What is Oppositional Defiant Disorder (ODD)?

by Dr. Shanthi Thomas

Are you familiar with children or teenagers who display disobedient and defiant behaviour? Of course all children are defiant and disobedient some time, but if a child displays such behaviour most of the time, it could be a case of Oppositional Defiant Disorder. Children and teenagers affected by this disorder display irritable, angry, hostile, argumentative and vindictive behaviour frequently. Unfortunately, it is one of the common behavioral disorders found in children and teenagers. The good news is that by 18 years of age, a lot of children would have outgrown this disorder. However, while it is present, it is nothing less than a nightmare for parents and teachers to handle.

Symptoms of ODD

At least four of the following symptoms are present in a child or teenager with Oppositional Defiant Disorder.

• Frequent arguments with adults
• Frequently losing temper
• Refusal to follow adults’ rules or requests
• Annoying people deliberately
• Blaming others for one’s own mistakes or misbehavior
• Being easily annoyed by others
• Being angry and resentful often
• Being vindictive or spiteful often
• Mean and hateful talking while upset

As can be expected, most teenagers and children with Oppositional Defiant Disorder suffer from impairments in academic, social or occupational functioning. Low self-esteem and difficulty maintaining relationships and friendships are also commonly observed symptoms.

Causes of ODD

Though many researchers suggest a strong genetic component in the incidence of Oppositional Defiance Disorder, the general consensus is that it is caused by a combination of biological, psychological and social factors. A lot of children with ODD come from families with a history of Attention Deficit Hyperactivity Disorder (ADHD), mood disorders such as Bipolar Disorder or Depression, and substance abuse. Some environmental factors such as lack of parental supervision, lack of structure in day-to-day activities, inconsistency in disciplinary practices, and exposure to violence and abuse, have also been cited as possible causes of ODD. Adopted children and children of divorced parents are seen to be at a higher risk of having this disorder.

Treatment for ODD

Treatment for ODD involves family-based interventions as well as psychotherapy and training for the child and parents. Typically the treatment lasts several months or a couple of years. Medications are used for ODD if it coexists with other disorders such as Attention Deficit Hyperactivity Disorder (ADHD), anxiety or depression. As such, there is no medicine approved for use to treat ODD.

The most important and effective treatment for ODD consists of:

• Parent training, which refers to training the parents to adopt parenting skills that are consistent, positive and less frustrating for all parties involved.
• Parent-child interaction therapy (PCIT) — This therapy involves a therapist coaching parents while they interact with their child. Usually, the therapist sits behind a one-way mirror and, using an audio device, guides parents through techniques that reinforce their child’s positive behavior.
• Individual and family therapy — Individual therapy for the child helps him or her manage anger and express feelings in a healthy way. Family therapy, on the other hand, helps the members of the family to learn how to work together.
• Cognitive problem-solving training — This is aimed at helping the child change thought patterns that lead to behavior problems.
• Collaborative problem-solving — Parents and the child work together to come up with solutions that work for both.
• Social skills training — This training may help the child to be more flexible and learn how to interact positively and effectively with peers.

How parents can help

Even if the family is not in a position to seek therapy, there are certain steps that the parents can take to lessen the ODD behaviors exhibited by the child, as given below.

1. Parents have to give clear instructions and follow through with appropriate consequences.
2. Parents have to recognize and praise the child’s good behaviour and positive characteristics so that the desired behaviour will be repeated.
3. Parents need to show consistent and unconditional love for their child and accept him even when he is proving to be difficult to handle.
4. If there is a situation where conflicts can occur with the child, take a time-out or break.  Also, support your child if he decides to take a time-out to prevent an emotional outburst.
5. Give choices about how or when a particular task can be done, not whether it should be done or not.
6. Try to keep your cool at all times. It is imperative that parents keep their composure because the chances of resolving the issues at hand are higher if you are calmer.