Oppositional Defiant Disorder (ODD) is a persistent pattern (lasting for at least six months) of negativistic, hostile, disobedient, and defiant behavior in a child or teen without serious violation of the basic rights of others.

Symptoms of ODD may include the following behaviors when they occur more often than normal for an age group: losing one's temper; arguing with adults; defying adults or refusing adult requests or rules; deliberately annoying others; blaming others for one's own mistakes or misbehavior; being touchy or easily annoyed; being angry and resentful; being spiteful or vindictive; swearing or using obscene language; or having a low opinion of one's self.

The cause of Oppositional Defiant Disorder is unknown at this time. The following are some of the theories being investigated:

• It may be related to the child's temperament and the family's response to that temperament.
• A predisposition to ODD is inherited in some families.
• There may be problems in the brain that cause ODD.
• It may be caused by a chemical imbalance in the brain.

The course of Oppositional Defiant Disorder is different in different people. It is a disorder of childhood and adolescence that usually begins by age 8, if not earlier. In some children it changes into a conduct disorder or a mood disorder. Later in life, it can develop into Passive Aggressive Personality Disorder or Antisocial Personality Disorder. With treatment, reasonable social and occupational adjustment can be made in adulthood.

Treatment of ODD usually consists of group, individual and/or family therapy and education, keeping a consistent daily schedule, support, limit-setting, discipline, consistent rules, having a healthy role model to look up to, training in how to get along with others, behavior modification, and sometimes residential treatment, day treatment and/or medication.

Helpful ways of dealing with ODD may include: attending therapy sessions; using ime-outs; identifying what increases anxiety; talking about feelings instead of acting on them; getting involved in tasks and physical activities that provide a healthy outlet for energy; learning to talk with others; developing a predictable, consistent daily schedule of activities; figuring out ways to have fun and feel good; learning to get along with other people; and learning to admit mistakes in a matter-of-fact way.

For more information about Oppositional Defiant Disorder, you can check out these sites on the web:
http://www.noah-health.org/english/illness/mentalhealth/cornell/conditions/odd.html
http://www.mentalhealth.com/dis/p20-ch05.html
http://www.klis.com/chandler/pamphlet/oddcd/oddcdpamphlet.htm

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The Effects of Prenatal Alcohol Exposure

by Amanda Marques

As prospective adoptive families prepare for the placement of a long awaited child, they are oriented to the best of adoption agencies' abilities on "what to expect" of a "special needs child". Agencies send families to valuable training, seminars, and orientations. They are interviewed by social workers, and asked to provide personal documents about birth, health, and finances. The families ultimately wait for that approval for placement. When finally matched with a child, families are prepared for the possible problems that may arise, given the availability of background information.

The unfortunate truth is that, even when agencies have a substantial amount of background information on a child's history, there are many things that cannot be predicted. The effects of drug and alcohol exposure are one of the many unpredictables. Given the rising number of children that are in the system due to parental involvement with drugs and alcohol, adoption professionals continually see numerous children flood the system with pre-natal exposure to alcohol and drugs. The scary reality is that many of these children do not show physical effects of exposure at birth, but the long-term emotional and behavioral problems can be devastating, not only to the family, but also the child's future. Families that are told their adopted child has been prenatally exposed to alcohol may not fully understand the long-term affects of Fetal Alcohol Syndrome (FAS) or Fetal Alcohol Effects (FAE).

In the late 1980's, Michael Dorris's book, "The Broken Cord" hit the shelves of bookstores nationwide. The book is a personal account of an adoptive family's life journey while they learned to cope with FAS and provide life-long care to their adopted son. The book came at a time when our government began public awareness campaigns to address the true concerns of women drinking during pregnancy. In 1981, the Surgeon General first advised that women should not drink alcoholic beverages during pregnancy because of the risk of birth defects and in 1989 Public Law 100-690 was implemented requiring that warning labels be on all alcoholic beverages sold in the United States. The book ultimately represents the true exhausting and debilitating effects of FAS. The most unfortunate fact is that FAS/FAE is the one birth defect that is 100% preventable.

For those many adoptive families, knowing that FAS is preventable is not as useful as knowing where to go if your child has Fetal Alcohol Syndrome. Having useful information on characteristics and symptoms may help some family's pinpoint a long- unanswered problem. In understanding that adoption agencies do their best to inform families of a child's history, there are the families that know their child was prenatally exposed to alcohol, but for others it is a guessing game. Being able to recognize certain characteristics and features may help families identify FAS/FAE and ultimately seek the necessary interventions. Unfortunately, it is often difficult to identify children who have FAS because the symptoms are similar to other disorders. The only way to find out for certain if a child has FAS is to measure the facial features when the person is a young child, test their urine immediately after birth, or get an accurate account of the birth mother's drinking habits while she was pregnant.

Fetal Alcohol Syndrome is defined by the Center for Disease Control as a birth defect caused by a woman drinking heavily during pregnancy. Growth retardation, abnormal facial features, and central nervous system problems characterize FAS. Children with FAS can have serious lifelong disabilities, including mental retardation, learning disabilities, and serious behavioral problems. Fetal Alcohol Effects is a less severe set of the same symptoms.

Children born with FAS are often abnormally small, and usually do not catch up as they get older. They may have small heads, flat nasal bridges, thinned upper lip and flat cheeks. A child born with FAS may exhibit the following behaviors; poor coordination, hyperactive behavior, learning disabilities, developmental disabilities (including speech and language delays), low IQ, and/or mental retardation. Many children with FAS/FAE have been diagnosed with Attention Deficit Hyperactivity Disorder, Conduct Disorder, and Oppositional Defiant Disorder.

Parenting a child with FAS/FAE and not knowing it can be a path that is never-ending, filled with unanswered questions and frustration. The key for families attempting to parent a child with FAS/FAE is having early intervention. Having appropriate therapeutic and educational services in place will help in raising a child with FAS.

According to the March of Dimes each year more than 50,000 babies are born with some degree of alcohol-related damages, and of these babies, 2,000-12,000 are born with FAS, a combination of physical and mental birth defects. This begs the question of how many adopted parents are parenting a child whose learning, behavioral, or social problems are a direct cause of the effects of FAS/FAE, but this has never been identified?

The National Organization on Fetal Alcohol Syndrome (Dr. Patricia Tanner-Halverson) offers the following characteristics of FAS/FAE and strategies for parents and caregivers of FAS and FAE children:

FAS children may have:

• Difficulty structuring work time.
• Impaired rates of learning.
• Poor memory.
• Trouble generalizing behaviors and information.
• Act impulsively
• Exhibit reduced attention span.
• Easily distracted.
• Display fearlessness and unresponsiveness to verbal cautions.
• Demonstrate poor social judgement.
• Cannot handle money age appropriately.
• Have difficulty internalizing modeled behaviors
• Differences in sensory awareness (hypo or hyper)
• Language production higher than comprehension.
• Poor problem solving strategies.

Some Effective Strategies:

• Fostering independence in self help or play.
• Give child choices and encourage decision-making.
• Focus on teaching daily living skills.
• Have child get ready for next school day prior to going to bed.
• Establish routines so child can predict coming events.
• Give child lots of advance warning that activity will soon change to another one.
• Be concrete when teaching a new concept. Show them.
• For unpredictable behavior at bedtime/mealtime, establish a firm routine.
• Break down their work down into small pieces so they do not feel overwhelmed.

Discipline:

• Set limits and follow them consistently.
• Change rewards of ten to keep interest in reward.
• Review and repeat consequences of behaviors. Ask the child to tell you consequences.
• Do not debate or argue over rules already established. "Just do it".
• Notice and comment when your child is doing well or behaving appropriately.
• Avoid threats.
• Redirect behavior.
• Intervene before behavior escalates.
• Avoid situations where child will be over stimulated.
• Have child repeat back their understanding of directions.
• Have pre-established consequences for misbehavior.
• Protect them from being exploited. They are naïve.

For more information on FAS/FAE contact the National Organization on Fetal Alcohol Syndrome at www.nofas.org or you can write to the organization at 1819 H. Street NW, Suite 750 Washington, DC 2006.

Early diagnosis can bring a more appropriate early intervention action, which can reduce some of the adverse effects this syndrome can bring into adolescence and adulthood. The long term physical and mental implications brought on by the alcohol indicates that Fetal Alcohol Syndrome is " not a childhood disorder, but a long term progression into adulthood" (Steven Schandler-Journal of Consulting Psychology). Early intervention is the key, but intervention is never to late. If you suspect that your child my have FAS/FAE contact your doctor to begin assessment that way you and your family can begin to put in place the appropriate type of education and therapeutic tools.