Oppositional defiant disorder (ODD) is one of many behavioral disorders observed in children. In ODD, a child exhibits recurring disobedience, hostility, and defiant behavior, often towards figures of authority. Normally, oppositional behavior is seen as part of normal development in young children as well as teenagers. However, if the child is hostile and uncooperative over a long period of time, and their behavior is serious enough to interfere with their social and academic development, the child needs to be treated.

Sometimes, even the most well behaved children can be difficult and demanding.

With ODD, a child exhibits a constant pattern of angry or verbally aggressive behavior, mostly towards parents and elders. While some estimates say up to 20 percent of school-age children suffer from ODD, most experts think this estimate is high when factoring in what is considered normal childhood behavior combined with possible biases based on race, gender, and family background. In younger children (late preschool), ODD is more common in boys than girls. By adolescence, ODD is known to occur equally in both sexes.

ODD can develop as early as preschool age and on through the adolescent years. A child or adolescent may throw temper tantrums and argue excessively with adults. A child with ODD tends to question rules imposed on him and blame others for their own mistakes. The child may show frequent resentment towards others and may become easily annoyed. In addition, he or she may be aggressive towards peers and exhibit spiteful and vindictive behavior. The symptoms are usually seen in multiple settings and may be more noticeable at home or school.

The important thing is to recognize the difference between a child or adolescent who throws a tantrum when they are tired, hungry, stressed, or upset and actual signs of ODD. There is reason for concern when the child displays a continuous pattern of negativity, hostility, and defiance that lasts for at least six months and disrupts the family, home, or school environment.

No single cause is responsible for ODD, but a combination of biological, psychological, and social factors may be involved.

Biological factors include:

 

• Inherited predisposition

 

• A parent with mood disorders such as depression or bipolar disorder

 

• A parent with drinking or drug issues

 

• Brain chemical imbalance

 

• A mother who smoked during pregnancy

 

• Poor nutrition

 

Psychological factors include:

 

• A neglectful or absent parent

 

• Poor relationship with one or both parents

 

• Difficulty processing thoughts and feelings

 

Social factors include:

 

• Chaotic environment

 

• Poverty

 

• Abuse

 

• Lack of supervision

 

• Uninvolved parents

 

• Inconsistent or harsh discipline

 

• Instability in the family (parents divorce or separate)

 

Analyzing and Diagnosing

There are certain criteria that a child must meet to be diagnosed with ODD, as per the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association. These include:

 

• Often loses temper

 

• Argues with adults

 

• Deliberately annoys people

 

• Defies rules

 

• Gets annoyed easily

 

• Anger and resentment

 

• Spiteful or vindictive

 

A pattern of behavior that includes at least four of the above-mentioned criteria that is not typical of your child’s peers will help establish the disorder. A child and adolescent psychiatrist or a mental health professional usually diagnoses ODD after gathering information from the child, parents, and teachers.

ODD can be difficult to diagnose and distinguish between similar disorders, such as attention deficit hyperactivity disorder (ADHD). In fact, doctors often diagnose ADHD and ODD together. To make the best determination of a child’s condition, a doctor’s analysis should also take into account:

 

• Severity of the child’s behavior

 

• Whether conflicts are with peers or authority figures

 

• Unfavorable environment at home

 

• Whether hostility is towards all authority figures or only parents

 

A combination of therapies is used to treat ODD. Depending on the child’s age, the severity of their behavior, and the existence of any coexisting medical condition, a plan of action can be developed.

Individual and family therapy consists of counseling the child to help him or her manage anger and the way they express feelings, as well as helping them improve the way they communicate. Family counseling for ODD is designed to help family members learn how to work together, as well as develop and reinforce positive thinking and discipline.

Parent-child interaction therapy (PCIT) involves therapists coaching parents on how to interact with the child. One PCIT method involves the therapist communicating with the parent from behind a one-way mirror using an audio device. The therapist guides the parents to engage the child using effective parenting techniques that reinforce positive behavior. Research shows that PCIT improves parenting, decreases the child’s behavior problems, and improves the quality of the parent-child relationship.

Other therapies include cognitive problem-solving training, which teaches the child to react positively to stressful situations. The parents and child are taught how to seek solutions that will work for all. Social-skills training helps the child interact positively and effectively with peers.

Medication maybe necessary at times to control the more distressing symptoms of ODD but is not used as a stand-alone treatment. Medication may be prescribed to help relieve symptoms when coexisting conditions such as depression, childhood psychosis, or ADHD are diagnosed.

Prognosis

Most children with ODD improve over time with treatment and will respond to positive parenting techniques and the introduction of improved communication skills that the child can use at home and at school. At times, there is a risk of developing conduct disorder (a more serious disruptive behavior disorder) especially in preschool children diagnosed with ODD. Continuous evaluation by a qualified mental health specialist will help keep the disorder in check and avoid future complications.

A calm and forgiving parent can make a huge difference in the life of a child with ODD. Try to always praise your child for any positive behavior you observe. Take time out to relax and feel positive so that your child can also learn to take breaks instead of overreacting to stressful situations. With the help of psychotherapy, parent-management training, and family therapy, a child with ODD can become symptom free. Parental love and support will help the child develop the communication and emotional skills they need to grow into confident and well-adjusted adolescents and young adults.