Arguing, tantrums, not listening, talking back. Sound familiar? There was probably just a collective nod from every parent throughout history. But the thing that’s different with oppositional defiant disorder (ODD) is that this kind of hostile, disobedient, and vindictive (yeah, children can be vindictive) behavior is persistent and has been going on for at least six months. Kids (and adults) with ODD will seem touchy and annoyed, easily lose their temper, and have angry outbursts—which are almost always directed at parents, teachers or other authority figures. Because it’s not just a passing mood, ODD can disrupt simple daily activities and family dynamics (especially if there are siblings) and can cause problems at school or work for adults.

What Are the Symptoms of ODD?

Symptoms of ODD may include:

  • Throwing repeated temper tantrums
  • Arguing frequently and excessively with adults, particularly those in positions of authority
  • Refusing to obey rules and follow requests
  • Doing things to purposely annoy or upset others
  • Blaming others for their misbehavior or mistakes
  • Having frequent outbursts of anger and resentment
  • Seeking revenge or being vindictive
  • Saying mean things when upset and using obscene language
  • Being moody and easily frustrated

Since many of these symptoms sound like the average week for most toddlers, it’s tricky to know when to get help. Also, ODD has a lot of cross over with other disorders like attention deficit hyperactivity disorder. Your pediatrician can help you decide if your child should be evaluated.

Is it ODD or is My Child Simply Misbehaving?

Only a mental health professional who is trained in recognizing ODD can make a diagnosis, but there are a two main questions that can help you decide if it’s time to see a professional. According to psychologist Adam Saenz, Ph.D., D. Min.,  where the behavior happens is one of those questions. “If misbehavior only occurs in one setting (say only at home, only at school, only on the sports field), then it’s likely a response to some environmental trigger,” he suggests. Children with ODD are typically disobedient, hostile, and vindictive in a variety of settings.

The second questions is: “Is the misbehavior getting in the way of having a normal, functioning life (for the child or the rest of the family)?” This might be tougher to answer, but think about your social life and academics. If your child is struggling in either of these two, then the answer is yes, the behavior is getting in the way of a normal life.

Risk Factors for ODD

The research on ODD is split. Some evidence suggests there are specific genetic factors that predispose children, other research shows correlations with the environment, such as family stress or caretaker depression. It’s likely that both factors contribute. In fact, some research has even pinpointed which symptoms relate more to genetics versus the environment.

Estimates suggest that 2%-16% of children and teens have ODD. It’s often diagnosed in preschool years. In younger children, ODD is more common in boys. Children living with mood disorders, anxiety, ADHD, and/or conduct disorder are also more likely to have ODD. The good news is some children do grow out of ODD and with intervention it can be managed. Adults who have ODD may have developed the disorder in childhood and not been diagnosed or treated.

Diagnosing ODD

The first step will be a medical exam. Your doctor will want to rule out any physical explanation. Next, you’ll see a psychiatrist or psychologist who will use specific assessment tools and criteria, as well as observation and reports from parents, teachers, and other authority figures, to help determine if your child has ODD.

There are three levels of ODD.

  • Mild: This is where the symptoms are confined to only one setting.
  • Moderate: Here some symptoms will be present in at least two settings.
  • Severe: Symptoms will be present in three or more settings.

ODD vs Disruptive Mood Dysregulation Disorder (DMDD)

Disruptive Mood Dysregulation Disorder (DMDD) is a type of depressive disorder diagnosed in children who struggle to regulate their moods and emotions in an age-appropriate way. Children with DMDD have frequent temper outbursts in response to frustration, either verbally or behaviorally. In between outbursts, they experience chronic, persistent irritability. Dr. Saenz suggests that the primary difference between ODD and DMDD is that meltdowns associated with DMDD are driven by mood instability, basically being overwhelmed by emotions. Meltdowns associated with ODD are most often associated with authority figures and are characterized by arguing, annoying others, blaming others for one’s own mistakes, and vindictiveness according to Dr. Saenz.

ODD Treatment

Psychotherapy and Behavioral Interventions

Cognitive-behavioral therapy (CBT), a type of psychotherapy, is commonly used to teach children how to deal with thoughts and feelings and teach them how to reshape them. Family therapy may also be used to help improve interactions with authority figures and communication among family members. Both parents and siblings can benefit from the support family therapy provides.

Parent Management Training

In parent management training, parents are taught specific strategies to use when their child has an outburst. Training also focuses on the importance of predictability and consistent consequences when the child doesn’t follow instructions. It’s helpful if all authority figures who spend a significant amount of time with the child partake in the training.

Medication

Medication is usually not prescribed; in fact, the FDA hasn’t approved any medications for ODD. If there is an overlap between ODD and ADHD (which is common), mood regulators, alpha (2)-agonists and antidepressants are used as second-line therapy.

Self-Help Strategies for Parents

One of the best things you can do is be upfront with teachers and other adults. The more they know, the better they understand and can handle situations that may come up. Children with ODD need a little more space and a little more time to process direction. Here are five strategies to help:

  • Set Clear Expectations and Consequences. According to psychologist Kahina A. Louis, Ps.yD, increasing structure at home is the first step in beginning to manage the behaviors associated with ODD. “This includes setting clear expectations of the rules/routine and even posting them somewhere where the child can see,” she says. “The consequences for non-compliance could also be posted under the rules/routine and should be fair and consistent. A fair consequence is one that makes sense based on the action (e.g., losing TV time that day or next for watching TV instead of completing a homework assignment).” It’s critical that you consistently enforce consequences for your child’s actions to teach them what to expect when they break the rules and what it means to be accountable for their actions. “Parents may even frame this to the child by saying “it’s your choice; either do [the desired behavior] or face the consequence,” advises Dr. Louis. “As the child begins to realize that what happens next is truly a result of their behavior, they can begin to take better control of their behaviors in order to achieve the desired result.”
  • Use praise and rewards.“Just as important as consequences, if not more, is the use of praise and rewards when the child engages in desired behaviors,” continues Dr. Louis. “Often, children with ODD are seen as the “bad” child and constantly receive negative feedback about themselves. This can lead to a negative relationship between themselves and their authority figures.”Recognizing when your child is behaving positively balances that out. “Parents should consistently let their child know when they are doing a good job, thank them for their positive behaviors, and apply rewards (such as extra play time, extended privileges, preferred family activity, etc.),” advises Dr. Louis. “Again, this shows the child that what happens next, a reward or a consequence, is their choice.”
  • Set boundaries by offering choices. Dr. Saenz also emphasizes the importance of choices when it comes to confronting your child’s ODD symptoms and reshaping their behaviors. “A primary strategy for dealing with uncooperative behavior is to set boundaries by offering choices,” he says. “For example, “Would you like to pick up your clothes or make your bed first?” instead of “You need to go clean your room.”
  • Help your child deal with their feelings Children with ODD are often moody, easily frustrated, and display angry outbursts, so “it is also important to help a struggling child understand and regulate the feelings that might be driving oppositional behavior,” notes Dr. Saenz. “Instead of asking, ‘What should you be doing right now’, ask, ‘How are you feeling right now?’ Then, validate the feeling by saying, “I understand how you feel.  Sometimes I feel that way when my boss asks me to do things that I don’t want to.’”
  • Link the feeling with the behavior. Once you have encouraged your child to discuss their feelings, and subsequently validated those feelings, Dr. Saenz stresses the importance of linking the feeling with the behavior. He suggests using a phrase such as, “It’s okay for you to feel angry, but it’s not okay for you to ignore my requests.  Before I ask you to follow my directions again, let’s deal with your anger by practicing our breathing exercises.” By meeting the child where they are emotionally, unpacking and validating those feelings, and calmly addressing them, you can contain your child’s anger before it spirals while still teaching them their behavior is unacceptable.

 

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Last Updated: Jun 10, 2020