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Understanding Oppositional Defiant Disorder

Oppositional Defiant Disorder (ODD) is a type of behavioural disorder that can be classified as a disruptive behaviour disorder (DBD). This is a common mental health issue diagnosed in children and adolescents. All children and adolescents can appear to be disruptive to those around them on occasion. Most times, this is brought on by particular needs that arise such as hunger, upset, stress, or tiredness. Oppositional behaviour, in general, is a normal part of development for children and adolescents. All children at some point of development can exhibit signs of argumentative behaviour seen as talking-back, disobedience, and defying parents and caregivers. In children and adolescents with ODD, there is an ongoing and consistent pattern of disobedience, hostility, and defiant behaviour towards authority figures. When these patterns begin to disrupt home life, school participation or relationships with peers or caregivers, it may be time to seek a professional opinion to determine if there is a diagnosis of ODD that requires treatment.

It is estimated that 1-16 percent of children and adolescents have ODD. Symptoms usually appear in late preschool or early school-aged children. ODD typically presents more in boys than girls when seen in younger children; however, in school-aged children and adolescents, ODD typically affects boys and girls equally.

It is unclear what the specific cause of ODD is, although it is believed it is believed among professionals and researchers that it is a caused by a combination of risk factors including biological, psychological, and social components.

Children with the following factors are more at risk of developing ODD*:

Biological Factors

  • A family history of attention-deficit hyperactivity disorder (ADHD), ODD, or any other form of conduct disorder
  • A family history of mood disorders including depression and anxiety, or bipolar disorder
  • A family history of substance abuse issues
  • Brain damage of impairment that has affected reasoning, judgment, and/or impulse control
  • Pre-natal exposure to nicotine or toxins
  • Poor nutrition

Psychological Factors

  • A poor relationship with a parent or caregiver
  • Neglect or attachment issues
  • Difficulty forming relationships or processing social cues

Social Factors

  • Low-income
  • Inconsistent environment
  • Abuse and/or neglect
  • Poor supervision or absent parents or caregivers
  • Inconsistent expectations and/or discipline
  • Family instability or major life changes

*Note: Derived from ODD: A Guide for Families, American Academy of Child and Adolescent Psychiatry’s Practice Parameter for the Assessment and Treatment of Children and Adolescents with Oppositional Defiant Disorder (2009) 

Signs and Symptoms

Signs and symptoms of ODD are typically observed in more than one area of the child or adolescent’s life. Sometimes, these occurrences can be more noticeable in the home or at school. One major indicator that many parents and caregivers report is that, from an early age, children with ODD are constantly rigid and demanding, than their sibling.

Some of these symptoms include*:

  • Multiple and frequent temper tantrums
  • Excessive arguing with adults or authority figures
  • Questioning rules
  • Active defiance – refusal to listen to requests from adults
  • Deliberate attempts to annoy or frustrate others
  • Blaming  of others for misbehaviours
  • Easily annoyed or irritated
  • Frequent anger
  • Spiteful attitude and revenge seeking

*Note: Derived from ODD: A Guide for Families, American Academy of Child and Adolescent Psychiatry’s Practice Parameter for the Assessment and Treatment of Children and Adolescents with Oppositional Defiant Disorder (2009)

Supporting a Child or Youth with ODD

Diagnosing

There is no simple test for ODD and a mental health professional is required to assess a child’s symptoms and behaviours. Clinical experience is needed to make an accurate diagnosis. During the initial phases of assessment, a physician may be required to rule out any physical issues that could cause the behaviours that are exhibited. It is also important to determine if any other disorders or mental health issues may be present, such as attention-deficit hyperactivity disorder (ADHD), learning issues or difficulties, or mood disorders such as depression, anxiety or bipolar. It is extremely difficult to treat or improve symptoms of ODD prior to treating other coexisting disorders. A mental health professional will likely collect information from multiple sources including parents or caregivers, teachers, and child care providers, and the child themselves. This will provide for a more accurate assessment of the behaviours such as severity, frequency, and if there are environmental causes that may be producing the behaviours like a stressful home. An assessment will also determine what might be acting as a trigger to the child by examining what happens before a challenging incident. These details can help determine if there is an actual ODD diagnosis or if the symptoms are in response to a short-lived, stressful situation.

Impacts of Grief, Loss, Attachment and Trauma

Children that have experienced grief, loss, and trauma in their lives are more likely to exhibit behaviours consistent with mental health issues such as ODD. It can be difficult to distinguish traits that are a direct result of early childhood experiences with what may be symptoms of a mental health diagnosis. Even if a child in care is psychologically healthy and well-adjusted, they are still more likely than other children to develop Attention Deficit-Hyperactivity Disorder and Oppositional Defiant Disorder. Often times, however, a stable, secure, and structured environment can help to diminish or lessen the likelihood of developing mental health issues such as ODD or behaviours that mimic these disorders. It is important for parents who have adopted or prospective adoptive parents to consider the impacts of grief, loss, attachment, and trauma, while observing and supporting a child through difficult behaviours.  

Treatment

There are many different forms of treatment for children with ODD; there is no one best treatment and effectiveness will depend on the child and the symptoms presenting. Some of the factors taken into consideration for treatment are age of the child, severity of behaviours, and other coexisting diagnoses.

Here is a breakdown of some of the forms of treatment for ODD:

  • Parent-Management Training Programs and Family Therapy: This type of therapy is used to teach parents and caregivers how to manage the child’s behaviour. Parents and caregivers are taught specific techniques using methods related to positive reinforcement and effective discipline.
  • Cognitive Problem-Solving Skills Training: This helps other professionals, such as teachers, to reduce inappropriate behaviours by teaching the child positive ways of responding to stressful situations; this training teaches how to see situations and respond productively.
  • Social-Skills Programs and School-Based Programs: These programs are used to teach children and adolescents how to relate to peers in a more positive manner and includes ways to improve school work; it is most successful when conducted in a familiar environment to the child
  • Medication: Medication can help with ODD and other coexisting diagnoses but is not effective alone and must be used in combination with therapy.

*Note: Derived from ODD: A Guide for Families, American Academy of Child and Adolescent Psychiatry’s Practice Parameter for the Assessment and Treatment of Children and Adolescents with Oppositional Defiant Disorder (2009)

Research has shown that ODD does improve over time. In fact, about 67 percent of children diagnosed with ODD who receive treatment will be symptom free approximately three years. Generally, the earlier the onset of symptoms, the more likely that child or adolescent will go on to have more persistent symptoms later on in life into adulthood. The outlook is positive for those parents who have their child assessed and treated. Additionally, children diagnosed in preschool are more likely to have a coexisting diagnosis of ADHD or mood disorders. However, it is important to note that most children and adolescents will see a significant improvement over time especially when treatment is applied and engaged in.

Parenting Tips

Parenting a child or youth with ODD can be challenging at times, but there are tips and ideas on how to help. Support is available for your child or youth, as well as parents and caregivers.

  • It’s all about the positives! Focus on positive reinforcement and praise for good behaviour like flexibility and cooperation.
  • Choose your battles. ODD is characterized as power struggle and it is your job to disengage in this – prioritize the things you want your child to do: I.e. If your child is going for a time-out, do not add extra time for arguing but simply state that the time-out will begin once your child is in their room.
  • Setting boundaries. Organize and implement reasonable and age-appropriate limits with consequences that can be enforced consistently.
  • Using supports. Highlight and promote interests other than focusing on your child’s ODD so that you don’t feel that dealing with the symptoms takes all your time and energy – get support from others including teachers, coaches/instructors, and your partner or other caregivers
  • Remember to take care of yourself! Take a break if you feel that the conflict with your child is worsening. This shows good role modeling for your child and supports your child in their own time outs as well. Manage your own healthy lifestyle choice like exercise and realization and use respite care or other breaks when needed.

*Note: Derived from Oppositional Defiant Disorder: A Guide for Parents, The Brown University Child and Adolescent Behaviour Letter, Gregory K. Fritz, M.D.

Helpful Links and Resources

Children’s Hospital of Eastern Ontario & Royal Ottawa Mental Health Centre - www.cheo.on.ca

WeRKids and Youth Mental Health - www.werkidsmentalhealth.ca

Sick Kids Hospital - http://www.sickkids.ca/psychiatry/

The Hincks-Dellcrest Centre - https://www.hincksdellcrest.org/

Content References

Rey, J. M. (1993). Oppositional defiant disorder. The American Journal of Psychiatry, 150(12), 1769-1778.

Fritz, G. K. (2012). Oppositional defiant disorder: A guide for parents. The Brown University Child and Adolescent Behavior Letter. Wiley Periodicals, Inc.

Poulton, A. S. (2010). Time to redefine the diagnosis of oppositional defiant disorder. Journal of Paediatrics and Child Health, 47, 332-334.

Abolt, T., & Thyer, B. A. (2008). Social work assessment of children with oppositional defiant disorder. Social Work in Mental Health, 1(1), 73-84.

American Academy of Child and Adolescent Psychiatry (2009). ODD: A guide for families by the American Academy of Child and Adolescent Psychiatry.