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Oppositional Defiant Disorder Strategies

Parenting a child who has very defiant behavior problems or who is diagnosed 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.

What is Oppositional Defiant Disorder (ODD)

Oppositional Defiant Disorder in children is more than just defiant behavior. It is when a child’s emotions and thoughts are out of balance, causing the child to defy and not cooperate.

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 for at least 6 months.

Boy holding fist - oppositional defiant disorder 5 year old strategies

Children diagnosed with ODD exhibit developmentally inappropriate negative, disobedient and defiant behavior toward authority figures. Children with ODD often have substantially strained relationships with peers and authority figures such as parents and teachers​1​.

ODD children are at substantial risk of mental health problems such as mood, anxiety, impulse‐control, and substance use disorders​2​. 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 life​3​.

ODD kids also have high rates of coexisting conditions such as Attention Deficit Hyperactivity Disorder (ADHD) and mood disorders that need to be attended to.

Related: What Is Attention Deficit Hyperactivity Disorder ADHD

Boy holding fists - What is odd

ODD Symptoms

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
  • Vindictiveness
    • 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 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 causes for 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.

odd can be caused by genetic inheritance

Biological

Most authorities believe that biological factors are important​4​.

Children with ODD may come from a family with a history of mental health disorders (e.g., DBD, ADHD, substance abuse, or mood disorders). They may be born with a difficult child 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 levels​5​.

Maternal smoking during pregnancy has also been found to be associated with ODD in children​6​.

Environmental toxins, such as lead, is another risk factor. High levels of lead in children are associated with high aggressiveness.

Related: What Is Temperament

oppositional defiant behavior can be caused by parenting

Ineffective parenting

Children are born with different temperaments. Some babies are easier, while others are more difficult to take care of. Many parents respond to difficult children with harsh, coercive, inconsistent, neglectful or abusive parenting techniques​7​. 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 punishment​8​. The behavior is also associated with negative reinforcement traps created by inconsistent parenting​9​.

odd can be caused by environment risk factors such as family stress

Early Developmental Stress

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, 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 children​10,11​.

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. Trauma also compromises these children’s ability to regulate their emotions and behavior​12,13​.

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 girls​8,14​.

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.r

ODD Diagnosis

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 centers​15​.

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.

Girl yells - Oppositional defiant disorder treatment

Oppositional Defiant Disorder Strategies & 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​16​. 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.

How To Parent A Child With ODD

Parenting a child with Oppositional Defiant Disorder is challenging and often exhausting.

The following are two proven strategies to parent an ODD child​17​.

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 training for parents are:

  1. 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.
  2. Build on positive reinforcement. Find ways to praise your child and reward prosocial and non-defiant behavior.
  3. Set reasonable, age-appropriate limits and apply consequences that can be readily and consistently enforced, such as gentle time-out, loss of privileges, etc.
  4. Choose your battles wisely by prioritizing things you want your child to do.
  5. 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. 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 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. Although CPS is a relatively new method compared to PMT, researchers have found that it produces equivalent results while attending 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. It aims to increase flexibility, adaptability, and problem-solving skills in both the parents and the children.

The principles​18​ of CPS are:

  1. Understand the specific adult and child’s contributing to the development of the child’s oppositional behavior
  2. Be aware of three elements in handling unmet parental expectations
    • imposition of adult will
    • collaborative problem solving
    • expectation removal
  3. Recognize the impact of each of these three elements on the parent-child interaction
  4. Along with their children, become proficient in resolving disagreements and defusing potentially conflicts that lead to oppositional episodes
  5. Improve parent-child compatibility

Editor's Choice

Here are a few books we 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 situation.

(Disclosure: I get a small commission for purchases made through the link below.)

Psychotherapy

Direct child-training approaches such as psychotherapy should be reserved for older children who have a higher capacity to benefit from the cognitive-behavioral approach.

Pharmacotherapy

When ODD co-occurs with other disorders such as Attention Deficit Hyperactivity Disorder, pharmacotherapy 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.

Intensive Program

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, the effectiveness of such methods is inconclusive in studies. Families and clinicians should weigh the potential benefits against the risks of such practices.


References

  1. 1.
    Frankel F, Feinberg D. Social problems associated with ADHD vs. ODD in children referred for friendship problems. Child Psychiatry Hum Dev. 2002;33(2):125-146. https://www.ncbi.nlm.nih.gov/pubmed/12462351.
  2. 2.
    Nock MK, Kazdin AE, Hiripi E, Kessler RC. Lifetime prevalence, correlates, and persistence of oppositional defiant disorder: results from the National Comorbidity Survey Replication. J Child Psychol & Psychiat. July 2007:703-713. doi:10.1111/j.1469-7610.2007.01733.x
  3. 3.
    Rowe R, Costello EJ, Angold A, Copeland WE, Maughan B. Developmental pathways in oppositional defiant disorder and conduct disorder. Journal of Abnormal Psychology. November 2010:726-738. doi:10.1037/a0020798
  4. 4.
    Dick DM, Viken RJ, Kaprio J, Pulkkinen L, Rose RJ. Understanding the Covariation Among Childhood Externalizing Symptoms: Genetic and Environmental Influences on Conduct Disorder, Attention Deficit Hyperactivity Disorder, and Oppositional Defiant Disorder Symptoms. J Abnorm Child Psychol. April 2005:219-229. doi:10.1007/s10802-005-1829-8
  5. 5.
    Tuvblad C, Zheng M, Raine A, Baker L. A common genetic factor explains the covariation among ADHD ODD and CD symptoms in 9-10 year old boys and girls. J Abnorm Child Psychol. 2009;37(2):153-167. https://www.ncbi.nlm.nih.gov/pubmed/19015975.
  6. 6.
    BURKE JD, LOEBER R, BIRMAHER B. Oppositional Defiant Disorder and Conduct Disorder: A Review of the Past 10 Years, Part II. Journal of the American Academy of Child & Adolescent Psychiatry. November 2002:1275-1293. doi:10.1097/00004583-200211000-00009
  7. 7.
    Stormshak EA, Bierman KL, McMahon RJ, Lengua LJ. Parenting Practices and Child Disruptive Behavior Problems in Early Elementary School. Journal of Clinical Child Psychology. February 2000:17-29. doi:10.1207/s15374424jccp2901_3
  8. 8.
    Loeber R, Burke J, Pardini DA. Perspectives on oppositional defiant disorder, conduct disorder, and psychopathic features. Journal of Child Psychology and Psychiatry. January 2009:133-142. doi:10.1111/j.1469-7610.2008.02011.x
  9. 9.
    Patterson GR. Coercion Theory: The Study of Change. The Oxford handbook of coercive relationship dynamics; 2016.
  10. 10.
    Loeber R, Lahey B, Thomas C. Diagnostic conundrum of oppositional defiant disorder and conduct disorder. J Abnorm Psychol. 1991;100(3):379-390. https://www.ncbi.nlm.nih.gov/pubmed/1918617.
  11. 11.
    Eckenrode J, Zielinski D, Smith E, et al. Child maltreatment and the early onset of problem behaviors: can a program of nurse home visitation break the link? Dev Psychopathol. 2001;13(4):873-890. https://www.ncbi.nlm.nih.gov/pubmed/11771912.
  12. 12.
    Ford JD. Traumatic Victimization in Childhood and Persistent Problems with Oppositional-Defiance. Journal of Aggression, Maltreatment & Trauma. July 2002:25-58. doi:10.1300/j146v06n01_03
  13. 13.
    SNOEK H, VAN GOOZEN SHM, MATTHYS W, BUITELAAR JK, VAN ENGELAND H. Stress responsivity in children with externalizing behavior disorders. Develop Psychopathol. June 2004. doi:10.1017/s0954579404044578
  14. 14.
    Kann RT, Hann FJ. Disruptive Behavior Disorders in Children and Adolescents: How Do Girls Differ From Boys? Journal of Counseling & Development. July 2000:267-274. doi:10.1002/j.1556-6676.2000.tb01907.x
  15. 15.
    Eyberg SM, Nelson MM, Boggs SR. Evidence-Based Psychosocial Treatments for Children and Adolescents With Disruptive Behavior. Journal of Clinical Child & Adolescent Psychology. March 2008:215-237. doi:10.1080/15374410701820117
  16. 16.
    Steiner H, Remsing L. Practice Parameter for the Assessment and Treatment of Children and Adolescents With Oppositional Defiant Disorder. Journal of the American Academy of Child & Adolescent Psychiatry. January 2007:126-141. doi:10.1097/01.chi.0000246060.62706.af
  17. 17.
    Ollendick TH, Greene RW, Austin KE, et al. Parent Management Training and Collaborative & Proactive Solutions: A Randomized Control Trial for Oppositional Youth. Journal of Clinical Child & Adolescent Psychology. March 2015:591-604. doi:10.1080/15374416.2015.1004681
  18. 18.
    Greene RW, Ablon JS, Goring JC. A transactional model of oppositional behavior. Journal of Psychosomatic Research. July 2003:67-75. doi:10.1016/s0022-3999(02)00585-8