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.
Table of Contents
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.
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 teachers1.
ODD children are at substantial risk of mood, anxiety, impulse‐control, and substance use disorders2. Boys with ODD 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 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 behaviors that are 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 ODD 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 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 levels5.
Related: What Is Temperament
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 has been shown to be associated with high aggressiveness.
Children are born with different temperaments. Some babies are easier to take care of while others more difficult. Many 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 oppositional and aggressive children behavior is highly correlated with aggressive parenting practice such as corporal punishment8.
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 children9,10.
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 behavior11,12.
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 girls8,13.
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 children.
Timing Of ODD Treatment
Many psychologists consider prevention and early treatment the keys in ODD intervention because 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 centers14.
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 outcomes.
Oppositional Defiant Disorder Treatment & Strategies
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 therapies15. 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 ODD is challenging and often exhausting.
The following are two proven strategies to parent an ODD child16.
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 these training 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, 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 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).
Collaborative & Proactive Solutions (CPS)
Although PMT is a well-established, proven treatment 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 give rise to the oppositional behavior. 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 and children learn to solve problems that contribute to defiant behaviors collaboratively and proactively. It aims to increase flexibility, adaptability, and problem solving skills in both the parents and the children.
The principles17 of CPS are:
- 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
Positive Discipline A-Z
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.
Parenting from the Inside Out
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. This book draws on findings in neuroscience and attachment research to help parents make sense of their life stories. Having a deeper self-understanding can help one become a better parent. 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 approach.
When ODD co-occurs with other disorders such as ADHD, 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. 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.
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.
- 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.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.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.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.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.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.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.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.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.
- 10.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.
- 11.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
- 12.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
- 13.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
- 14.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
- 15.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
- 16.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
- 17.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