Oppositional defiant disorder (ODD)
Oppositional defiant disorder (ODD)
Even the best-behaved children can be difficult and challenging at times. But if your child or teen has a persistent pattern of tantrums, arguing, and angry or disruptive behavior toward you and other authority figures, he or she may have oppositional defiant disorder (ODD).
As a parent, you don't have to go it alone in trying to manage a child with oppositional defiant disorder. Doctors, counselors and child development experts can help.
Treatment of ODD involves therapy, training to help build positive family interactions, and possibly medications to treat related mental health conditions.
It may be difficult at times to recognize the difference between a strong-willed or emotional child and one with oppositional defiant disorder. It's normal to exhibit oppositional behavior at certain stages of a child's development. But there is a range between the usual independence-seeking behavior of children and that of oppositional defiant disorder.
Signs of ODD generally begin before a child is 8 years old. Sometimes ODD may develop later, but almost always before the early teen years. When ODD behavior develops, the signs tend to begin gradually and then worsen over months or years.
Your child may be displaying signs of ODD instead of normal moodiness if the behaviors:
The following are behaviors associated with ODD:
These behaviors might cause your child to regularly and consistently:
In addition, your child isn't likely to see his or her behavior as defiant. Instead, your child will probably believe that unreasonable demands are being placed on him or her.
Related mental health issues
The symptoms of ODD may be difficult to distinguish from those of other behavioral or mental health problems.
It's important to diagnose and treat any co-occurring illnesses because they can create or worsen irritability and defiance if left untreated. Additionally, it's important to identify and treat any related substance abuse and dependence. Substance abuse and dependence in children may be associated with irritability and changes in the child's usual personality.
When to see a doctor
The earlier this disorder can be managed, the better. Treatment can help restore your child's self-esteem and rebuild a positive relationship between you and your child. Your child's relationships with other important adults in his or her life — such as teachers, clergy and care providers — also will benefit from early treatment.
There's no known clear cause of oppositional defiant disorder. Contributing causes may be a combination of inherited and environmental factors, including:
ODD is a complex problem involving a variety of influences, circumstances and genetic components. There's no single factor that causes ODD.
Possible risk factors include:
Stressful changes that disrupt a child's sense of consistency — such as divorce or changing child care — increase the risk of disruptive behavior. However, though these changes may help explain disrespectful or oppositional behavior, they don't excuse it. If you're concerned about your child's behavior or trouble adjusting to life changes, talk with your doctor.
Many children with oppositional defiant disorder have other treatable conditions, such as:
If these conditions are left untreated, managing ODD can be very difficult for the parents, and frustrating for the affected child. Children with oppositional defiant disorder may have trouble in school with teachers and other authority figures and may struggle to make and keep friends.
ODD may be a precursor to other, more-severe problems such as conduct disorder, substance abuse and severe delinquency.
Preparing for your appointment
If your child has signs and symptoms common to oppositional defiant disorder, make an appointment with your child's doctor. After an initial evaluation, your doctor may refer you to a mental health professional, who can help make a diagnosis and create the right treatment plan for your child.
Here's some information to help you prepare for your appointment, and what to expect from your doctor.
What you can do
Questions to ask the doctor at your child's initial appointment include:
Questions to ask if your child is referred to a mental health provider include:
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask additional questions during your appointment.
What to expect from your doctor
Tests and diagnosis
To be diagnosed with oppositional defiant disorder, a child must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.
Criteria for oppositional defiant disorder to be diagnosed include a pattern of behavior that lasts at least six months and includes at least four of the following:
These behaviors must be displayed more often than is typical for your child's peers.
In addition, to be diagnosed with oppositional defiant disorder, a child's disruptive behavior:
It can be difficult for doctors to sort and exclude other associated disorders — for example, attention-deficit/hyperactivity disorder versus oppositional defiant disorder. These two disorders are commonly diagnosed together.
Treatments and drugs
Treating oppositional defiant disorder generally involves several types of psychotherapy and training for your child — as well as for you and your co-parent. Treatment often lasts several months or longer.
If your child has co-existing conditions, particularly ADHD, medications may help significantly improve symptoms. However, medications alone generally aren't used for ODD unless another disorder co-exists.
The cornerstones of treatment for ODD usually include:
As part of parent training, you may learn how to:
Although some parent management techniques may seem like common sense, learning to use them in the face of opposition isn't easy, especially if there are other stressors at home. Learning these skills will require consistent practice and patience.
Most important in treatment is for you to show consistent, unconditional love and acceptance of your child — even during difficult and disruptive situations. Don't be too hard on yourself. This process can be tough for even the most patient parents.
Lifestyle and home remedies
At home, you can begin chipping away at problem behaviors by practicing the following:
At first, your child probably won't be cooperative or appreciate your changed response to his or her behavior. Expect that you'll have setbacks and relapses, and be prepared with a plan to manage those times. In fact, behavior can temporarily worsen when new limits and expectations are set. However, with perseverance and consistency, the initial hard work often pays off with improved behavior and relationships.
Coping and support
Being the parent of a child with ODD isn't easy. Counseling for you can provide you with an outlet for your frustrations and concerns. In turn, this can lead to better outcomes for your child because you'll be more prepared to deal with problem behaviors. Here are some tips to help you:
Last Updated: 2012-01-06
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