Oppositional Defiant Disorder

What is it?

It’s normal to be defiant during childhood and adolescence. Our bodies and minds are undergoing huge changes. Meanwhile, we’re trying to figure out who we are, what we stand for and where we want to go in life. It’s a complicated and turbulent time.

But defiance has its limits. Occasional outbursts and moodiness are expected, while ongoing problems with aggression, anger and hostility are not. People that struggle to control these emotions may have oppositional defiant disorder, also known as ODD.

ODD is a disorder in which a child or teenager displays ongoing patterns of argumentative behavior, vindictiveness, irritable mood and issues listening to authority. It commonly occurs alongside other conditions, such as ADHD, depression, anxiety and learning difficulties.

What are the symptoms?

Symptoms of ODD often emerge during elementary school. Like all mental conditions, ODD exists on a spectrum ranging from mild to severe. When diagnosing a patient, doctors will need to confirm that symptoms have been present for at least 6 months, and that they cannot be explained by another condition or recent injury. Symptoms include: 

• Frequent arguing with adults and authority figures 
• Throwing temper tantrums 
• Annoying or upsetting others on purpose 
• Being easily annoyed or irritated 
• Having extreme emotional outbursts 
• Blaming wrongdoings on others 
• Being inappropriately touchy 
• Routinely defying rules or requests 
• Demonstrating vindictive behavior

ODD can have a huge impact on a child’s ability to do well in school, maintain healthy relationships, stay out of trouble and partake in extracurricular activities. The disorder is more common in boys than girls. In severe cases, ODD can develop into a condition known as conduct disorder.

What are some common warning signs?

ODD can easily be confused for other conditions, like ADHD, anxiety or hormonal moodiness. It can also manifest differently depending on a child’s age and gender. In boys, ODD often shows itself as aggressive behavior, while girls are more likely to lie or refuse orders from adults.

When trying to determine if a child is suffering from ODD, it’s important that parents and loved ones pay attention to their behavior at home, school and in various social settings. Some children are more disruptive in one environment, than they are in another. For example, a child may be extremely defiant with teachers, but less so with their parents.

Talk to your child’s teachers about their conduct during class and with other students. Talk to other parents and see if they’ve noticed problematic behavior during playdates. Keep track of how long this behavior has been going on for, and if it’s worsening.

Ask yourself the following questions:

• Does poor performance in school coincide with issues at home?
• Has there been an increase in temper tantrums or emotional outbursts?
• Have these behaviors lasted for a period of six months or longer?
• Are they making an effort to disobey, even when they’ve been warned about consequences or told the proper rules?

If so, you should find time to sit down with them and discuss seeking help.

What causes ODD?

The exact causes of ODD are unknown. Doctors believe a range of factors play a role in its development, including: 

• Being genetically predisposed (i.e. other family members struggle with ODD)
• Experiencing a traumatic brain injury after which symptoms arise
• Having a chemical imbalance in the brain
• Having other related mental conditions, such as anxiety or depression
• Being raised in a toxic home environment, or living with parents/guardians who struggle with addiction 
• Being bullied or not accepted by peers
• Being abused as a child

How is it treated?

Treatment for ODD often involves family-based interventions and psychotherapy. Common approaches include:  

• Cognitive Behavioral Therapy: A form of psychotherapy that challenges negative thinking patterns and behaviors. It’s rooted in the idea that our attitudes greatly impact how we think and behave. In CBT, a therapist will help you replace negative thinking patterns and behaviors with more positive ones. 
• Parent-child interaction therapy (PCIT): A form of therapy in which professionals coach parents through interactions with their child, in hopes of improving their bond, equipping them with productive parenting techniques, and minimizing ODD symptoms. 
• Social skills training: A form of therapy that teaches children how to better interact with peers. 
• Problem Solving Skills Training (PSST): A form of therapy that helps children develop problem-solving skills in order to minimize emotional outbursts and frustrations. 

Other forms of family therapy may be recommended to improve household relationships, communication styles and coping strategies. There are no medications approved specifically for ODD, and they are not considered a go-to treatment. However, some children find success using meds to address symptoms of co-occurring disorders, like anxiety, depression or irritability. There is some evidence that dietary supplements like Omega 3s can alleviate symptoms as well. 

Lastly, Behavioral Modification techniques can also be effective. This therapeutic approach aims to change negative habits and behaviors using a variety of methods such as boundary setting, consequence and reward systems, and token economies.

It’s important to remember that treatment plans are personalized. People should work one-on-one with a doctor to find one that fits their needs. Just because a medication or therapeutic approach helps someone else, doesn’t mean it’ll be the right solution for you or your child.

How can I help a loved one with ODD?

Helping a child with ODD can be hard. It’s common for them to get angry when confronted or asked to attend therapy. That said, there are things parents, siblings and teachers can do at home and school to help encourage recovery. Such as: 

• Reward good behavior: Let them know when they’ve done a good job. Explain why you’re proud so they understand why they’re being rewarded. 
• Set a positive example: Lead by example in social scenarios, around the house, at school, and when communicating with their siblings or peers. It’s important that they have a baseline for good behavior. 
• Communicate rules clearly: Make sure your expectations are understood up front so there isn’t the potential for miscommunication. When things go wrong, stick with this rule. Clearly articulate what went wrong and why you’re upset.
• Follow through with consequences: Enforce rules when they’re broken, rather than being lenient. If you don’t, they won’t have an incentive to correct their behavior. That said, don’t set unnecessarily strict punishments for small mishaps. 
• Create routines: Create systems for navigating home, school and free time. Schedules can help a child stay on track. Involve them in the scheduling process so they feel like it’s their own.
• Pick your battles: Don’t fight about everything. Learn to brush things off, even when you’re frustrated. Children with ODD can feel singled out by adults. It’s important that everything doesn’t feel like a struggle. 

If you’re a parent or primary caregiver of a child with ODD, consider finding counseling for yourself. It’s important that you maintain your own mental wellbeing while helping them find theirs.