Treating Your Child's Oppositional Defiant Disorder (ODD)

What is Oppositional Defiant Disorder?

Oppositional defiant disorder (ODD) is one of the three disruptive behavior disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, which is published by the American Psychiatric Association. This is the most common psychiatric problem in children. Over 5% of children have it. In younger children boys have it more than girls, but as children grow older, the rate is the same in both.

ODD is characterized by aggressiveness and hostility toward others, particularly parents, teachers, and other figures of authority. These children willfully try to bother and irritate others. They tend to be argumentative and to get into fights a lot. They are also easily annoyed and refuse to take responsibility for the things that they do.

Because their behavior is so difficult, ODD children have a lot of trouble getting along with family and friends, and tend to have a lot of difficulty in school.

What is Oppositional Defiant Disorder Like?

Oppositional Defiant Disorder children are experts at manipulating others. They cause a lot of discord. These children are masters of putting adults against each other, including spouse against spouse and parents against teachers. They can cause a lot of chaos at home and unless the parents are on alert, ODD children can strain or even destroy a marriage.

These children are constantly angry. They lose their temper and fight with adults. They talk back, argue, and refuse to follow even simple directions; often for no apparent reason.

Children with ODD are stubborn and repeatedly test limits, even as young children. They are easily annoyed and blame others for their mistakes. Their behavior can get them into a lot of trouble. However, they refuse to take responsibility for the consequences of their actions. Rather they identify these outcomes as someone else's problem.

What are the Symptoms of ODD?

Some children are just stubborn. Some are argumentative. Some are hard to get along with and don't like to be told what to do. These are characteristics of normal children. What separates children with Oppositional Defiant Disorder from normal children is not so much what they do, but to the degree that they do it.

It is normal for children to have occasional bouts of difficult behavior. This is especially true of children who are in developmental stages of ages of transition; such as between the ages three to five or during adolescence. During these periods, children try to assert themselves and can become very defiant.

In addition, normal children who are tired, hungry or disturbed about something often react by being defiant. So Oppositional Defiant Disorder is not characterized so much by the type of behavior that these children display, but by the degree and frequency they display these behaviors.

Normal children can be defiant, but their behavior does not disrupt their life. It is not like that with Oppositional Defiant Disorder children. ODD children are difficult and argumentative to the extent that their behavior interferes with their school performance, their ability to perform in school, and sometimes, their relationships with other children.

The following is a list of the behaviors that Oppositional Defiant Disorder children frequently display:

• Get angry frequently
• Talk back to adults
• Openly disobey instructions
• Thwart rules
• Intentionally bother others
• Refuse to take responsibility for their actions
• Refuse to take responsibility for their misbehaviors
• Are quick to take offense and get annoyed easily
• Are quick to anger
• Tend to be resentful, cruel, or malicious
• Speak harshly
• Seek revenge
• Have temper tantrums often

Parents of ODD children often claim that even when they were very young, their children were inflexible and demanding.

Diagnosing Oppositional Defiant Disorder

ODD children are not that different from normal but difficult children. The difference is one of frequency and intensity. If you feel your child may have Oppositional Defiant Disorder, you will need to consult a psychiatrist or qualified mental health professional to get a comprehensive evaluation.

Here is a simple ODD Screening Test which you can try.

What Causes Oppositional Defiant Disorder?

No one really knows what causes Oppositional Defiant Disorder. Researchers have proposed two theories.

One theory is that Oppositional Defiant Disorder comes from incomplete behavioral development. For reasons unknown, these children do not master the developmental tasks that their peers accomplish as small children. ODD children get stuck in the 2-4 year old defiant stage. For some reason these children just don't grow out of it.

The second theory suggests that Oppositional Defiant Disorder is caused as a result of the negative interactions that these children have while growing up. It is their interactions with adults that bring out their oppositional defiant behavior.

There are physical, psychological, and social factors that are connected with the occurrence of ODD. Genetics seems to play a part. There are indications that being oppositional is a strongly inherited characteristic. Also, women who smoke during pregnancy and pregnant women who drink alcohol excessively have children with ODD more commonly.

Children who live in an abusive home more commonly have ODD. Homes where there is drug or alcohol abuse, poverty or lots of violence tend to foster the development of defiant children. Other psychological and social risk factors include living in an unstable home environment or being raised by a single parent.

Complicating Conditions

Oppositional Defiant Disorder almost never comes alone.

• 50-65% of ODD children also have ADHD
• 35% of these children will eventually have an affective disorder
• 20% develop some kind of mood disorder, such as Bipolar Disorder
• 15% eventually have some type of personality disorder
• A large number of ODD children have a co-existing learning disorder

Any child who is suspected of having Oppositional Defiant Disorder needs to be evaluated for other disorders as well. It is imperative to uncover the co-existing problems. Addressing these other conditions is one of the keys to treating Oppositional Defiant Disorder.

Long Term Outlook

What happens to a child with ODD? They usually follow one of four paths.

1. Your child may grow out of Oppositional Defiant Disorder: Half of the preschoolers who are thought to be ODD no longer are considered to have ODD by the time they are 8. However, in children 8 and older, 3/4 of them will still meet the diagnostic criteria when they are older.

2. Your child's ODD may change into another condition: 5-10% of the preschool children with ODD have their diagnosis changed to ADHD when they are older. At times, these children get worse and eventually meet the diagnostic criteria of Conduct Disorder, the most serious of all childhood disruptive disorders. If a child is going to go in this direction, it usually takes place quite early. A child who has ODD for three years and hasn't developed Conduct Disorder, will probably never develop it.

3. Your child may continue to have Oppositional Defiant Disorder and nothing else: This is quite unusual. Only 5% of children follow this path.

4. Your child may begin to show signs of another disorder along with ODD: This is the most common path.

Medical Treatment of Oppositional Defiant Disorder

The research of the value of medical treatment of ODD is still in the preliminary stages. However, the results, so far, suggest that medication may have some benefit when other disorders are present, also.

In one study, researchers looked at the effectiveness of using Ritalin to treat children who had both ADHD and ODD. They found that by the end of the study 90% of the children who received Ritalin no longer had Oppositional Defiant Disorder.

This was not a well run study because the researchers did not include in their results those children who were too defiant to comply with the treatment program. However, even if these children were included in the results and listed as treatment failures, the rate of success using Ritalin was 75%. A highlight of this study is that the researchers found that even when the ADHD was not severe enough to warrant the use of Ritalin, giving the medication did help with the ODD.

The effectiveness of Strattera has been studied in children with both ADHD and ODD. The results are mixed. Some studies show that Strattera makes a difference in ODD, some show that it doesn't.

Both Omega-3 oils and vitamin E were tested in ODD children. Both seemed to help with the behavior to some degree.

Psychological Intervention

The primary way of treating Oppositional Defiant Disorder is through parent management training. The younger your child is when you enroll in such a program, the better the outcome. If you want to help your child; some form of parent training program is essential. See the recommended resources below.

These programs can be quite expensive, costing $100 or more per week for a period of several months to half a year. Insurance usually will not pay for such programs.

Advice to Parents

There is far too little known about this extremely common childhood behavior disorder.

The most effective approach to treating ODD is:

1. Get a thorough medical and psychological evaluation: The key to helping an ODD child is to first know exactly what his problems are.

2. Treat any other co-existing condition aggressively: Whether your child has some other medical condition, such as ADHD, a physical problem such as a Sensory Deficit Disorder or a Learning Disorder; taking care of his other problems is the key to successfully alleviating much of your child's oppositional behavior.

3. Consider giving your child an Omega-3 supplement and a vitamin E supplement: Most children are deficient in these nutrients and there are no ill effects if your child gets more than he needs. Even if it does not help with the ODD, your child will in all likelihood be much healthier if he receives these supplements.

Conclusion

Raising a child with Oppositional Defiant Disorder is hard. However, it can be done.

If you identify your child's other problems and treat them; AND if you develop your parenting skills through a specialized parenting program you will be successful.

Recommended Resources...

More Information:

Health Scout

University of Maryland

University of Virginia

Wikipedia

Online Treatment Program:

Oppositional Defiant Disorder Child Treatment Program

Note: This program is designed for children ages 2-12. However, there is a link on this page for parents of teens with ODD.

Other Resources

Online Screening test: