What is Oppositional Defiant Disorder? 1,2,3 Oppositional defiant disorder (ODD) is one of a group of behavioral disorders called disruptive behavior disorders. Children and teens with ODD have a pattern of disobedient, hostile, and defiant behavior directed toward authority figures including parents, teachers, principals, and coaches. All children go through periods of uncooperative or hostile behavior that is actually normal, independence seeking behavior especially in toddlers and teenagers, but those with ODD exhibit these behaviors at school, at home, and in public on a constant basis and symptoms interfere with learning, classroom and household functioning, and relationships with others. ODD can first appear in late preschool or early school-aged children, but typically starts by age 8. What are symptoms of Oppositional Defiant Disorder? It can be difficult for some parents to see defiant behavior as a symptom of a mental health disorder, and it can be tempting to assume that a child will “grow out of it.” Common behaviors seen in those with ODD include:1,3,4 Defiance Spitefulness and revenge seeking Negativity Hostility and verbal aggression, mean and hateful talking Frequent temper tantrums Excessive arguments with adults Refusing to comply with rules and requests Deliberately annoying and upsetting others Touchy or annoyed by others Blaming others for their mistakes Frequent outbursts of anger and resentment Has few or no friends, or has lost friends These behaviors are constant, last longer than six months, and are excessive compared to the behavior of other children the same age. Girls may show symptoms differently than boys showing aggression through words rather than actions, and other indirect ways such as lying and being uncooperative, where a boy may lose his temper and argue with an adult. Estimates suggest between 1-16% of children and adolescents have ODD. In younger children ODD is more common in boys, but once reaching school age, boys and girls are equally diagnosed. A diagnosis of ODD can be accompanied by other mental health disorders including ADHD (most common), anxiety disorders, mood disorders, learning disorders, and language disorders. 1,2,5 What causes Oppositional Defiant Disorder?1,4 Many parents report that from an early age their child with ODD was more rigid and demanding than siblings or peers. Science has not identified any one cause of ODD but biological, psychological, and social risk factors are all thought to contribute to risk. Biological risk factors include: A parent with ADHD, ODD, Conduct Disorder, mood disorder, substance abuse or drinking problem. Brain chemical imbalance.Exposure to toxins, exposure to smoke during pregnancy, and poor nutrition. Psychological factors include: A poor relationship with at least one parent, parental neglect or absence. Difficulty forming social relationships or processing social cues. Social Risk Factors: A chaotic environment, inconsistent discipline, family instability including divorce or frequent moves. What can be done to treat Oppositional Defiant Disorder? A treatment plan will be tailored to the needs and behavioral symptoms of each child as well as age, severity, and co-occurring mental health conditions. ODD treatment can last several months or more and requires a parent’s commitment and follow-through, below are some treatment options that may be employed:1,6 Individual/Behavioral therapy-Cognitive problem-solving skills to reduce inappropriate behaviors teaching positive ways of responding to stressful situations, and social skills training to relate more positively to peers and improve communication skills. Manage anger and express feelings in a healthy way. Parent Child Interaction Therapy (PCIT)- coaching parents while they interact with their children using strategies to reinforce their child’s positive behavior, improving the quality of the parent-child relationship and decreasing problem behaviors. Seeking treatment for any co-occurring mental health condition or learning disorder can decrease the behavioral symptoms of ODD. If left untreated, ODD can develop into Conduct Disorder, a more serious behavioral disorder that can lead to destructive antisocial behavior, and an increased risk of substance abuse and delinquency. Parenting a child or teen with ODD can be a trying and difficult challenge for parents, intervention strategies that work with most children such as time-outs, removal of privileges, and grounding often do not work with ODD. Seeking support and counseling means you as a parent gain strategies to react calmly when confronting extreme behavior, and learn ways of coping with the stress of parenting in the face of such difficult circumstances.1,2 Resources: 1 American Academy of Child & Adolescent Psychiatry 2 American Association for Marriage and Family Therapy 3 US National Library of Medicine, Medline Plus 4 AACAP – Children with Oppositional Defiant Disorder 5 Hopkins Medicine – Oppositional Defiant Disorder 6 Mayo Clinic – Oppositional Defiant Disorder
