Risk Factors Associated with Oppositional Defiant Disorder among Children in Selected Primary Schools in Nairobi County, Kenya

The main purpose for this study was to evaluate the efficacy of cognitive behavior therapy (CBT) among children with oppositional defiant disorder (ODD) in selected primary Schools in Nairobi County, Kenya. The rise in defiance cases among children in schools in Kenya, the social, educational and economic impact it has on the children and their families have led for the need for proper diagnosis and effective intervention. The objective of this study was to determine the risk factors associated with oppositional defiant disorder among children. Quasi experimental research design was used in the study with a sample of 180 respondents . The study involved children aged between 9 to 14 years. Purposive sampling was used in selecting the two schools. 315 respondents completed the demographic questionnaires; the respondent’s parents also completed the socio-demographic questionnaires. Teachers and parents completed the CADBI at baseline assessment to identify those with symptoms of ODD. Systematic sampling method was applied on 249 participants who met the criteria for ODD because the number exceeded the required sample size. Risk factors associated with ODD were; religion, educational level of the respondents, conflicted relationship with parents, punishment in school, socio economic status and suspension from school, respondents whose parents were casual laborers, the level of education of the respondent’s parents. Significance was reported at p < 0.05. In conclusion, primary schools need to have professional psychologists to provide counseling services to the children presenting with ODD symptoms and devise intervention that will help in the management of ODD . This will help the children function well both socially and academically. This will also stop the progression of ODD to other mental disorders when they are adults for example; Depression, Anxiety, Antisocial Disorder which causes problems with adjustment in the community. © 2018 Elixir All rights reserved. Elixir Social Studies 122 (2018) 51872-51881 Social Studies Available online at www.elixirpublishers. com (Elixir International Journal) Susan Chang’orok et al./ Elixir Social Studies 122 (2018) 51872-51881 51873 According to Klein and Forehand, (2000) risk factors can be defined as those factors associated with a higher likelihood of negative outcomes and have mainly been studied in relationship to the development of problem behavior. In order to accurately identify support strategies for parents whose children exhibit behavioral problems, it is essential to have an understanding of the factors that place children at risk of, or contribute to the development of such behavior in the first place. Research suggested that, in isolation, risk factors may make relatively little contribution to the development of behavioral problems, whereas such factors in combination may be powerful determinants of negative outcomes (Klein & Forehand, 2000). Problems result from interactions between characteristics of the child and situations within the family, peer group, school and community. Therefore, it can be expected that families with multiple risk factors experience more problems and thus also a greater need for support. Cummins and McMaster’s study (2006) found that children who screened positive for mental health difficulties were more socially disadvantaged, had more behavioral difficulties and adaptive behavior problems, more physical health problems, more family problems, more life stress and poorer coping skills. Therefore, an understanding of the key risk factors associated with the onset and development of child behavioral problems, and in turn, an identification of high risk groups of children is important in the effective identification and design of supports for parents and children. A study by Fossum (2008) deduced that disruptive behavioral disorders such as ODD are frequently seen by the mental health community service in the US and are the regular reasons for referring children to mental health service in Norway. Children with ODD are at risk of developing a variety of problems including peer rejection, school failure, substance abuse, and criminality for which the prognosis is poor. In a longitudinal perspective, a substantial number of children displaying early symptoms of ODD go on to adolescence and young adulthood experiencing significant mental health problems, physical health problems, academic problems, economic problems, and engaging in serious violence (Burke, Hipwell, & Loeber, 2010). There seems to be no one cause of ODD as per McKinney and Renk’s (2007) argument that many factors, such as familial, biological, environmental, and individual have been associated with behavioral problems in children. In line with this view, Fossum (2008) expressed that child factors such as temperament; high rates of disruptive, impulsive, inattentive and aggressive behaviors; and family factors such as parenting, parental psychopathology, marital adjustment, and maternal age do indeed contribute to ODD. An extensive study by Patterson (1986) revealed that parenting is an important factor in the development of aggressive behaviors. As cited in Fossum (2008), Patterson asserted that parenting practices have indeed been recognized to be among the most powerful predictors of antisocial behavior and that several aspects of child rearing such as poor supervision, lack of parental warmth, and harsh styles of discipline are correlated with disruptive behavior in children. In agreement, Granero, Louwaars, and Ezpeleta (2015) argued that ODD is conceptualized as the result of the interaction of individual characteristics such as a high negative affectivity, low effortful control, and difficulties in social learning or emotional deregulation; with environmental adversities such as dysfunctional parenting style, parental psychopathology, socioeconomic problems, or family conflict. Behavioral problems may present in a variety of ways across a wide range of contexts over time. Social and parental expectations change across developmental stages as children’s communication, self-regulation, social skills, and coping skills mature. Most of the time, behavioral problems are short in duration, minor in severity, and co-occur with developmental stages and changes in familial and social expectations. Thus, risk factors and causal pathways in the development of behavioral problems are viewed within a transactional context involving developing children within an environment. A disorder results from interrelated maladaptive social, emotional, and/or cognitive competencies that hinder adjustment to the environment at a specific stage of development. It is important therefore to recognize both individual and environmental factors in the development of behavioral problems. According to a study by McKinney and Renk (2007) sex differences between boys and girls often have been noted for behavioral problems, with boys tending to have a higher number and a greater severity of behavioral problems relative to girls. For example, boys tend to exhibit more mother reported physical aggression and fewer prosocial behaviors. Such findings may be due in part to societal or stereotypical expectations regarding appropriate behaviors for boys versus girls. For example, parents may reinforce antisocial behaviors differentially in boys versus girls, suggesting that the initial developmental pathways to behavioral problems may be the same between the sexes but that these pathways then are influenced directly by parental responses. Furthermore, ODD arises out of a complex mix of risk and protective factors originating in the bio-psychosocial constellation of an individual. According to APA, (2013), these factors include temperamental factors related to problems in emotional regulation such as high levels of emotional reactivity, and poor frustration tolerance. The literature concerning underlying factors for disruptive behaviors identifies dysfunctional parent-child interactions, and child abuse as some of these behaviors. McKinney and Renk (2007) reported that low social economic status has also been identified as a demographic risk factor for behavioral problems. Other research has also determined that low socialeconomic status is a risk factor for almost 60% of families of children with behavioral problems in contrast to 23.8% of families of children without behavioral problems (McKinney & Renk, 2007). Additionally, there is evidence of a close response relationship between child behavior and poverty: the longer a child is in poverty, the more at risk they are of behavioral problems when compared to children from families in short term poverty or affluence (Duncan, BrooksGunn, Klebanov, 2004). The prevalence of significant emotional and behavioral problems were found to be 6% higher for children from lower socioeconomic groups than the average 10% for children at primary school level in a recent study in the South East of Ireland. Consistently, research on parenting variables demonstrated that parents of children with behavioral problems may be less consistent in their parenting, show more negative expectations, be less caring, and show higher levels of stress than parents of children without such problems. Further, negative parenting styles (e.g., uninvolved, Susan Chang’orok et al./ Elixir Social Studies 122 (2018) 51872-51881 51874 rejecting, harsh) have been related to behavioral problems in children. For example, children with problematic behaviors have a history of higher rates of negative interaction and of lower rates of harmonious interaction (McKinney & Renk, 2007). Ongoing parental conflict, particularly where it directly involves children increases the risk of poor outcomes for children. McKeown , Pratsche, Haase, (2003) found the first and most important process to affect child wellbeing, as reported by the child, was that of unresolved problems between the child and its parents, includ