Oppositional Defiant Disorder

Oppositional Defiant Disorder

Oppositional Defiant Disorder

Oppositional defiant disorder (ODD) is a childhood condition that is characterized by defiant, disruptive, and disobedient behaviors such as arguing or answering back to adults and authority figures.

Other behaviors include children losing their temper; blaming others for their mistakes and/or misbehavior; intentionally engaging in activities known to annoy other people; being vindictive, resentful, overly sensitive, and easily annoyed.

ODD vs Conduct Disorder

Although there is some overlap between ODD and conduct disorder, the behaviors seen in those with ODD are usually less severe — their behaviors aren’t usually aggressive and/or destructive resulting in harm to others and damage to property, while those with conduct disorders are.

Symptoms of Oppositional Defiant Disorder:

Children with ODD might:

  • Have frequent outbursts of anger or temper tantrums
  • Deliberately try to annoy, antagonize, test limits, or upset others
  • Be spiteful, resentful, and seek revenge
  • Swear or use obscene language
  • Say cruel, hostile, and hateful words, especially when upset
  • Frequently argue with adults, be stubborn, confrontational
  • Persistently resist or defy parents’ or guardians’ rules or requests – unwilling to negotiate, give in, or compromise
  • Place blame for their behavior on others rather than accept personal responsibility for it

Some children only show their ODD symptoms in the home, while others are defiant everywhere, but most exhibit these behaviors with people they know well. They may not present on an initial visit with a therapist, and when questioned may say their outbursts and behavior are because of unfair treatment or situations.

Diagnosis of Oppositional Defiant Disorder:

It is not uncommon for children to exhibit many ODD behaviors from time to time, but it is considered a criterion for diagnosis when the behavior presents more often than in other children of the same level of development and the same age.

For a diagnosis of ODD to be made in children, the child’s behaviors must:

  • Be present for at least six months
  • Present four or more behaviors (from the symptoms list)
  • Cause significant impairment in social and scholastic functioning
  • Happen far more often than is typically observed in children of the same age and developmental level
  • Not only occur during psychotic or mood disorder episodes, such as depression
  • Not meet criteria for conduct disorder or antisocial personality disorder if the individual is over 19

Severity

Individuals can present symptoms in different levels of severity. Clinically, this has been formalized into three groups, and they are defined by the number of settings in which the behaviors occur. These levels include:

  • Mild – Only in one setting like home, school, or work
  • Moderate – At least two settings
  • Severe – Three or more settings

Causes of  Oppositional Defiant Disorder:

As with many conditions and disorders, the exact cause of oppositional defiant disorder is not clear. Factors that may contribute to the development of the disorder could stem from a combination of both environmental and genetic elements, including:

  • Environmental – problems at home, parent’s substance abuse, ineffective parenting, neglect or abuse, lack of supervision, harsh or inconsistent consequences and discipline
  • Genetics – inherited traits that can result in neurobiological differences in temperament or disposition

Treatment for Oppositional Defiant Disorder:

Family-based interventions are the primary treatments for addressing oppositional defiant disorder, but a more comprehensive treatment plan may include other types of psychotherapy and training for both the child and the parents, and this can often last several months.

Treatment is also required for any co-occurring disorders or conditions known or diagnosed at the time, since they can contribute to worsen oppositional symptoms if they are not treated.

Typical ODD treatment types:

  • Parent-child interaction therapy (PCIT) – Sessions are conducted where the therapist can observe the child interacting with their parents to best offer input on any corrections. In one format — using a one-way mirror to ensure the therapist is not seen by the child— the therapist will observe the family interactions and provide guidance and coaching through an earpiece. The sessions help improve the parenting skills through both implementing or improving positive reinforcement for good behavior as well as developing consistent and appropriate consequence-based correction. Because the child is unaware of the therapist interaction, they associate the skills with the parent.
  • Parent training – to help parents develop parenting skills that are positive, consistent, and low on frustration. The therapist may also choose to involve other authority figures like teachers in the training. The goal of the training is for these techniques of consistent acceptance and love to become habitual and instinctive when under pressure or in an emotionally charged situation. Getting to this goal will require patience and much practice. Even for the most patient people, this can be a tough, challenging process, and giving yourself time to grow into it is important.
  • Individual and family therapy – help the child and family members learn how to express their feelings and anger in a healthy, controlled way. Improves the relationships and communication dynamics within the family.
  • Social skills training – For interactions that take place outside the home, such as in school or at the playground, etc., social skills training can be a valuable tool to teach them how to have more positive and effective interactions, as well as be more flexible.
  • Cognitive problem-solving training – Children learn how to accurately identify thought patterns that result in problematic behavior and then change them to be more constructive and positive. In addition, collaborative problem-solving with family members and authority figures teaches the child how to work with them to create solutions that work for both sides.

Medication – It is rare that a treatment plan would only consist of medication since none have yet been identified to be a suitable solitary treatment. Typically, medications are only a part of the overall treatment when there are other co-occurring conditions like depression, anxiety, or ADHD.

Outlook for Oppositional Defiant Disorder:

Children with the milder cases of ODD frequently get better with age, while children diagnosed with more severe cases of ODD may develop a conduct disorder.

 

Symptoms of Oppositional Defiant Disorder:

Children with ODD might:

  • Have frequent outbursts of anger or temper tantrums
  • Deliberately try to annoy, antagonize, test limits, or upset others
  • Be spiteful, resentful, and seek revenge
  • Swear or use obscene language
  • Say cruel, hostile, and hateful words, especially when upset
  • Frequently argue with adults, be stubborn, confrontational
  • Persistently resist or defy parents’ or guardians’ rules or requests – unwilling to negotiate, give in, or compromise
  • Place blame for their behavior on others rather than accept personal responsibility for it

Some children only show their ODD symptoms in the home, while others are defiant everywhere, but most exhibit these behaviors with people they know well. They may not present on an initial visit with a therapist, and when questioned may say their outbursts and behavior are because of unfair treatment or situations.

 

Diagnosis of Oppositional Defiant Disorder:

It is not uncommon for children to exhibit many ODD behaviors from time to time, but it is considered a criterion for diagnosis when the behavior presents more often than in other children of the same level of development and the same age.

For a diagnosis of ODD to be made in children, the child’s behaviors must:

  • Be present for at least six months
  • Present four or more behaviors (from the symptoms list)
  • Cause significant impairment in social and scholastic functioning
  • Happen far more often than is typically observed in children of the same age and developmental level
  • Not only occur during psychotic or mood disorder episodes, such as depression
  • Not meet criteria for conduct disorder or antisocial personality disorder if the individual is over 19

Severity

Individuals can present symptoms in different levels of severity. Clinically, this has been formalized into three groups, and they are defined by the number of settings in which the behaviors occur. These levels include:

  • Mild – Only in one setting like home, school, or work
  • Moderate – At least two settings
  • Severe – Three or more settings
 

Treatment for Oppositional Defiant Disorder:

Family-based interventions are the primary treatments for addressing oppositional defiant disorder, but a more comprehensive treatment plan may include other types of psychotherapy and training for both the child and the parents, and this can often last several months.

Treatment is also required for any co-occurring disorders or conditions known or diagnosed at the time, since they can contribute to worsen oppositional symptoms if they are not treated.

Typical ODD treatment types:

  • Parent-child interaction therapy (PCIT) – Sessions are conducted where the therapist can observe the child interacting with their parents to best offer input on any corrections. In one format — using a one-way mirror to ensure the therapist is not seen by the child— the therapist will observe the family interactions and provide guidance and coaching through an earpiece. The sessions help improve the parenting skills through both implementing or improving positive reinforcement for good behavior as well as developing consistent and appropriate consequence-based correction. Because the child is unaware of the therapist interaction, they associate the skills with the parent.
  • Parent training – to help parents develop parenting skills that are positive, consistent, and low on frustration. The therapist may also choose to involve other authority figures like teachers in the training. The goal of the training is for these techniques of consistent acceptance and love to become habitual and instinctive when under pressure or in an emotionally charged situation. Getting to this goal will require patience and much practice. Even for the most patient people, this can be a tough, challenging process, and giving yourself time to grow into it is important.
  • Individual and family therapy – help the child and family members learn how to express their feelings and anger in a healthy, controlled way. Improves the relationships and communication dynamics within the family.
  • Social skills training – For interactions that take place outside the home, such as in school or at the playground, etc., social skills training can be a valuable tool to teach them how to have more positive and effective interactions, as well as be more flexible.
  • Cognitive problem-solving training – Children learn how to accurately identify thought patterns that result in problematic behavior and then change them to be more constructive and positive. In addition, collaborative problem-solving with family members and authority figures teaches the child how to work with them to create solutions that work for both sides.

Medication – It is rare that a treatment plan would only consist of medication since none have yet been identified to be a suitable solitary treatment. Typically, medications are only a part of the overall treatment when there are other co-occurring conditions like depression, anxiety, or ADHD.

 

Causes of Oppositional Defiant Disorder:

As with many conditions and disorders, the exact cause of oppositional defiant disorder is not clear. Factors that may contribute to the development of the disorder could stem from a combination of both environmental and genetic elements, including:

  • Environmental – problems at home, parent’s substance abuse, ineffective parenting, neglect or abuse, lack of supervision, harsh or inconsistent consequences and discipline
  • Genetics – inherited traits that can result in neurobiological differences in temperament or disposition
 

Outlook for Oppositional Defiant Disorder:

Children with the milder cases of ODD frequently get better with age, while children diagnosed with more severe cases of ODD may develop a conduct disorder.

Sources MAYO CLINIC – ODD Diagnosis andTreatment | MAYO CLINIC – ODD Causes and Symptoms | HOPKINS MEDICINE – ODD in Children | CHILDRENS HOSPITAL – Symptoms and Causes | WEBMD – ODD Diagnosis | MEDLINE PLUS – Causes | PSYCH CENTRAL | WEBMD – Temper Tantrums