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David Baxter

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Oppositional defiant disorder (ODD)
By Mayo Clinic Staff
Dec 19, 2007

Even the best-behaved children can be difficult and challenging at times. Teens are often moody and argumentative. But if your child or teen has a persistent pattern of tantrums, arguing, and angry or disruptive behaviors toward you and other authority figures, he or she may have oppositional defiant disorder (ODD). As many as one in 10 children may have oppositional defiant disorder in a lifetime.

Treatment of oppositional defiant disorder involves therapy and possibly medications to treat related mental health conditions. As a parent, you don't have to go it alone in trying to manage a child with oppositional defiant disorder. Doctors, counselors and child development experts can help you learn specific strategies to address oppositional defiant disorder.

Signs and symptoms
It may be tough at times to recognize the difference between a strong-willed or emotional child and one with oppositional defiant disorder. Certainly there's a range between the normal independence-seeking behavior of children and oppositional defiant disorder. It's normal to exhibit oppositional behaviors at certain stages of a child's development.

However, your child's issue may be oppositional defiant disorder if your child's oppositional behaviors:

A
  • re persistent
  • Have lasted at least six months
  • Are clearly disruptive to the family and home or school environment
The following are behaviors associated with ODD:

  • Negativity
  • Defiance
  • Disobedience
  • Hostility directed toward authority figures
These behaviors might cause your child to regularly and consistently show these symptoms:

  • Frequent temper tantrums
  • Argumentativeness with adults
  • Refusal to comply with adult requests or rules
  • Deliberate annoyance of other people
  • Blaming others for mistakes or misbehavior
  • Acting touchy and easily annoyed
  • Anger and resentment
  • Spiteful or vindictive behavior
  • Aggressiveness toward peers
  • Difficulty maintaining friendships
  • Academic problems
Related mental health issues
Oppositional defiant disorder often occurs along with other behavioral or mental health problems such as attention-deficit/hyperactivity disorder (ADHD), anxiety or depression. The symptoms of ODD may be difficult to distinguish from those of other behavioral or mental health problems.

It's important to diagnose and treat any co-occurring illnesses because they can create or worsen irritability and defiance if left untreated. Additionally, it's important to identify and treat any related substance abuse and dependence. Substance abuse and dependence in children or adolescents is often associated with irritability and changes in the child or adolescent's usual personality.

Causes
There's no clear cause underpinning oppositional defiant disorder. Contributing causes may include:

  • The child's inherent temperament
  • The family's response to the child's style
  • A genetic component that when coupled with certain environmental conditions ? such as lack of supervision, poor quality child care or family instability ? increases the risk of ODD
  • A biochemical or neurological factor
  • The child's perception that he or she isn't getting enough of the parent's time and attention
Risk factors
A number of factors play a role in the development of oppositional defiant disorder. ODD is a complex problem involving a variety of influences, circumstances and genetic components. No single factor causes ODD. Possible risk factors include:

  • Having a parent with a mood or substance abuse disorder
  • Being abused or neglected
  • Harsh or inconsistent discipline
  • Lack of supervision
  • Poor relationship with one or both parents
  • Family instability such as occurs with divorce, multiple moves, or changing schools or child care providers frequently
  • Parents with a history of ADHD, oppositional defiant disorder or conduct problems
  • Financial problems in the family
  • Exposure to violence
  • Substance abuse in the child or adolescent
When to seek medical advice
If you're concerned about your child's behavior or your own ability to parent a challenging child, seek help from your doctor, a child psychologist or child behavioral expert. Your primary care doctor or your child's pediatrician can refer you to someone.

The earlier this disorder can be managed, the better the chances of reversing its effects on your child and your family. Treatment can help restore your child's self-esteem and rebuild a positive relationship between you and your child.

Screening and diagnosis
Behavioral and mental health conditions are difficult to diagnose definitively. There's no blood test or imaging technique that can pinpoint an exact cause of behavioral symptoms, though these tests are sometimes used to rule out certain conditions. Physicians and other health professionals rely on:

  • Their clinical judgment and experience
  • Information gathered from parents and teachers, who may fill out questionnaires
  • Information gained from interviewing the child
Normal child and adolescent behavior and development can be challenging in their own right, but ODD is distinct due to the frequent and significant disruptions that are caused in the child's life at home, school, or in a job where authority figures have clear limits and expectations for behavior.

It can be difficult for doctors to sort and exclude other associated disorders ? for example, attention-deficit/hyperactivity disorder versus oppositional defiant disorder. These two disorders are commonly diagnosed together.

Complications
Many children with oppositional defiant disorder have other treatable conditions, such as:

  • Attention-deficit/hyperactivity disorder (ADHD)
  • Depression
  • Anxiety
If these conditions are left untreated, managing ODD can be very difficult for the parents, and frustrating for the affected child. Kids with oppositional defiant disorder may have trouble in school with teachers and other authority figures and may struggle to make and keep friends.

ODD may be a precursor to other, more severe behavioral disorders such as conduct disorder, but this is controversial.

Treatment
Ideally, treatment for oppositional defiant disorder involves your primary care doctor and a qualified mental health professional or child development professional. It may also help to seek the services of a psychologist specializing in family therapy.

These health professionals can screen for and treat other mental health problems that may be interfering with oppositional defiant disorder, such as ADHD, anxiety or depression. Successful treatment of the often-coexisting conditions will improve the effectiveness of treatment for ODD. In some cases, the symptoms of ODD disappear entirely.

Successful treatment of oppositional defiant disorder requires commitment and follow-through by you as a parent and by others involved in your child's care. Most important in treatment is for you to show consistent, unconditional love and acceptance of your child ? even during difficult and disruptive situations. Doing so can be tough for even the most patient parents.

Learning or improving parental skills
A mental health professional can help you learn or strengthen specific skills and parenting techniques to help improve your child's behavior and strengthen your relationship with him or her. For example, you can learn how to:

  • Give effective timeouts
  • Avoid power struggles
  • Remain calm and unemotional in the face of opposition
  • Recognize and praise your child's good behaviors and positive characteristics
  • Offer acceptable choices to your child, giving him or her a certain amount of control
  • Establish a schedule for the family that includes specific meals that will be eaten at home together, and specific activities one or both parents will do with the child
  • Limit consequences to those that can be consistently reinforced and if possible, last for a limited amount of time
Success requires perseverance, hard work
Although some parent management techniques may seem like common sense, learning to use them in the face of opposition isn't easy, especially if there are other stressors at home. Learning these skills may require counseling, parenting classes or other forms of education, and consistent practice and patience.

At first, your child is not likely to be cooperative or to appreciate your changed response to his or her behavior. Expect that you'll have setbacks and relapses, and be prepared with a plan to manage those times. In fact, behavior often temporarily worsens when new limits and expectations are set. However, with perseverance and consistency, the initial hard work often pays off with improved behavior and relationships.

Individual and family counseling
Individual counseling for your child may help him or her learn to manage anger. Family counseling may help improve communication and relationships and help family members learn how to work together.

Self-care
At home, you can begin chipping away at problem behaviors by practicing the following:

  • Recognize and praise your child's positive behaviors.
  • Model the behavior you want your child to have.
  • Pick your battles. Avoid power struggles.
  • Set limits and enforce consistent reasonable consequences.
  • Set up a routine. Develop a consistent daily schedule for your child.
  • Build in time together. Develop a consistent weekly schedule that involves parents and child being together.
  • Work with your spouse or others in your household to assure consistent and appropriate discipline procedures.
  • Assign your child a household chore that's essential and that won't get done unless the child does it. Initially, it's important to set your child up for success with tasks that are relatively easy to achieve and gradually blend in more important and challenging expectations.
Coping skills
For yourself, counseling can provide an outlet for your own mental health concerns that could interfere with the successful treatment of your child's symptoms. If you're depressed or anxious, that could lead to disengagement from your child ? and that can trigger or worsen oppositional behaviors. Here are some tips:

Learn ways to calm yourself. Keeping your own cool models the behavior you want from your child.
Take time for yourself. Develop outside interests, get some exercise and spend some time away from your child to restore your energy.
Be forgiving. Let go of things that you or your child did in the past. Start each day with a fresh outlook and a clean slate.
 

butterfly88

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Hi Dr. Baxter -

In pursuit of my MA, I learned a bit about disruptive disorders including CD and ODD. I'm interested though to learn a bit more specifically regarding any types of interventions. It's my understanding that the most effective approach is behavioral interventions (e.g., implementing contingencies of reinforcement, parent training, etc).

My 14 year-old niece exhibits each and every behavioral characteristic of ODD, as well as DX of ADHD and depression. She is also severely learning disabled and epileptic, therefore, medication to address ADHD has been difficult as it often interferes with her anti-seizure medication.

In school - she is non-complaint, oppositional, curses out teachers, and spends a GOOD deal of time out of the class (in detention, at the principals office, etc.) She is failing every class, and I feel, is suffering from learned helplessness. She has only (if ever) very infrequently had success in school, therefore the environment is extremely aversive. She fails to even try to engage in school work and there are no contingencies in place to reinforce appropriate behavior. And more troubling, reinforcement for the inappropriate behavior is so often provided by ways of escape from the school environment (being sent to the office, home-suspensions, etc).

At home she is pretty much the same. And the same problems that exist in school regarding a lack of reinforcement contingencies also exist at home. I've tried repeatedly to discuss these issues with my sister - as my niece is also very much an attention seeker - so when my sister yells and screams at her - this behavior, while perhaps punishing to someone else, only serves to reinforce the inappropriate behavior.

This post is getting a lot longer than I intended - sorry. I guess what I am asking is this - do you think it would benefit my niece to be evaluated for ODD? Will it in any way help her or hurt her to have such a DX? Here in the states she is already classified as a student with a disability and as such is receiving special education services. My concern is that those with a classification of an Emotional/Behavioral Disorder are often shunned by the schools and sent off to "alternative" placements. This most certainly would not benefit my niece - as she needs appropriate role-models not juvenile offenders.

Is there a way to help her without getting the DX?
 

Misha

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My mom "diagnosed" me with this when I was a kid. I find it so hard with childhood diagnoses, it's so normal for a child to have characteristics of so many disorders... but they're just being children. When my mom came up with this title for me, she spoke to our family doctor, who said "Why label it? She is who she is.... lets take it from there." In my situation, that was wise. Although I never lived down my mom's view of there being something "wrong" with me.
 

butterfly88

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Hi Misha -

Yes, I agree that many times most children engage in many these types of behaviors, and "labeling" in those situations is completely uncalled for. My concern is that my niece has been engaging in these behaviors now for going on 3 years and they are escalating in frequency, duration, and intensity - and are having a severe and negative impact on her life. :(
 

Misha

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Butterfly.... I agree that when it's so prominent it's good to have an idea of what's going on. Keep us updated on what is happening with your niece.
 
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Hi Butterfly 88 I think getting professional opinion in this case will not do your neice any harm as she is already struggling. Getting her help now while she is young is important because if this behavior is not dealt with it will only esculate. See what a professional says and let them decide what is needed for your niece. You can only go with what you think and your sister thinks is right here. I took my daughter in at age 13 for help and yes she was labelled but she got the help she needed at the time thanks mary.
 

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