“Oppositional Defiant Disorder”
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What is it?

Remember when your child was going through the "terrible two's"? Did that stage seem to continue as your child got older?

Children and adolescents with Oppositional Defiant Disorder, or ODD, are much more difficult to be with than other children their age.

They display hostile behaviors which occur more often than normal and are usually seen before the child reaches eight years of age.

ODD ADHD

Characterized by aggressiveness, rather than impulsiveness.

Characterized by impulsiveness, rather than aggressiveness.

Child purposefully annoys people.

Annoyance is usually not purposeful.

Child does not have difficulty with concentrating or sitting still.

Child fidgets, has difficulty with concentration, and has trouble sitting still.

Behavior is purposeful, intended to "get a rise" out of others.

Child often acts without thinking ahead.

1. A child with ODD is usually much more difficult to deal with than a child who has ADHD. A child with ADHD may impulsively push another child too hard on a swing and knock the child to the ground, and then generally feel bad about it afterward. However, a child with ODD might say s/he didn’t do it, then brag about it to friends later. ADHD sometimes goes away without intervention, but ODD rarely does.

2. How are ODD and Conduct Disorder related? Currently, the research shows that in many aspects, Conduct Disorder is a more severe form of ODD. Thus, severe ODD may develop into Conduct Disorder. Milder ODD usually does not "turn into" Conduct Disorder. The common thread that separates ODD from Conduct Disorder is safety. If a child has conduct disorder, there are more concerns for the safety of others and their possessions. Behaviors such as fire-setting and vandalism are common in Conduct Disorder, and often the safety of the child with Conduct Disorder is also of great concern. Children with ODD are generally an annoyance, but not especially dangerous.

ODD Conduct Disorder

Disobedience and opposition to authority.

Severe disobedience and opposition to authority.

Hostility is shown through deliberately annoying others or verbal aggression.

Hostility is shown through physical aggression.

Behaviors may or may not be seen at home and in school and other community settings.

Behaviors are persistent both outside of the home setting.

Basic rights of others or age-appropriate societal rules are not usually violated.

Basic rights of others or age-appropriate societal rules are often

3. What happens to children who have ODD when they grow up?

There are three main paths that children with this disorder will take. First, there will be some lucky children who outgrow this disorder. The exact percentage who outgrow it is not known, but it is probably not the majority.

Second, ODD may turn into Conduct Disorder. This usually happens fairly early in childhood. That is, after 3-4 years of having ODD, if it hasn’t turned into Conduct Disorder, it probably never will.

Third, the child may simply continue to have ODD. Recent research suggests that this is probably the most common path. Another common occurrence is that children who have ODD develop signs of mood disorders or anxiety as they get older.

Parent-Help Suggestions

Children and adolescents with ODD are much more difficult to be with than other children of their age. The destructiveness and disagreeableness are purposeful.

They like to see you get mad. Every request can end up as a powerful struggle. Lying becomes a way of life, and getting a reaction out of others is the chief hobby. Perhaps hardest of all to bear, they rarely are truly sorry and often believe nothing is their fault.

After a child with ODD "blows up", s/he is often calm and collected. Then the parents and other family members may feel they have been provoked into being angry. This is understandable, because they may have been tricked, bullied, or lied to, or may have witnessed an intolerable temper tantrum by the child with ODD.

Children and adolescents with ODD produce strong feelings in other people. They try to provoke reactions in people, and they are often successful. Common issues include inciting spouses to fight with each other rather than focusing on the child, making outsiders believe that the parents are at fault for conflicts, making vulnerable people believe that they can "save" the child by doing everything the child wants, setting parents against grandparents, setting teachers against parents, and even inciting the parents to abuse the child.

Non-Medical Strategies for Managing ODD

The essence of this group of interventions is to make it impossible for ODD to "work". It is a way of making sure all the attempts to annoy or irritate others and to cause fighting are not successful.

1. Adults must work together.
Children with ODD are quite successful at placing the blame for their behaviors on others, including parents and/or teachers. Thus, adults must come together and challenge anything that the child tells you about how others treat them. In order for this to work effectively, all parties need to talk directly with each other without the child being present.

o Talk regularly with teachers and principals about the child's school behavior.
o Establish a policy at both home and school not to rely exclusively on information your child gives you about what others have done.
o Sit down with all caregivers (including baby sitters, grandparents, aunt, uncles) to make sure they understand ODD and that they follow the above policy.
o Do not include the child in these discussions with other caregivers.
2. Have a plan and try not to show any emotion when reacting to the child’s behavior.
If you react too emotionally, you may make big mistakes in dealing with the child. Everyone needs to agree in advance on what to do when the child engages in certain behaviors-- and then be prepared to follow through calmly.

Behavior modification strategies have been used successfully in the therapeutic treatment of ODD, and can also be used effectively in the home. The central premise of behavior modification (or behavior therapy) is that behavior is maintained by its consequences.

It suggests that old behaviors resist change unless new behaviors are followed by more rewarding consequences. Many therapists suggests that for the most part, focusing on the positive behaviors and not reacting emotionally to the negative behaviors is the key to getting behaviors to change.

For behavior modification to work, the program must involve certain components:

o Target only a few important behaviors, rather than trying to fix everything. For example, you may wish to focus on eliminating highly objectionable behaviors such as hitting others, stealing, or swearing.
o Be very concrete about the expected behavior. Instead of saying, "listen when I am talking," say, "Sit down and make eye contact with me when we are talking."
o Be consistent -- no bending of the rules under any circumstances!
o Rewards for good behavior should not be money or things that are bought. Rather, grant rewards that involve activities that the child enjoys.
o Rules should be simple and straightforward so as to be easily understood. If your child can read, write the rules and consequences (both negative and positive) into a contract and have the child sign it.
3. Decide which behaviors you are going to ignore.

Most children and adolescents with ODD are doing too many things you dislike to include all of them in a behavior management plan. The key caregivers have to decide ahead of time which behaviors will be targeted for change, and which will simply be ignored.

Professional Interventions

Raising a child with ODD can be an exhausting and frustrating challenge. Professional interventions have been devised to give parents a greater understanding about the causes of this disorder, as well as empower them to regain control of their child.

Parent-training and support classesThe central focus of therapy is usually behavioral, which is implemented through parent training. Parent training and support can often be held in a group setting. In these courses, parents learn specific behavioral techniques which help increase the maintenance of control in the relationship with the child. Gradual shaping of the child’s behavior toward more age-appropriate behaviors is accomplished through the implementation of a behavioral monitoring and reward program.

PsychotherapyFamily and individual treatment can be effective in some cases. This method is heavily focused on the child’s behaviors and causative factors, which may not be appropriate for all families. However, if the child is experiencing a co-existing disorder, family and/or individual therapy can be useful in reducing the family’s (and child’s) concerns, stress, and relationship difficulties.

MedicationsODD is usually a co-existing disorder. If your child has another existing condition, talk with your doctor or therapist about the right medical interventions for your child.

When do you consider medications?

There are three reasons to consider medication:
1. If medically treatable co-existing conditions are present (e.g., ADHD, depression, anxiety, etc.).
2. If non-medical interventions have not been successful.
3. When the symptoms are very severe, and you believe your child’s safety may be at risk due to their behavior.
Which drugs should your child take?

Ask your child's doctor or therapist about their preferences for medications, and then do some of your own research. Look for drugs that have been proven safe for children, have no long-term side effects, and have been found in research studies to be effective. Each drug has certain side effects that need to be monitored.

Potential Resources

 Behavioral health professionals trained to deal with children and adolescents (including psychologists, social workers, counselors, and social workers)
 School psychologists, counselors, and teachers
 Your family doctor or pediatrician
 Your minister, rabbi, bishop, or priest
 Parent support groups
 Parents Anonymous
 Your health insurance company (look for "behavioral health services" or "mental/nervous services" listed in your health benefits booklet)
 Community information-and-referral services
Authors, in order of contribution:

 Shelisa Bartholomay  Beth Keen, Ph.D. © 2000-2005 Notmykid.org All Rights Reserved.

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