ODD or Oppositional Disorder – What do I do about it?

Oppositional defiant disorder (ODD) is a serious, family-straining condition often associated with violent outbursts, persistent disobedience, and school expulsions. Parents complain, “he was aggressive and violent. He’d lash out, and he’d hit me and his sister. He’d make holes in the wall. He refused to go to school most days, forcing his father to drag him to the car in his pajamas, hoping he would get dressed on the way. He stole things from his brother, he broke his father’s tools, and didn’t do his homework. In eighth grade, he refused to wear clean clothes for weeks, opting for the dirtiest, most ragged outfits he could find. The prolonged clash culminated in a screaming argument.” Oppositional defiant disorder or ODD is characterized by violent outbursts, resistance to rules, and a predilection for spiteful behaviors — along with attention deficit disorder (ADHD or ADD) and may include, Asperger’s syndrome.

ODD is more than backtalk or the occasional tantrum. It’s a persistent, excessive pattern of negative behaviors against authority figures in a child’s life, lasting for six months or more. Like thousands of kids with ODD, many spend their childhoods being expelled from school, clashing with police, and pushing those around them to the edge of sanity. “It takes away your feeling of any kind of empowerment as a parent.” That’s a terrible feeling. That’s when you get really angry.

“You can’t be consistent when somebody doesn’t care about the consequences.” If mom took his things away, he broke into her bedroom to get them back. If she said he couldn’t watch TV, he turned it on anyway. “In this case we are talking about a 14-year-old kid who’s 5’9” or so. Do you think a 5’2 female is going to wrestle him out of the living room?”

Why Does ODD Develop? Though the exact causes of ODD are not fully understood, Dr. Russell Barkley outlines four contributing factors in Defiant Children: A Clinician ’ s Manual for Assessment and Parent  Training :

  • Negative patterns in the parent-child relationship: “Ineffective, inconsistent, indiscriminate, and lax or even timid child management methods being employed by parents” can be a major factor in a child developing ODD. But it isn’t the whole story. “It would be erroneous to conclude from this that all defiant behavior results from the parent–child relationship.”
  • Natural characteristics of the child: Children who have a more negative temperament from birth — an unusually fussy baby, for instance — may be more likely to develop ODD later on. Children who are impulsive — often due to abnormalities in their amygdala, prefrontal cortex, or anterior cingulate — may also be more prone to ODD.
  • Natural characteristics of the parents: Parents of children with ODD are more likely to have psychiatric disorders like depression, ADHD, or antisocial personality disorder, which can lead to inconsistent or negative parenting patterns that increase the risk for defiance. Younger parents, too — particularly single parents — have a greater risk of their child developing ODD.
  • Additional social or familial context: Human behavior is heavily influenced by the world around us, and this remains true for ODD. Poor families with access to fewer resources may be at higher risk for defiant children. Children of divorce may also be at greater risk. (2)

“The most evidence-based treatment approach is behavior-based parent training,” said David Anderson, Ph.D., senior director of the ADHD and Behavior Disorders Center of the Child Mind Institute. Though many parents may be inclined to try to tackle it on their own, he said, “When you have families that are engaged in this much parent-child conflict, you don’t normally see kids ‘grow out of it’ easily.” The focus of a parent-focused clinical approach is on helping parents with things like consistent discipline, de-escalation strategies, and implementing positive praise.

“Medications are not specifically indicated for ODD alone,” Anderson said, but “[they] are often prescribed for comorbidity.” That means that if the child has another condition, like ADHD, getting some of those ADHD behaviors under control with medication may help the child access coping skills that allow him to manage his defiance. It also helps you, the managing adult to cope with the situation.

This was based upon an article by Devon Frye in Attitude magazine.
  1. Frye, D. (2019). Back From the Brink: Two Families’ Stories of Oppositional Defiant Disorder. Attitude, 1-7. doi:9/21/2018Oppositional Defiant Disorder: Stories of Family Survivalhttps://www.additudemag.com/oppositional-defiant-disorder-adhd-family-stories/?utm_source=eletter&utm_medium=email&utm_campaign=best_sept.
  2. Barkley, R. A. (2013). Defiant children: A clinicians manual for assessment and parent training. New York: The Guilford Press.

 

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