What is ODD in children
Oppositional Defiant Disorder (ODD) is defined as a recurrent pattern of anger/irritable mood, argumentative/defiant behavior, or vindictiveness lasting for at least 6 months.
ODD 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.
Kids with ODD often exhibit developmentally inappropriate negative, disobedient and defiant behavior toward authority figures. They tend to have frequent angry outbursts. They also have substantially strained peer relationships, parent-child relationship and relationships with authority figures such as teachers1.
These children are at significant risk of mental health problems such as mood, impulse‐control, substance use, and anxiety disorders2. Boys with Oppositional Defiant Disorder are more likely than girls to develop behavioral disorder, antisocial personality disorder or 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.
ODD Symptoms – Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM 5)
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
Symptoms of ODD 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.
What Causes ODD In A Child
ODD is not caused by one single definitive factor. There are a number of risk factors that have been identified to contribute to the disorder.
Child Biological Factors4
- Genetics – Even though genetics by itself isn’t a risk factor, it can become one in the presence of other factors. Intergenerational transmission can also occur when children come from a family with a history of mental health disorders (e.g., DBD, ADHD, substance abuse, or mood disorders).
- Neuroanatomy – Brain functioning deficits such as frontal lobe damage or amygdala impairment can lead to impulsive aggression and difficulty in suppressing negative emotion.
- Neurotransmitters – Chemical imbalance in the brain results in aggression.
- Hormones and nervous system – Lower arousal or cortisol levels when exposed to frustration may cause aggression in order to raise those levels5.
- Prenatal and perinatal problems – Maternal smoking during pregnancy and birth complications are associated with ODD in children6.
- Neurotoxins – Environmental toxins, such as lead, are risk factors. High levels of lead in children are associated with high aggressiveness.
Child functional factors6
- Difficult temperament – Difficult children can be harder to soothe. When dysregulated, it may encourage ineffective parenting which provokes oppositional behavior.
- Poor social skills – Kids who fail to read social cues from others tend to attribute hostile intentions to those around them, indirectly leading to antisocial behavior.
- Less moral reasoning – Those with less moral development violates other people’s rights and rules7.
- Ineffective parenting – extensive research has confirmed that poor parenting is related to disruptive behavior in ODD children8.
- Harsh discipline – Aggressive discipline such as corporal punishment is one of the strongest predictors of oppositional behavior9. It tends to result in faulty neuroception of safety in the child.
- Peer effects – Both peer rejection and association with deviant peers are risk factors.
- Socioeconomic status (SES) and neighborhood – Many ODD kids are particularly associated with lower SES and disadvantaged neighborhoods.
- Life stressors and coping skills – Exposure to daily stressors early in life, such as family dysfunction, adds to the risk for ODD10. External stress factors (e.g. poverty, lack of structure, and community violence) or internal stress factors (e.g. single parenting, domestic violence, child abuse11, or parental depression, substance abuse, antisocial behavior and aggressive behavior) can also play a role in the severity of behavioral issues in children12,13.
Oppositional Defiant Disorder Statistics
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 girls14,15.
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 under age 3 because frequent 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 mental health professionals consider prevention, early detection, and early treatment the keys in ODD intervention. Children with early onset of ODD are three times more likely to develop psychiatric disorders later in life.
These early intervention can be delivered in clinics, schools, or community centers16.
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 Treatment
Treatment options 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 therapies17.
Proper treatment strategies can be formed by working with your child’s healthcare provider and school. A treatment plan should target domains and child’s behavior that are dysfunctional and impairing the child’s life.
Prescribed treatment of ODD usually consists of a combination of the following.
Parenting Management Training (PMT)
For school-age children, parenting management training is the most commonly recommended approach as the first-line treatment.
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.
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.
How to parent a child with ODD
One of the most significant risk factors for ODD is ineffective parenting18. However, it may not be the cause or the only cause for the child’s disorder. Scientists find that ODD is more likely caused by a combination of factors rather than one risk factor alone. Thus, treating multiple domains tends to be more successful than treating a single factor19.
Along with seeking medical treatment for your child, parents can help by modifying their parenting practices or ensuring they do not worsen the condition, regardless of whether parenting is the cause.
The following are two proven discipline strategies to parent an ODD child20.
Parenting Management Training (PMT)
For school-age children, parenting management training is the most commonly recommended approach as the first-line treatment. The underlying principles of this parent training are:
- Be a good role model by reducing coercive 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 good 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, child’s teacher, 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 model21. 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 principles22 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
Frequently Asked Questions
Although bad parenting practice is a potential cause for ODD, it is not the only plausible cause. Genetic or early developmental stress could lead to this, too. If you worry about your parenting strategies being the reason for your child’s ODD behavior, the best thing to do is to get professional diagnosis and help. Keep in mind that you don’t need to be perfect to be a good parent. We cannot control all factors in our kids’ lives. As long as you have your child’s best interest in mind, that’s good enough.
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