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Oppositional Defiant Disorder Overview

The severely defiant and combative behavior associated with ODD is more than that of just an unruly child. See more parenting pictures.
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Defiant behavior is a normal part of being a kid. There isn't a preschooler on the planet that doesn't enjoy at least an occasional temper tantrum, and most teenagers are fiercely dedicated to rebellion, whether or not they have a cause. Even babies are defiant, purposefully throwing their mashed peas on the floor as a way of saying, "I'm done eating and I'd like to be released from this confining high chair before I start crying." But for some kids, defiance goes beyond the realm of normal behavior. They become so uncooperative and combative that the defiant behavior interferes with their ability to learn, thrive and get along with people. This is called oppositional defiant disorder (ODD) and it occurs in about 10 percent of children in the U.S.

Parents of children with ODD know that the behavior associated with this condition is more than just that of a difficult child. ODD kids are keenly interested in challenging and upsetting the authority figures in their lives and have the unfortunate habit of blaming others for their own mistakes or bad behavior. These qualities can cause a lot of problems in a child's relationships with parents, teachers and other caregivers. Children with ODD often have severe social and academic impairments compared with their non-ODD peers. In fact, their degree of social impairment is usually greater than that of children with depression, bipolar disorder or multiple anxiety disorder [source: American Academy of Family Physicians].

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The specific cause of ODD is unknown, but several theories are currently being explored. One offers a genetic explanation for ODD, in which children who have a family history of ODD are more likely to develop the condition themselves. In contrast, developmentally based theories are focused on a parent's response to normal defiance in the child at an early age. The idea is that the parents' reaction to defiance somehow fuels the defiant behavior. Other research seeks to identify environmental triggers of ODD in children who may be biologically susceptible to it. Such triggers may include harsh or inconsistent parenting practices, parental mental health problems or exposure to domestic violence or divorce [source: Tynan].

There are several troubling symptoms of ODD, but they're often similar to "normal" acts of defiance. So how can you tell the difference between a particularly obstinate child and one suffering from ODD? Keep reading to learn more.

 

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The symptoms of oppositional defiant disorder (ODD) are all considered normal behaviors for children, especially toddlers and teenagers. This makes ODD difficult to define and diagnose. The key is the intensity and duration of the symptoms. For example, whereas a normal toddler may kick and scream about some perceived injustice for several minutes, an ODD child may continue such behavior for several grueling hours. And whereas a normal teenager may periodically enjoy annoying his or her younger siblings, the ODD teen will disrupt an entire classroom to the point that his actions result in expulsion.

According to the American Academy of Family Physicians, ODD refers to a recurrent pattern of developmentally inappropriate, negativistic, defiant and disobedient behavior toward authority figures beginning in childhood or adolescence [source: American Academy of Family Physicians]. Specific symptoms of ODD may include:

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  • Being "touchy" or quick to lose one's temper
  • Being argumentative with authority figures
  • Refusal to comply with requests or rules
  • Deliberately annoying people
  • Blaming others for one's own mistakes or misbehavior
  • Vindictiveness, spitefulness and having a tendency to seek revenge

For a diagnosis of ODD, a child must display these symptoms for at least six months. The symptoms must also be present in multiple settings -- say at home and at school -- and the child must show some degree of impairment. For example, the symptoms may be affecting the child's health or ability to learn. Moreover, a diagnosis of ODD requires that other potential causes of the symptoms, such as a psychotic or mood disorder, be ruled out [source: American Academy of Family Physicians].

Parents, teachers or other authority figures initially identify most children who are suffering from ODD. However, an actual ODD diagnosis requires an evaluation by a psychiatrist or mental health professional. An ODD diagnosis is usually made based on a series of behavioral and psychological tests as well as input from parents, teachers and members of the child's extended family. In many cases, children suspected of having ODD can be reliably screened during the preschool years [source: Keenan].

ODD can be difficult to distinguish from several other behavioral disorders, including depression, conduct disorder and attention deficit hyperactivity disorder (ADHD). In the next section, we'll compare ODD with these and other pediatric mental health conditions.

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Children and teens diagnosed with ODD also suffer from other psychological conditions such as depression.
Children and teens diagnosed with ODD also suffer from other psychological conditions such as depression.
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Oppositional defiant disorder (ODD) is challenging enough on its own, but it's made worse when it coexists with other behavioral and psychological problems. Unfortunately, about 90 percent of children with ODD meet the criteria for a diagnosis of at least one other condition, such as anxiety, attention deficit hyperactivity disorder (ADHD), conduct disorder or substance abuse problems [source: Nock]. ODD is also common in children with Tourette syndrome, Asperger syndrome and sensory processing disorders. In most cases, ODD appears first. One exception is ADHD, which more often shows up before ODD in patients with both conditions.

Among children with ADHD, about 40 percent also have ODD [source: Biederman]. The link between ADHD and ODD is not well understood, but there is a lot of research currently underway on the subject. This is partly owing to the fact that people with a childhood history of both ODD and ADHD have high rates of psychiatric and psychosocial conditions compared with people who have ADHD alone [source: Harpold].

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Another condition that is closely linked with ODD is conduct disorder. Conduct disorder is considered a more serious version of ODD since it involves cruelty to people or animals, destruction of property and theft or other serious rule violations. By contrast, kids with ODD do not usually hurt people, steal or destroy property. It is important for parents of a child with ODD to be aware of the symptoms of conduct disorder, since nearly half of ODD patients will eventually develop this condition [source: Nock].

ODD is also closely associated with depression, anxiety and substance abuse problems [source: Biederman]. In fact, about half of ODD patients will go on to develop one of these conditions. Having one or more of these conditions is usually a bad sign. ODD that coexists with one or more other conditions is associated with worse outcomes in the long-term.

ODD, ADHD and conduct disorder are the three most common reasons for referral to mental health services among children. Of the three, ODD is considered the mildest condition. This may be because the symptoms of ODD are closest to what's considered "normal behavior" for children. That doesn't mean that ODD is easy to treat, as we will explore in the next section.

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Treatment for ODD is centered on behavioral therapy, but specific treatment for ODD depends on the age of the child, his or her level of impairment and any coexisting conditions he or she may have. It also depends on the willingness of parents to engage in meaningful therapy with the child, as this is often an integral part of treatment. The basic goal of ODD therapy is to guide patients through the process of "unlearning" bad behavior and relearning effective ways of relating to others. This almost always includes individual psychotherapy for the child as well as individual and group therapy for his or her parents.

The goal of cognitive behavioral therapy is to teach children to understand and redirect their negative feelings and to reestablish positive associations with authority figures. Social skills training for the child can also be helpful, as it improves a child's ability to relate to others and remain in control of aggressive emotions. Each of these strategies is also very helpful at restoring the parent-child bond.

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Parental involvement in ODD therapy is a very important component of treatment for ODD. Mothers and fathers of ODD patients will be encouraged to take parent-training courses and participate in parent-child interaction therapy and/or collaborative problem solving. These techniques are invaluable to parents dealing with an ODD child and are considered critical to the long-term recovery of the ODD child.

In addition to behavioral therapies, treatment for ODD may also include medication in cases where ODD coexists with other conditions, such as ADHD. For example, stimulant medications used to treat ADHD may also be effective at reducing oppositional symptoms [source: American Academy of Child and Adolescent Psychiatry].

There are also simple, real-life strategies for managing an ODD kid, including knowing when to pick your battles. The key is remembering that children with ODD are driven by the need to engage in combat. They care less about the reasons for or consequences of the fight. For them, the important thing is to push the buttons of their authority figure. This is why ODD can be a serious obstacle to succeeding in school. Parents of ODD kids should work with their child's teacher to incorporate ODD management strategies during the school day. Read on to learn more about coping with ODD in the classroom.

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Teachers dealing with ODD children must learn when to negotiate and when to walk away.
Teachers dealing with ODD children must learn when to negotiate and when to walk away.
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Children of all ages are prone to misbehave at school on occasion, but for children with oppositional defiant disorder (ODD), bad behavior is taken to the extreme. ODD can cause kids to be extremely annoying, combative, uncooperative and often hostile. The good news is that there are ways to prevent ODD from causing complete chaos in the classroom.

First, teachers should communicate with the child's parents as much as possible. Because a child may behave differently at home and at school, parents may not be aware of their child's school-specific symptoms. It is also important to discipline the child in a manner that is consistent with the child's home setting, so teachers and parents should be sure to come to an agreement on this.

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For teachers, it's helpful to keep in mind that ODD kids are unlikely to respond to the threat of punishment. This is because their interest in winning the battle is stronger than their fear of its consequences. For this reason, keeping an ODD child from a beloved item or activity may have little or no effect. More often, the promise of a reward is more motivating for an ODD kid. But in either case, be sure to negotiate your terms when the child is calm. Once the conflict starts, a child with ODD becomes virtually uncontrollable.

For some teachers who have experience with ODD kids, the name of the game is avoiding conflict in the first place. For example, many teachers know that giving praise whenever possible may be enough to keep the ODD symptoms at bay. Many also know that there will be times when nothing will prevent an ODD episode from occurring. When confronted with an ODD child that has gone off the deep end, there may be no way to ease him or her back into the classroom rhythm. For this reason, it's helpful to have a space in the classroom or just outside in the hallway dedicated for cooling off.

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Oppositional defiant disorder (ODD) is a difficult condition to diagnose in any child, but may be even more difficult to diagnose in teens. After all, teenagers are defiant by nature. However, normal defiance does not interfere with a child's ability to learn and get along with others. For teens with ODD, almost every aspect of life becomes a struggle. And because ODD usually develops in earlier childhood, teenagers with the condition have often been dealing with symptoms for many years.

In terms of symptoms, ODD in teens is basically the same as ODD in younger children. The main difference is that teenagers are bigger, stronger and smarter, so they're capable of doing more damage. Parents and teachers of ODD teens should arm themselves with all available knowledge and resources about this condition in order to maintain a semblance of harmony. They should also keep in mind that once a fight has begun, an ODD teen won't easily give up. The key is to prevent an outburst of ODD in the first place, and to deflect any sign of combat the moment it rears its ugly head. If this doesn't work, be prepared to walk away. It's sometimes better to give up than to fight an unwinnable war.

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Because parents of ODD kids often play a role in the development of the condition, they can and should be a part of treating it. Strong parenting styles -- both too lenient and too strict -- can contribute to the development of ODD. For this reason, it can be very helpful for parents to enroll in individual or group parenting courses and workshops that are designed to teach effective methods of discipline for teens. ODD research overwhelmingly supports the idea that therapy is most effective when it includes parents and other family members. So keep in mind that your ODD teen may be able to overcome this disorder independently, but the odds of success are significantly better with your help.

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Sources

  • Biederman, J., et al., "The long-term longitudinal course of oppositional defiant disorder and conduct disorder in ADHD: Findings from a controlled ten-year prospective longitudinal follow-up study." Psychological Medicine, 2008, No. 28 (Accessed February 19, 2010) http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=1890480
  • Harpold, T., et al. "Is oppositional defiant disorder a meaningful diagnosis in adults? Results from a large sample of adults with ADHD." Journal of Nervous and Mental Disease, 2007; 195:7. (Accessed February 19, 2010) http://journals.lww.com/jonmd/Abstract/2007/07000/Is_Oppositional_Defiant_Disorder_a_Meaningful.8.aspx
  • Keenan, K., et al. "Further evidence of the reliability and validity of DSM-IV ODD and CD in preschool children." Journal of the American Academy of Child and Adolescent Psychiatry, 2007; 46:4. (Accessed February 19, 2010) http://www.journals.elsevierhealth.com/periodicals/jaac/article/PIIS089085670961697X/abstract
  • Mental Health Disorders: Oppositional Defiant Disorder, University of Virginia Health System, September 11, 2007. (Accessed February 19, 2010) http://www.healthsystem.virginia.edu/UVaHealth/adult_mentalhealth/odd.cfm
  • Nock, Matthew K., et al. "Lifetime prevalence, correlates and persistence of oppositional defiant disorder: Results from the national comorbidity survey replication." Journal of Child Psychology and Psychiatry, 2007; 48:7 (Accessed February 19, 2010) http://www.wjh.harvard.edu/~nock/nocklab/Nock%20et%20al_2007_JCPP_ODD.pdf
  • Oppositional Defiant Disorder, American Academy of Family Physicians. October 1, 2008 (Accessed February 19, 2010)http://www.aafp.org/afp/2008/1001/p861.html

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