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Article published 9th June 2008

Obsessional, aggressive, defiant the characteristics of a typical teenager, or cause for concern and alarm?

How do you spot the difference between a child who is 'pushing the boundaries' and one with genuine difficulties?

What should you look out for?

Oppositional defiant disorder (ODD)

Oppositional defiant disorder is used to describe long-lasting, aggressive and defiant behaviour that is extreme and outside the normal range.

It is characterised by a persistent disobedience and opposition to authority figures (such as parents, teachers or other adults). Such behaviour is usually less severe than conduct disorders, but equally persistent. The basic rights of others are still respected and age-appropriate societal rules and behaviour are not violated.

ODD is characterised by aggressive, negative, hostile and defiant behaviour, which may be strongest in the home. Children with ODD will blame others rather than themselves and may seem angry and resentful, especially towards adults. Outwardly a child may appear irritable, with frequent temper outbursts, frustration and intolerance. Self-esteem is usually low though it’s likely the child will project an image of toughness. Additional symptoms of anxiety and depression are common.

Conduct disorders

Conduct disorders embrace behaviour that violates the social rules and rights of others and are typically present in the home, school and wider community.

Children and adolescents with conduct disorders tend to be physically aggressive. They may fight, bully, be cruel to people and animals, destroy other people’s property (possibly including arson) or steal.

Stealing ranges from ‘borrowing’ others’ possessions to shoplifting, forgery, car theft and burglary. Children with this disorder often lie, are truants, cheat at schoolwork and display callous behaviour. They may use or abuse tobacco, alcohol and other drugs at an unusually early age and be sexually precocious. Such behaviour must have persisted for six months or more for a conduct disorder diagnosis.

Schools employ a variety of strategies when working with youngsters with conduct disorders, including behaviour management, social skills (often through enhanced personal, social and health education (PSHE) input), strategies to improve self-esteem and self-control, and close liaison and involvement with parents or carers.

Obsessive compulsive disorder (OCD)

This is a condition where the sufferer experiences recurrent thoughts or images which they recognise as senseless, but which nevertheless disturb them.

Obsessions are often accompanied by excessively repetitive acts (compulsions or rituals such as continually washing hands), carried out in order to reduce the anxiety resulting from an obsession. Sufferers try to avoid situations or activities that remind them of their obsession. A sufferer may worry about acting on unwanted or senseless urges or impulses, such as harming someone they are close to, or worry obsessively about terrible things happening to them, or repeatedly experience unpleasant thoughts or images. Symptoms may manifest as physical difficulties, fast heartbeat, trembling or panic attacks. OCD usually appears in adolescence or early childhood. Medication and counselling may be of help to some sufferers.

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