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Oppositional Defiant Disorder: Causes, Symptoms, & Treatment
Oppositional defiant disorder is a psychological disorder affecting up to 20% of school-age children. (PubMed, referenced October 10, 2013). The symptoms range from mildly frustrating to severely debilitating for the child and overwhelming for the parents or caregiver. Unfortunately, as a psychological diagnosis, oppositional defiant disorder has received little research funding or social interest.
Causes
Because of the lack of research into oppositional defiant disorder, there are several theories regarding the causes, but no definitive results. Theories include:
- Genetic predisposition
- Brain chemical abnormalities
- Psychosocial factors
As a board certified psychiatric-mental health registered nurse, I have had the opportunity to work with many children who have oppositional defiant disorder, along with the families of those children. These are the characteristics of the families I have observed. These characteristics are supported by the limited research into this psychological disorder:
- Inconsistent limit setting
- Family discord
- Parents with behavioral problems (e.g. antisocial personality disorder)
- Parents with substance abuse/addiction
Additionally, I have noticed an increase in oppositional and defiant behaviors in children who have had exposure to various drugs during pregnancy. Methamphetamine in particular seems to have a profound effect on the child’s development.
Symptoms
Symptoms of oppositional defiant disorder begin in childhood by the age of 8 years and must last 6 months or longer. Diagnosis may occur after the age of 8 years if the symptoms were present before the child was 8 years old. The symptoms are as follows:
- A pattern of disobedience in regard to authority figures, particularly parents and teachers
- Excessive and/or persistent anger
- Vengeful with a lack of sensitivity to others’ feelings
- Purposely annoys others, such as parents, siblings, and classmates
- Argumentative and stubborn
- Frequent temper tantrums and/or angry outbursts
- Easily annoyed and frustrated by others and situational events
- Does not take responsibility for mistakes
- Blaming and unapologetic
Treatments
Parents of children with oppositional defiant disorder likely are frustrated and overwhelmed. Often they feel as though they have “tried everything” with little or no positive results, maybe even seeing a worsening of behavior. While there is no perfect method of treating oppositional defiant disorder, the most effective treatment thus far is positive reinforcement of healthy behaviors with a lack of attention to oppositional and defiant behaviors.
When a caregiver gives attention for oppositional and defiant behaviors, even though that attention may be negative or corrective in nature, the child still receives a positive benefit of attention. Over time, the child with oppositional defiant disorder may receive very little attention except negative attention and so he/she learns to continue to act out in order to receive any attention.
To correct this problem, parents and caregivers must stop giving any attention for argumentative, stubborn behavior. It may be extremely difficult to ignore, especially in social situations; however, this must be done consistently regardless of the social setting.
In addition to withdrawing attention for oppositional and defiant behaviors, parents and caregivers need to transition to giving positive attention for any non-defiant behaviors. Positive attention may be:
- Verbal praise
- Physical affection (e.g. hugs, kisses)
- Special privileges
- Small treats or gifts
Do not go overboard on special privileges or treats as the child may begin to use manipulation tactics to get these things. Positive attention for non-defiant behaviors should be immediate. For example, consider if two children are playing together and the child without oppositional defiant disorder wants to share a toy. If the child with oppositional defiant disorder participates in sharing without arguing, the child should be immediately rewarded. Praise would be most appropriate here: “You did a great job sharing your toys with Timmy!”
Some parents or caregivers may choose to use a special board or object to give immediate rewards. Examples of this type of positive attention include:
- A poster board that you and the child decorate together. The child earns stars or a favorite type of sticker to be put on the board for any nondefiant behaviors.
- A glass jar that is filled with a marble each time the child behaves appropriately. When the jar is full of marbles, the child earns a special reward, like going out for ice cream or having a friend sleep over. This particular system gives the child the immediate reinforcement of the marble, in addition to the long-term reward when the jar is full.
This change in parenting style must occur over time to be effective. Do not expect immediate results. The transition will be difficult and the child with oppositional defiant disorder may test the parent and caregivers for some time. The child may not understand why attention is being withdrawn and the child may actually escalate his/her behaviors for a period of time. Be dedicated through this time period. Remind yourself of how wonderful it will be when the child improves. Once the child learns that you are going to give positive attention for good behavior, he/she will begin to transition more quickly.
Summing Up ODD
- ODD is a pattern of behavior, not an isolated event
- ODD symptoms begin before 8 years of age
- ODD symptoms include a pattern of hostile, stubborn, defiant behavior
- ODD is treatable with behavioral therapy, such as positive attention for nondefiant behaviors and withdrawing attention for defiant behaviors
- Parents of children with ODD may need therapy or support groups. Help is out there.
Support for Parents and Caregivers
In the meantime, it may be beneficial for parents and/or the entire family to enter therapy together. It is likely that the stress of trying to help the child with oppositional defiant disorder has put a strain on everyone involved and perhaps created some unhealthy behaviors in other children and a wide array of emotions in the parents. A trained therapist can help the entire family unit work through these feelings and experiences while helping to keep you on track with your new parenting techniques.
Additionally, there are some online support groups for parents of children with oppositional defiant disorder. You may find it helpful to relate with others who have experienced what you are experiencing. This is one site that offers an online support group for parents of children with oppositional defiant disorder:
http://www.dailystrength.org/c/Oppositional-Defiant-Disorder-ODD/support-group
If at any time, you become worried about your safety or the safety of your child or children, contact a health care provider or emergency services immediately.
© 2013 Leah Wells-Marshburn
Comments
My son has a different condition, but I really like the marble idea. I'm going to try it.
I am a 61yr grandmother who has been raising 3 grandchildren,two since birth one since age 4.Two of the children were born opiate addicted. The oldest was on methadone and recovered easily.She is now 14yrs old,a syraight A student (as is her 9yr old brother)and a member of the National Honor Society.The middle child is less than 2yrs younger then her sister. This child was unwanted and the parents were heavy heroin users on addition to other substances.The court gave me custody and we adopted this child.She has been extremely difficult. She can be cruel to her siblings and tp my husband and myself.She started using foul language which she never hears in our home.She had done relatively well in school and no disciplinary problems in school
Just at home.She started to get physical with me.Im ashamed to say at times I would behave as badly as she and if she wpuld yell and say I hate you I would yell the same thing back at her.I would then feel disgusted and ashamed of myself.I love this child fiercely. I fear for her.If she could bring out such an emotion from someone who loves her then what about someone who does not.Someone who doesn't know what her issues are. Over the past two years her biological mother has been in constant contact. She is now clean,sober and a productive member of society. This child begged to go and live with her mom for the school year.She was making great progress.No cursing,no hitting and doing chores without being td to but. .she began lying constantly and getting in fights in school to the point she had to withdraw her and homeschool her.She wants to place her in a residential home where she feels she will get the help she needs. I am torn about this.Im afraid she will feel like she is being rejected yet once again.I know this child needs help.We had been on counseling for many years.I know all about posotive reinforcement and how difficult it is to ignore Fu directed at me.There is so much more tp this story. If anyo e has any suggestions it would be greatly appreciated
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You are most welcome, elizabethberger. Any time.
Thank you, NurseLeah. x
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elizabethberger,
I am sure you are, as you say, sore and sad. It is indescribably painful to let someone you love so much be so very far away, if even for a short time and even when you know in your heart of hearts it is the best thing you can do for them. You may even feel like you are abandoning him. I don't know the particulars of your situation, but I know when children are out of state for treatment, parents often will say they feel in a way like they have abandoned their child, even though it is not the case. It is hard for the mind to tell the heart the logical stuff. The heart has its own ways. I often have to remind myself that what I am doing is for the greater good. I say it over and over, like a mantra, when I am feeling guilt for certain things. I've heard other nurses say things like, "It hurts now so you can heal later," often in reference to things like IVs and catheters. It doesn't always work when I am talking to myself, but sometimes it gets me through for a while.
I am sure you are looking for answers, and I needed your feedback. I don't want loved ones to take what I have said as an accusation or blame. I am not offended, but I appreciate your concern. I am sending positive thoughts up your way and really wishing for the best possible outcome for you, your son, and your family.
It is a hard thing to deal with as a parent. That is not to say that I, as the parent of a child with ODD, wish for any other child than my own. I love my son and would have him as he is always, PLEASEG-D. I think when I read articles about it, I tend to overreact as it is close to me. I also think, in some way, I blame myself. However, I am a loving and affectionate, doting and caring parent who did everything I could to help my child before doing the last scenario….sending him to a safe place to get the help he needs that neither laymen nor parents can do. There are many factors….too many to list. Each person is different. If I offended you, it was not what I meant to do. It just happened, sending him away, so i am sore and sad. Thank you
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@elizabethberger,
I mentioned there are several theories about ODD, but nothing proven yet. When describing what I have seen in practice I did not mean to imply those are the only possible causes of ODD, but those are commonalities in many families with a child diagnosed with ODD. There is a wealth of information available from scholarly articles and educational websites regarding the theorized causes of ODD. A good example is the Mayo Clinic's website. This is their section on the causes of ODD:
"There's no known clear cause of oppositional defiant disorder. Contributing causes may be a combination of inherited and environmental factors, including:
A child's natural disposition
Limitations or developmental delays in a child's ability to process thoughts and feelings
Lack of supervision
Inconsistent or harsh discipline
Abuse or neglect
An imbalance of certain brain chemicals, such as serotonin"
(Accessed December 3, 2013 from: http://www.mayoclinic.com/health/oppositional-defi...
As you can see, the theory that parenting styles, abuse, neglect, etc. are causes of ODD is not simply my personal opinion. Just to clarify in my article I added 3 bulleted points of common theories. I hope that helps folks who read this in the future understand better what I am trying to portray.
The point of the article was to help people who are struggling. Not every technique works for every family. I hope that your son has success with the therapeutic residential school. I have seen several children improve dramatically with similar programs and strong support.
Best wishes to you and yours.
@The Stages of ME,
Thank you so much for stopping by, reading, and commenting. Yes, it is quite difficult to watch a child suffer, especially one you love and especially when the usual parenting techniques don't seem to work. It is painful for the entire family and can cause such a mix of emotions.
I was interested in seeing this article as I have a son with ODD. He is ten years old. I just sent my son to a therapeutic residential school in the South, far from our house. I believe your article is replete with info, but far from complete. And, I take offense at your 'causes.' While, of course, those caring for our children have a huge role in the development of our children, simply saying that (paraphrasing) parents and their actions and or addictions is a cause is quite demeaning, clinically false and downright dangerous. As a loving parent without mental illness history, i have two children, each of whom are so different, and each of whom are raised in the same place with the same people. One has ODD, one is high functioning with great friends. This is written as an article, but should be, instead, a personal opinion.
Hello nurseleah
I think it is wonderful you have shared some good information here. A great starting point for parents meeting this challenge. As a therapist myself I find there is of course many opinions in the treatments and descriptions of any disorder and therefore triggers emotion in the battle, however, I am sure this article is a pearl for many new to this struggle. Blessings to you and all in there journey with this topic :)
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Denise, thank you for stopping by, commenting, and sharing your experiences. We can all learn so much from each other. I see the effects you are talking about in the in-patient psychiatric setting as well. The children with ODD often aggravate the other children, who have a variety of psychiatric illnesses, to the point of confrontation or aggression. It is quite difficult to manage, to say the least! I do hope that with increased attention, knowledge, and funding that more research can be done to help these children and their families.
Leah
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Eddy, Thank you so very much for voting and sharing!!! I really try to get information out there, so I am very grateful for your help in sharing it.
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thewritingowl, thank you so much for your thorough comment on the many theories associated with ODD. You are absolutely right that there is no known cause and many theories. Forgive me for implying that parents are the sole cause for ODD. That was not the intention. I meant only to describe the family patterns I have observed in an in-patient psychiatric hospital where many of our children and adolescents suffer from ODD. It is quite possible that while patterns may worsen the disorder, the disorder could have spawned the pattern to begin with. By the time I see children in an in-patient setting, much has already happened outside the hospital. Regardless of which came first, the parenting style must be adapted to help the child and the family work through this disorder.
You mention that ODD often occurs with other disorders. I have seen this as well; however, ODD does occur without any other psychiatric diagnoses. There is, as you say, a high correlation with ADHD. If a child has any comorbid conditions, then a treatment plan would need to be tailored to include all conditions, not just ODD.
Again, thank you for all the great info. I'm sure it will benefit those who are interested in the various proposed theories related to ODD.
Great information! I worked with several children who had ODD in the school setting as a School Psychologist. It was one of the most difficult to deal with, as it had such a drastic effect on other students. We had to limit the contact of the student with ODD in groups in order to keep the other students safe!
Such an interesting hub and one which I am sure will benefit many readers.
Voted up, across and shared.
Eddy.
I read your article with personal interest and I just wanted to say that while parenting style can increase the negative behaviors of ODD it is not usually cited as the only cause. The strategies that you suggest are helpful too and we use most of them but I think further research will show there also genetic and biological factors to ODD.
ODD doesn't really occur on its own that much instead it often occurs in conjunction with ADHD (which is known to have a strong genetic and possibly environmental basis). Also many children and teens with ODD also have other problems, such as learning disabilities, mood disorders (such as depression), and anxiety disorders. As you say exact studies in causation are limited at present but those that do exist all cite the following as possible causes of ODD. So I don't think it is absolutely fair to blame it all solely on the parenting style. (while I do concede inconsistent parenting can worsen the problem).
I think that one reason not mentioned why parenting can have an adverse effect on the ODD child is because parents try to discipline this child the same way as they would have done with their other children. This parenting approach seemed to work quite well with our daughter who is a very well adjusted and happy teenager. But unfortunately the same strategies were largely unsuccessful with our son because he also has ADHD, Autism and anxiety disorder and is non-verbal.
So I think saying parenting style is the main reason for ODD is just unfair. Whereas I do agree it is a contributing factor. As I must also agree that my own Aspergers has undoubtedly contributed to my son having Autism.
The following is an excerpt from http://www.webmd.com/mental-health/oppositional-de... which lists all the possible causes of ODD.
Biological: Some studies suggest that defects in or injuries to certain areas of the brain can lead to serious behavioral problems in children. In addition, ODD has been linked to abnormal amounts of certain types of brain chemicals, or neurotransmitters. Neurotransmitters help nerve cells in the brain communicate with each other. If these chemicals are out of balance or not working properly, messages may not make it through the brain correctly, leading to symptoms of ODD, and other mental illnesses. Further, many children and teens with ODD also have other mental illnesses, such as ADHD, learning disorders, depression, or an anxiety disorder, which may contribute to their behavior problems.
Genetics: Many children and teens with ODD have close family members with mental illnesses, including mood disorders, anxiety disorders, and personality disorders. This suggests that a vulnerability to develop ODD may be inherited to begin with.
Environmental: Factors such as a dysfunctional family life, a family history of mental illnesses and/or substance abuse, and inconsistent discipline by parents may contribute to the development of behavior disorders.
Biological: Some studies suggest that defects in or injuries to certain areas of the brain can lead to serious behavioral problems in children. In addition, ODD has been linked to abnormal amounts of certain types of brain chemicals, or neurotransmitters. Neurotransmitters help nerve cells in the brain communicate with each other. If these chemicals are out of balance or not working properly, messages may not make it through the brain correctly, leading to symptoms of ODD, and other mental illnesses. Further, many children and teens with ODD also have other mental illnesses, such as ADHD, learning disorders, depression, or an anxiety disorder, which may contribute to their behavior problems.
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