Oppositional Defiant Disorder (ODD)
Parenting a child who has very defiant behavior or who is diagnosed with Oppositional Defiant Disorder (ODD) can be very exhausting and frustrating. These parents need to employ strategies that are different from those used to parent a typical child.
What is Oppositional Defiant Disorder?
ODD is more than just bad behavior. It is when a child’s emotions and thoughts are out of balance causing the child to defy and not cooperate.
Oppositional Defiant Disorder (ODD) is a type of Disruptive Behavior Disorder (DBD).
In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), ODD is defined as a recurrent pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months.
Children diagnosed with ODD exhibit developmentally inappropriate, negative, defiant, and disobedient behavior toward authority figures. Children with ODD often have substantially strained relationships with peers and authority figures such as parents and teachers.
ODD children also have high rates of coexisting conditions such as Attention Deficit / Hyperactivity Disorder (ADHD) and mood disorders that need to be attended to.
Oppositional Defiant Disorder Symptoms
To be diagnosed to have ODD, an individual must have at least 4 symptoms from the following3:
- Often loses temper
- Often touchy or easily annoyed
- Often angry and resentful
- 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 are distinguished from behaviors that are developmentally appropriate for children of different ages. For example, for children younger than 5 years, the behavior should occur on most days; for children 5 years or older, the behavior 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
The risk factors for ODD are not well understood. It appears there is no single, overwhelming cause that produces ODD. However, three dimensions of risk factors have been identified to contribute4:
Children with ODD may come from a family with a history of disorders (e.g. DBD, ADHD, substance abuse or mood disorders). They may be born with a difficult temperament. Or they may have lower arousal levels or cortisol levels when exposed to frustration causing them to more likely engage in fights to raise those levels7.
Many parents respond to difficult children with harsh, coercive, inconsistent, neglectful or abusive parenting techniques. As a result, those children have difficulty with attachment and cannot read social cues to act in a socially appropriate way8‘9.
Stressed parents are more likely to use ineffective parenting strategies and cause even more stress for the family.
External stress factors (e.g. poverty, lack of structure and community violence) 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.
These 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 and compromise their ability to regulate their emotions and behavior11.Research shows that 3 risk factors contribute to ODD: biological, ineffective parenting & stress.Click To Tweet
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 about equally in boys and girls. 12‘13. 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 children14.
Timing Of ODD Treatment
Many psychologists consider prevention and early treatment a key element in ODD intervention because children with early onset of ODD are three times more likely to develop CD later in life15. These interventions can be delivered in clinics, schools or community centers16.
In preschools, programs such as the Head Start have been shown to be 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 outcomes17.Oppositional defiant disorder: prevention and early treatment are key elements in ODD interventionClick To Tweet
Oppositional Defiant Disorder Strategies and Treatment
Treatments are determined based on many factors, including the child’s age, the severity of symptoms, and the child’s ability to participate in and tolerate specific therapies. 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:
Parenting Management Training
For school-age children, parenting management trainings are the most commonly recommended as the first line of approach18. The underlying principles of these trainings for parents are:
- Be a good role model by reducing coercive parent-child interactions. If you are overwhelmed with emotions yourself, take a break. Don’t contribute to the conflict.
- Build on positive reinforcement. Find ways to praise your child and reward prosocial and non-defiant behavior.
- Set reasonable, age appropriate limits and apply consequences that can be easily and consistently enforced, such as time-out, loss of privileges, etc.
- Choose your battles wisely by prioritizing things you want your child to do.
- Manage your own 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 (not against your child).
Here are two books I highly recommend to all parents, including parents who are dealing with a defiant child. Although these books do not address ODD specifically, the parenting strategies outlined in them are sound and effective in almost any parenting and disciplinary situations.
Positive discipline is a disciplinary principle based on mutual respect and positive guidance. It focuses on creating learning opportunities for the future instead of punishing mistakes of the past. The author has written a series of books on this topic, each caters to a slightly different age group or audience. My recommendation is to start with this one which covers all you need to know about Positive Parenting and then supplement with others in the series as your child ages.
Our childhood affects how we parent no matter how much we want to deny it. Even for those who have had a happy childhood, they may still have unresolved issues that prevent them from being the best parents they can be.
Age-appropriate strategies given in this book not only help parents deal with day-to-day struggles, but also demonstrate how to use “brain integration” to help children grow and thrive.
Direct child-training approaches such as psychotherapy should be reserved for older children who have greater capacity to benefit from the cognitive-behavioral approaches19.
When ODD co-occurs with other disorders such as ADHD, pharmacotherapy may be used. 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. Patient and families need to commit to long term participation.
In addition, early treatment is recommended in order to increase treatment efficacy and long-term outcomes (AACAP, 2012).
Occasionally, the severity, persistence or unusualness of the disruptive behavior 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, the effectiveness of such treatments is inconclusive in studies. Families and clinicians should weight the potential benefits against the risks of such treatments.
Loeber, et al., 2000 ↩
Hall et al, 2000 ↩
Burke et al., 2002 ↩
Jacobson, Prescott, & Kendler, 2002 ↩
Snoek et all, 2004 ↩
Coie & Dodge, 1998 ↩
Hinshaw & Lee, 2003 ↩
Coie & Dodge, 1998 ↩
Carlson 2010; Putnam 2006 ↩
Hinshaw and Lee, 2003 ↩
Burke et al., 2002; Connor, 2002; Hinshaw and Anderson, 1996; Rutter et al., 1999 ↩
Eckenrode et al., 2000 ↩
Eyberg, Nelson, & Boggs, 2008 ↩