaluation
Medical history and physical examination to rule out other similar conditions
Treatments
Psychotherapies like Family therapy, Parent-child interaction therapy, Peer groups etc are found beneficial in the management of ODD.
The most important among them is cognitive behavioural therapy to improve:
- anger management skills
- communication skills
- impulse control
- problem-solving skills
Medications like antidepressants should be used in cases needed.
Parents can help their children manage ODD by:
- increasing positive reinforcements and reducing negative reinforcements
- using consistent punishment for bad behaviour
- using predictable and immediate parenting responses
- forming positive interactions in the household
- Avoiding environmental or situational triggers
- Meditation, Yoga, Regular exercise
Prognosis
It is not easy to completely cure ODD. But with proper medication and therapies, symptoms can be managed and quality of life will be improved.
Complications
- Poor performance at school or work
- Antisocial behaviour
- Trouble controlling impulses
- Alcohol or drug problems
- Suicide tendencies
- Attention deficit hyperactivity disorder (ADHD)
- Conduct disorder
- Depression
- Anxiety
- Learning disorders
- Communication disorders
Disease & Ayurveda
Mental disorders in Ayurveda comes under the heading unmada which is classified into many types, mostly according to the symptoms. It develops even in children in the same way. Ayurveda also classifies persons according to psychological traits in the name of Sattwa into deva, aarsha, gaandharva etc. But it is important to understand unmada is a pathological condition where Sattwa is physiological and individually different behaviour patterns only. ODD can be classified into Unmaada where Vaata and PItta doshas show their vitiated signs.
Nidana
Consuming food items which are opposite in potency
Insulting god, teachers and noble people in society
Sudden fear and sudden happiness
Unwholesome and unfamiliar physical and mental activities
Purvaaroopa
Not mentioned
Samprapti
Due to the causative factors, the vitiated doshas move irregularly all over the body and cause imbalance in circulation & metabolism. These vitiated doshas when affect hrudaya(seat of all emotions and vitality) and the manovahasrotas(channels carrying psychic impulses), they develop diseases of the mind.
Lakshana
Faulty intellect, beliefs, and thoughts
Grandeur and aggression
Delusion and confusion
Impatience
Unsteadiness of eyes & emotions
Irrelevant speech
Sensation of vacant mind
Divisions
Nija
Agantu
Prognosis
Yaapya
Chikithsa
Treatment of unmada mostly depends upon the signs and symptoms. A person with OCD can have effective Ayurveda treatment and the quality of life can be improved. When the patient may not be knowing, cleaning the body by expelling out the metabolic waste accumulated in it can enhance proper metabolism. When the metabolism is normal, the brain functions and thereby behaviour of the person get better.
Samana
Takradhaara
Udwartanam
Abhyangam
Moordhapichu
Brumhanam
Sodhana
Snehapanam
Swedanam
Vamanam
Virechanam
Nasya-dhoomapaanam
Snehavasti
Kashayavasti
Commonly used medicines
Mridweekadi kashayam
Brahmeedrakshadi kashayam
Drakshadi kashayam
Brahmarasayanam
Chyavanaprasam
Kallyanaka ghrutam
Saaraswata ghrutam
Brahmi Ghrutham
Manasamitra vatakam
Shaddharanam Churna
Vaiswanara Churna
Ashta Churna
Gorochanadi Gutika
Brands available
AVS Kottakal
AVP Coimbatore
Vaidyaratnam oushadhasala
SNA oushadhasala
Home remedies
Strategies that can be tried at home to a child has ODD include:
- Praise specific positive behaviours.
- Offer rewards for good behaviour, especially for younger children.
- Parents should model the behaviour as a good person.
- Avoid power struggles.
- Set clear limits and boundaries.
- Follow a consistent schedule and routine.
- Spend quality time together.
- Make sure both parents or other family members are working together consistently.
Diet
- To be avoided
Heavy meals and difficult to digest foods – cause indigestion.
Junk foods- cause disturbance in digestion and reduces the bioavailability of the medicine
Carbonated drinks – makes the stomach more acidic and disturbed digestion
Refrigerated and frozen foods – causes weak and sluggish digestion by weakening agni (digestive fire)
Curd – causes vidaaha and thereby many other diseases
- To be added
Light meals and easily digestible foods
Green gram, soups, buttermilk boiled with turmeric, ginger and curry leaves
Freshly cooked and warm food processed with cumin seeds, ginger, black pepper, ajwain etc
Behaviour:
Better to avoid exposure to excessive sunlight wind rain or dust.
Avoid lifting heavy weights and other vigorous physical activities.
Maintain a regular food and sleep schedule.
Avoid sedentary lifestyle. Be active.
Yoga
Stretching exercises, meditation for relaxation and following a specific Yogacharya with yoga asanas like suryanamaskara, pavanamuktasana, vajrasana, etc are recommended for improving circulation and digestion.
Regular exercise helps improve bioavailability of the medicine and food ingested and leads to positive health.
Yoga can maintain harmony within and with surroundings.
Suryanamaskara
Pavanamuktasana
Vajrasana
All the exercises and physical exertions must be decided and done under the supervision of a medical expert only.
Research articles
https://www.ncbi.nlm.nih.gov/books/NBK557443/#_article-26231_s5_
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