Episode Transcript
Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.
Interviewer: We're here with Dr. Matthew Woolley, clinical psychologist and an assistant professor of psychiatry at the University of Utah. Thank you for being on the show today.
Dr. Matthew Woolley: Thanks for having me.
Interviewer: Kathy from Sandy, Utah has sent us a question. She wants to know if one of her students has something called ODD, oppositional defiant disorder. She's a private piano teacher. She has a young student of hers that she calls impossible. About half of the time she says he can be worked with, but the other half he gets easily distracted. If asked to do something he often refuses saying, "I don't want to." When asked why he did something he'll reply, "Because I'm stupid." He also mocks and mimics me at times. His mom who sits in on the lesson seems to know he can be impossible. She non-verbally acknowledges it to me, but doesn't ever do anything to correct his behavior. She's at her wits end and wants to know if he has ODD. While surfing she came across this disorder. Let's talk about what is operational defiant disorder.
Dr. Matthew Woolley: It's oppositional defiant disorder. That means that kids who have this, it's a disruptive behavior disorder meaning it's a pattern of behavior that disrupts their normal ability to function and interact with other people.
Interviewer: To some extent all kids have that though, don't they really?
Dr. Matthew Woolley: Yeah, I might still have a little of it, you know. The truth is that everybody gets a little oppositional at times. Children certainly can be oppositional, but it's a consistent pattern of behavior where it's not just opposing things that you're asked to do. There's a pattern of being angry, upset, easily irritable as well as opposing rules in your environment. These kids are not necessarily law breaker kids. They may follow the rules of society, but rules like sit down and play the piano and that sort of thing. They often say no. In fact, it's interesting that sometimes these children will often display a pattern of illogical oppositional behavior. That's actually one of the key marks meaning that asking them to do something that they may normally want to do they'll get into an argument with you about it or how to do it. Instead of the typical child saying, "Yeah, I'd love to go to the movies." they might argue with you about the time. They're looking for opportunities to establish a bit of control.
Interviewer: Is it a chemical imbalance in the brain that causes it, or what's exactly going on?
Dr. Matthew Woolley: There are some heritable factors, however a lot of that behavior then becomes reinforced early on. What will happen is a child will be fairly difficult, forceful and oppositional from a very early age, and parents kind of give in to that early on because it's easier to give in to these tough kids. That dramatically reinforces this behavior, so later on by the time they hit even kindergarten, they're at the ripe old age of five, people are saying things like, "Well, they've always been this way." It's a combination of both heritable genetic factors, but early learning that, "I get my need met this way by being oppositional when I feel threatened."
Interviewer: What are some of the symptoms?
Dr. Matthew Woolley: Well, certainly being opposing a normal, typical request by adults and parents. There is a consistent pattern here. This is nearly all of the time that we're getting into arguments. That's probably the hallmark behavior. Defying rules, but not necessarily breaking laws, meaning these aren't kids that are necessarily out stealing, but they are kids that feel like they don't have to do what adults tell them to in a particular context like school or home. They tend to be more irritable, angry outbursts, emotional melt downs happen more frequently and it can co-occur often with ADHD. If you have a child who has been diagnosed with ADHD, which could be the inattentive type or the combined type with both hyperactivity and inattention, those kids are at higher risk for having this behavior as well.
Interviewer: When does this type of disorder start to develop, how old?
Dr. Matthew Woolley: We often see parents bringing children in in early elementary school. They've usually been able to handle this kid's behavior, but by the time they hit kindergarten or first or second grade it's starting to become a problem because they're being oppositional with teachers and people like that as well. However, if you look back usually the behavior can be budding and beginning in toddlerhood.
Interviewer: Do boys get it more than girls?
Dr. Matthew Woolley: It's more common in boys than girls, but girls certainly are not immune to it.
Interviewer: What's the takeaway that you would have for Kathy? It sounds like you're recommending that maybe she should talk to the parent.
Dr. Matthew Woolley: Parents don't often like to be told by folks that their kids are difficult. Probably the less threatening thing is to go visit with the pediatrician.
Interviewer: Go with the pediatrician.
Dr. Matthew Woolley: Yeah, I'm a psychologist, and I recognize that there's a little bit of hesitancy on parent's part to get involved with a psychologist even though psychologists would be the ones that the pediatrician are likely to refer them to.
Interviewer: It comes a little bit easier from a pediatrician than it does a music teacher.
Dr. Matthew Woolley: Yea, definitely. I often tell parents it's easy to get into a pediatrician. Usually you can jump in on an appointment within 24 to 48 hours at most pediatricians offices. Maybe keep a little brief description with you so that you can describe to the pediatrician what you're seeing, and he or she is likely to be able to help you understand it better and maybe refer you to a psychologist where you can get the proper assessment.
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