How Do Oppositional and Obsessive-Compulsive Behaviors Develop Together in Children?

What you need to know

• About 9% of children show both oppositional defiant behaviors and obsessive-compulsive behaviors from ages 6-13.
• When these behaviors occur together, children tend to have more severe symptoms and difficulties.
• Identifying these patterns early can help target interventions to support better adjustment as children develop.
• Key areas to focus on include managing emotions, improving executive functioning skills, and supporting peer relationships.

Understanding oppositional and obsessive-compulsive behaviors in children

As children grow and develop, some may struggle with behavioral or emotional challenges. Two common types of difficulties that can emerge in childhood are oppositional defiant behaviors and obsessive-compulsive behaviors.

Oppositional defiant behaviors involve frequent arguing, losing one’s temper, being easily annoyed, deliberately annoying others, blaming others, and acting spiteful. These behaviors are typically directed at authority figures like parents or teachers.

Obsessive-compulsive behaviors involve having unwanted, intrusive thoughts (obsessions) and feeling compelled to perform certain actions repeatedly (compulsions). For children, this might involve excessive hand washing, organizing objects in a very particular way, or needing to perform certain routines.

While these two types of behaviors may seem quite different, this study found that they often occur together as children develop. Understanding how and why this happens can help parents and professionals better support children who are struggling.

How the study was conducted

The researchers followed 563 children from ages 6 to 13, assessing them each year on measures of:

• Irritability (e.g. losing temper, being easily annoyed)
• Defiant behaviors (e.g. arguing, deliberately annoying others)
• Obsessive-compulsive behaviors

They used advanced statistical techniques to identify groups of children who showed similar patterns in how these behaviors developed over time.

Key findings: Four developmental patterns

The study identified four main patterns in how oppositional and obsessive-compulsive behaviors developed from ages 6-13:

1. Low levels of all behaviors (62% of children)
2. High obsessive-compulsive behaviors only (9.4%)
3. High irritability and defiance only (19.2%)
4. High levels of all behaviors - irritability, defiance, and obsessive-compulsive (9.4%)

Let’s look at each of these groups in more detail:

1. Low levels of all behaviors

The majority of children (62%) showed consistently low levels of irritability, defiance, and obsessive-compulsive behaviors throughout the study period. This represents typical development for most children.

2. High obsessive-compulsive behaviors only

About 9% of children showed high levels of obsessive-compulsive behaviors, but low irritability and defiance. Key characteristics of this group included:

• High rates of anxiety disorders
• More internalizing symptoms like depression and social withdrawal
• Higher negative emotions
• More frequent tics and hoarding behaviors
• Lower levels of surgency (a temperament trait involving high activity and pleasure-seeking)

3. High irritability and defiance only

Approximately 19% of children showed high levels of irritability and defiant behaviors, but low obsessive-compulsive behaviors. This group tended to have:

• More disruptive behavior disorders like ADHD
• Higher self-reported anger/irritability by early adolescence
• More difficulties with cognitive regulation and executive functioning

4. High levels of all behaviors

About 9% of children showed high levels across all three types of behaviors - irritability, defiance, and obsessive-compulsive symptoms. This group had the most severe difficulties overall, including:

• Highest rates of disruptive behavior disorders
• Most severe oppositional defiant symptoms
• Highest levels of externalizing problems like aggression and rule-breaking
• Most difficulty with peer relationships
• Lowest levels of effortful control (ability to manage attention and behavior)
• Most impairment in daily functioning
• Greatest difficulties with executive functioning skills by adolescence

Why it matters: Impact on children’s development

The study found that when oppositional and obsessive-compulsive behaviors occur together, children tend to have more severe symptoms and greater impairment compared to when they occur separately.

Specifically, children with high levels of all behaviors showed:

• More psychiatric diagnoses and comorbid conditions
• Greater functional impairment in daily life
• More peer relationship problems
• Lower effortful control (ability to regulate behavior and emotions)
• More difficulty across multiple areas of executive functioning

This suggests there may be a synergistic effect when these behaviors co-occur, leading to more significant challenges for children as they develop.

The researchers note that middle childhood (ages 6-10) appears to be a key period when these behaviors are most likely to co-occur at high levels. This highlights the importance of early identification and intervention.

Practical implications

The findings have several important implications for supporting children’s healthy development:

Early assessment is key

Given that co-occurring oppositional and obsessive-compulsive behaviors are associated with more severe difficulties, it’s important to assess for both types of behaviors when children are showing problems in either area. Don’t assume that a child with oppositional behaviors isn’t also struggling with obsessive-compulsive symptoms, or vice versa.

Focus on emotion regulation

High levels of irritability were a key feature for children with co-occurring behavioral challenges. Teaching children strategies to manage strong emotions and frustration may be particularly beneficial.

Build executive functioning skills

Children with both oppositional and obsessive-compulsive behaviors showed the greatest difficulties with executive functioning by adolescence. Interventions that target skills like attention control, flexibility, planning, and organization may be helpful.

Support peer relationships

Difficulty with peers was another hallmark of children with co-occurring behavioral challenges. Helping children develop social skills and positive peer relationships could have protective effects.

Consider family-based approaches

The study found that children with both types of behaviors placed a high burden on families. Interventions that support the whole family system may be most effective.

Individualize treatment

While there were clear patterns, every child is unique. The specific behaviors and challenges a child displays should guide treatment planning.

Conclusions

• Oppositional and obsessive-compulsive behaviors often develop together in childhood, particularly during ages 6-10.
• When these behaviors co-occur, children tend to have more severe symptoms and greater impairment across multiple areas of functioning.
• Early identification of these patterns can help target interventions to support better outcomes as children develop.
• Key areas to focus on include emotion regulation, executive functioning skills, and peer relationships.
• Individualized, family-centered approaches are likely to be most beneficial for children struggling with both types of behaviors.

By understanding how these behavioral patterns unfold during childhood, parents, teachers, and mental health professionals can better support children’s healthy development and target interventions to those who need them most.