Oppositional Defiance Disorder

The following is an overview of Oppositional Defiance Disorder.  For further information on ODD, links are provided at the bottom of the page. Symptoms    Diagnosis Treatment Comorbidity and ODD Differences Between ODD and ADHD Parent Strategies Medication Further Information

Symptoms 

The following symptoms must be present for more than six months and are measured against the norm for the specific age group: 

	Often losing temper
	Argumentative
	Aggressive
	Defiance of adult rules
	Uncooperative
	Deliberately aggravating others
	Easily irritated
	Being angry or resentful
	Blaming others for own misbehavior
	Low self-esteem
	Easily frustrated
	Moody

All of the above symptoms do not need to be present. Diagnostic criteria states that four or more of the above symptoms must be present for at least 6 months.  As with many disorders, symptoms may appear differently in different individuals.  Symptoms of ODD normally appear prior to the age of 8.  Many times these patterns of behavior can occur between the ages of 1 and 3.

Diagnosis 

ODD is diagnosed by a mental health professional.  An evaluation will include speaking with the child, speaking with the parents, and a review of medical history.  A physical exam should be completed to rule out any physical causes. 

Treatment 

	Family and/or individual therapy
	Behavior modification
	Structured environment
	Social skills training
	Parent Training
	Medication, if necessary

Comorbidity and ODD 

Oppositional Defiance Disorder is rarely seen alone.  Most children diagnosed with ODD have also or will be diagnosed with at least one other neuropsychiatric disorder.  Some common co-existing conditions are: 

	ADD/ADHD
	Depression
	Anxiety

Differences between ADHD and ODD 

While ODD is characterized by aggressiveness, ADHD is characterized by impulsiveness.  Other children and adults may become irritated with the behavior and impulsiveness of ADHD children, however, this behavior is not normally done to purposely annoy others.  With ODD, however, many times it is purposeful and meant to annoy and irritate those around them. 

For parents of children with ODD, every conversation can become a power struggle.  Temper tantrums and rages can become a common occurrence and often the child with ODD feels no remorse for their actions.  They will lie and blame others for their actions.  They may break other children’s toys or purposely drive them to tears.  They often become bullies and fight continuously with siblings.  

Parent Strategies 

What can parents do to help their child to cope and to make living a little easier for the entire family? 

1)      Work together.  Although this may sound easy, it is actually quite difficult.  Children with ODD can be very manipulative.  They can try to convince their mother that their teacher hates them and mistreats them, they can tell their father how their mother treats the other children better and is mean to them.  They can tell the teacher about how they are abused at home.  Much of this has to do with blaming others for their actions and refusing responsibility.  Some may be because they have learned over time that the more discord they can create among the adults in their life, them more attention is drawn away from them.  It is important, therefore, to sit down with all the adults that are in your child’s life.  Have information available on ODD, what it is and what are the symptoms.  Decide as a group that you will not believe anything that is said by the child without checking it out first.  If he should come home from school with a story on how the teacher singled him out and punished him for no reason, take the time to talk with the teacher and find out what is going on before taking any action. 

2)      Make a plan.  Decide beforehand what the consequences will be for certain actions.  Take the time to think about every scenario that might come up and determine a consequence and a reward for each.  Write it down and make copies for each adult in your child’s daily life. If your child is old enough to read, make a copy for them.  Make sure each person follows it.  Consistency and structure will eliminate the possibility of the child playing one adult off another. 

3)      Choose one or two behaviors to work on at one time.  Do not try to change all negative behavior at the same time.  If your child has frequent temper tantrums or uses profane language or hits other children, choose one of these to begin with.  Once you have gained control of that behavior, move on to another.

4)      Use as little emotion as possible when reacting to a behavior.  Children with ODD can relish the reaction their behavior can cause. If you limit the negative attention and remain calm while reacting and referring to a consequence, then they will not have the satisfaction of your anger.

5)      Reduce the amount of time your child watches television.  Have a list of positive, productive games, tasks and activities.  Monitor your child to make sure that they do not spend hours watching television. 

6)      Take care of yourself.  Many time children with ODD will try to control the entire family, as well as exploiting weaknesses.  Make sure that you take care of yourself so that you are prepared and can calmly deal with your child.  Find some time to be by yourself, find some time for your husband and you to be alone together.  

Medications for ODD 

Although parents never want to place their child on medication, sometimes it is necessary to do so.  Your physician will discuss with you what medications might work best and the side effects of each.  Because ODD is rarely seen alone in a child (normally there are other co-existing conditions) medication must work together if the child is on medication for another disorder.  Always  be sure to use medications under a doctor’s care. 

A few of the medications sometimes used to control ODD are: 

	Clonidine
	Risperidal
	Zyprexa
	Seroquel

Further Information

Indicators for ODD - Common behavioral traits of children with ODD.

Diagnostic Criteria - From Internet Mental Health criteria used in the diagnosis of ODD

Treatment - Current treatment methods for ODD

Power Struggles - It takes two for a power struggle to develop. Disengaging yourself can eliminate the struggle.

Could Something Really Be Wrong With My Difficult Child? - If you think that there is something "wrong" with your child, chances are you are right.  Trust your own judgement and intuition.