Typically first diagnosed in elementary-aged youth, Oppositional Defiant Disorder, or ODD, is a psychiatric condition characterized by a chronic pattern of disruptive behavior. Estimates suggest that anywhere from 6 - 10% of children have ODD. Core features include negativity, anger and hostility, verbal aggression, and behavioral outbursts. While all children periodically display developmentally appropriate oppositional behavior and test limits, those with ODD have frequent anger outbursts and repeatedly refuse to comply with rules and instructions.
The DSM-5 Criteria: Oppositional Defiant Disorder (ODD)
Symptoms must be present for a minimum of once per week for at least 6 months, occur in at least one setting (home, school, or with peers), cannot only involve siblings, and negatively impact social, educational, and work functioning.
- Often loses temper
- Easily annoyed
- Frequently angry and resentful
Argumentative and Defiant Behavior
- Argues with adults and authority figures
- Actively defies or refuses to comply with rules and requests
- Deliberately annoys others
- Blames others for his or her mistakes - child often sees himself/herself as the blameless victim and then feels justified for acting out because he/she was treated unfairly
- Spiteful or vindictive towards others - child will attempt to get back if you if he/she feels wronged, seeks revenge
What to Know
1) ODD frequently occurs in conjunction with other psychiatric disorders including Attention Deficit Hyperactivity Disorder (ADHD), learning disabilities, mood disorders (depression), and anxiety disorders. It is important to treat the co-occurring disorders as the symptoms of ODD may otherwise be difficult to address successfully.
2) There are no FDA-approved medications for ODD. However, many medications such as those used in the treatment of ADHD can decrease defiant behaviors. For example, many children with ADHD are impatient and quite impulsive. These youth are often easily triggered and respond first and think/reason second. Using an ADHD medication such as Adderall XR or Strattera will improve impulsive behavior; and, in turn, provide an opportunity for the child to stop and think and come up with a better choice.
3) Positive parenting techniques are critical in the treatment of ODD. Here are a few effective parenting strategies to incorporate as part of the overall treatment plan:
- Incorporate praise and positive reinforcement - rather than focus primarily on what your child did wrong, emphasize what he/she did right particularly when he/she responds to requests the first time asked, demonstrates patience and good frustration tolerance, or uses words to express anger rather than engaging in destructive behavior
- Model appropriate behavior - as parents we, too, get fed up and angry so when this occurs we should take our own time-out to calm down rather than give into our hard day and frustration and start yelling; try your best not to over-react as our children our watching
- Pick your battles - forego doling out severe consequences for a heavy sigh or eye roll and don't tack on an extra day of punishment for a small misdeed so as to avoid unnecessary power struggles with your child, this doesn't mean you overlook all misbehavior but instead focus on the really problematic actions
- Make sure the punishment fits the crime - consequences should be reasonable, developmentally appropriate, and consistent otherwise they are ineffective and lose their value
- Remember you are your child's parent and not their friend so please act accordingly
These are just a few important facts about ODD. Feel free to post any comments or questions you might have, and check back next week for another post on a different psychiatric illness.