Parenting a child with oppositional defiant disorder (ODD) can be very exhausting and frustrating. These parents need to employ Oppositional Defiant Disorder strategies that are different from those used to parent a typical child.
Table of Contents
- What is Oppositional Defiant Disorder (ODD)
- ODD Symptoms
- Oppositional Defiant Disorder Causes
- How Common Is ODD In Children
What is Oppositional Defiant Disorder (ODD)
In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM 5), Oppositional Defiant Disorder is defined as a recurrent pattern of anger/irritable mood, argumentative/defiant behavior, or vindictiveness lasting for at least 6 months.
Oppositional Defiant Disorder in children is a type of Disruptive Behavior Disorder (DBD). It is more than just defiant behavior. A child has ODD when their emotions and thoughts are out of balance, causing the child to vigorously defy and not cooperate, for an extended period of time.
Children diagnosed with ODD often exhibit developmentally inappropriate negative, disobedient and defiant behavior toward authority figures. They have substantially strained relationships with peers and authority figures such as parents and teachers1.
ODD children are at substantial risk of mental health problems such as mood, anxiety, impulse‐control, and substance use disorders2. Boys with Oppositional Defiant Disorder are much more likely than girls to develop Conduct Disorder (CD), while girls with ODD are more likely to develop depression later in life3.
ODD kids also have high rates of coexisting mental health conditions such as Attention Deficit Hyperactivity Disorder (ADHD) and mood disorders that need to be attended to.
To be diagnosed to have ODD, an individual must have at least 4 symptoms from the following:
- Angry/Irritable Mood
- Often loses temper
- Often touchy or easily annoyed
- Often angry and resentful
- Argumentative/Defiant Behavior
- Often argues with authority figures or with adults (if a child or adolescent)
- Often actively defies or refuses to comply with requests from authority figures
- Often deliberately annoys others
- Often blames others for his or her mistakes or poor behavior
- Has been spiteful or vindictive at least twice within the past 6 months
Note: Symptoms are distinguished from the child’s behavior that is developmentally appropriate for children of different ages.
For example, for children younger than 5 years old, the misbehavior should occur on most days; for children 5 years or older, the misbehavior should occur at least once per week.
Symptoms may be present at home, in the community, at school, or in all three settings.
Oppositional Defiant Disorder Causes
Causes of Oppositional Defiant Disorder are not well understood. It appears there is no single, overwhelming cause that produces ODD. However, there are risk factors that have been identified to contribute.
Most authorities believe that biological factors are important4.
Children with ODD may come from a family with a history of mental health disorders (e.g., DBD, ADHD, substance abuse, or mood disorders). Or the child may be born with a difficult child temperament. They may have lower arousal levels or cortisol levels when exposed to frustration, causing them to more likely to engage in fights to raise those levels5.
Maternal smoking during pregnancy has also been found to be associated with ODD in children6.
Environmental toxins, such as lead, is another risk factor. High levels of lead in children are associated with high aggressiveness.
Children are born with different temperaments. Some babies are easier, while others are more difficult to take care of. Some parents respond to difficult children with harsh, coercive, inconsistent, neglectful or abusive parenting techniques7. As a result, those children have difficulty with attachment and cannot read social cues to act in a socially appropriate way.
Research also shows that an oppositional and aggressive child’s behavior is highly correlated with aggressive parenting practices such as corporal punishment8. The behavior is also associated with negative reinforcement traps created by inconsistent parenting9.
Early Developmental Stress
Stress during a child’s early development is another potential cause of ODD. It is associated with the disorder through different pathways.
First, stressed parents are more likely to use ineffective parenting strategies and cause even more stress for the family.
Second, external stress factors (e.g. poverty, lack of structure, community violence and child maltreatment) or internal stress factors (e.g. single parenting, parental depression, substance abuse, antisocial behavior, aggressive behavior, poor family functioning, domestic violence or child abuse) also seem to play a role in the severity of disruptive behaviors in children10,11.
These different stress factors can leave a child traumatized, leading to Post Traumatic Stress Disorder (PTSD). Traumatized children display more oppositional defiant behavior because trauma can cause them to be more vulnerable to stressors. Trauma also compromises these children’s ability to regulate their emotions and behavior12,13.
How Common Is ODD In Children
Studies suggest that 1 to 20 percent of children and adolescents have ODD. It typically begins by age 6-8.
In younger children, it is more common among boys. In older children, ODD is found equally in boys and girls8,14.
Children who exhibit a persistent pattern of oppositional behavior during preschool years are also more likely to be diagnosed with ODD during their elementary years.
Typically, ODD is not diagnosed in children younger than age 3 because temper tantrums, one of the criteria for ODD, is a common and developmentally appropriate behavior for these young children.
After age 3, children are more capable of expressing frustrations verbally and behaving in more socially acceptable ways. Therefore, ODD is better diagnosed in late preschool or early school-age children.
Timing Of ODD Treatment
Many psychologists consider prevention and early treatment the keys in ODD intervention. Children with early onset of ODD are three times more likely to develop CD later in life.
These early interventions can be delivered in clinics, schools, or community centers15.
In preschools, programs such as Head Start are effective in preventing future delinquency, which is one of the more negative outcomes for children with ODD.
Home visitations to high-risk families by trained clinicians have also produced positive outcomes.
Oppositional Defiant Disorder Strategies & Treatment
Treatments are determined based on many factors that may include the child’s age, the severity of symptoms, and the child’s ability to participate in and tolerate specific therapies16. Proper treatment strategies can be formed by working with your child’s healthcare provider and school. A treatment plan should target domains and behavior that are dysfunctional and impairing the child’s life.
Prescribed treatments and interventions usually consist of a combination of the following list.
How To Parent A Child With ODD
Parenting a child with Oppositional Defiant Disorder is challenging and often exhausting. The following are two proven discipline strategies to parent an ODD child17.
Parenting Management Training (PMT)
For school-age children, parenting management training is the most commonly recommended as the first line of approach. The underlying principles of this parent training are:
- Be a good role model by reducing coercive parent-child interactions. If you are overwhelmed with emotions, take a break. Don’t contribute to the conflict, and model how to properly handle one.
- Build on positive reinforcement. Find ways to praise your child and reward prosocial and non-defiant behavior.
- Set reasonable, age-appropriate limits and consequences ahead of time. Apply consequences that can be readily and consistently enforced. Examples of consequence are gentle time-out, loss of privileges, etc.
- Choose your battles wisely. Avoid power struggles by prioritizing things you want your child to do the most.
- Manage your stress and create a support network for yourself. It is hard to parent an ODD child. Find other adults such as your spouse, teachers, coaches to work together with your child and support each other. Make sure you are working with your child, not against your child.
Collaborative & Proactive Solutions (CPS)
Although PMT is a well-established, proven treatment plan in large sample size, there are some noticeable shortcomings:
- PMT doesn’t work well in older, more aggressive youth, and the attrition rates in the program can be quite high (up to 50%).
- Children with ODD have problems with authority often due to controlling parenting practice. Yet PMT’s primary focus is improving compliance of rules while not addressing the parent-child process that gives rise to the oppositional behavior problems. This is likely the reason why it doesn’t work well with older children.
Collaborative & Proactive Solutions (CPS) is an alternative strategy for parents of ODD kids. It is an intervention based on a cognitive behavioral therapy model18. Although CPS is a relatively new method compared to PMT, researchers have found that it produces equivalent results while overcoming to some of PMT’s shortfalls.
CPS focuses primarily on helping parents learn to solve problems that contribute to defiant behavior problems collaboratively and proactively with children. The purpose is to increase flexibility, adaptability, and problem-solving skills in both the parents and the children.
The principles19 of CPS are to help parents:
- Understand the specific adult and child’s contributing to the development of the child’s oppositional behavior
- Be aware of three elements in handling unmet parental expectations
- imposition of adult will
- collaborative problem solving
- expectation removal
- Recognize the impact of each of these three elements on the parent-child interaction
- Along with their children, become proficient in resolving disagreements, preventing power struggle and defusing potentially conflicts that lead to oppositional episodes
- Improve parent-child compatibility
Direct child-training approaches with a therapist such as psychotherapy should be reserved for older children who have a higher capacity to benefit from such an approach.
When ODD co-occurs with other disorders such as Attention Deficit Hyperactivity Disorder, medication may be needed. However, this should only be done after other strong treatment alliances such as parenting training and psychotherapy are established.
In general, all of these treatments are not brief since establishing new attitudes and behavior patterns takes time. One-time or short-duration treatments are not likely to be effective. Patients and families need to commit to long term participation.
Also, early treatment is recommended to increase treatment efficacy and long-term outcomes.
Occasionally, the severity, persistence, or unusualness of the disruptive problem behaviors would reach the subthreshold level for Conduct Disorder (CD). When that happens and when the patient fails to respond to other treatment regimes, intensive and prolonged treatment such as intensive day treatment, residential, etc. may be warranted. However, success in such methods has not been proven in studies. Families and clinicians should weigh the potential benefits against the risks of such practices.
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