What Parents Need to Know About Oppositional Defiant Disorder in Their Child

It's not unusual for kids -- especially those in their "terrible twos" and early teens -- to defy authority every now and then. They may express their defiance by arguing, disobeying, or talking back to their moms and dads, teachers, or other adults. When this behavior lasts longer than six months and is excessive compared to what is usual for the youngster's age, it may mean that the child has a type of behavior disorder called Oppositional Defiant Disorder (ODD).

ODD is a condition in which a youngster displays an ongoing pattern of uncooperative, defiant, hostile, and annoying behavior toward people in authority. The child's behavior often disrupts the child's normal daily activities, including activities within the family and at school.

Many kids and adolescents with ODD also have other behavioral problems, such as attention-deficit/hyperactivity disorder, learning disabilities, mood disorders (such as depression), and anxiety disorders. Some kids with ODD go on to develop a more serious behavior disorder called conduct disorder.

Symptoms of Oppositional Defiant Disorder—

Symptoms of ODD may include:

• Actively refusing to comply with requests and rules
• Being spiteful and seeking revenge
• Blaming others for your mistakes
• Deliberately trying to annoy or upset others, or being easily annoyed by others
• Excessively arguing with adults
• Having frequent outbursts of anger and resentment
• Saying mean and hateful things when upset
• Swearing or using obscene language
• Throwing repeated temper tantrums

In addition, many kids with ODD are moody, easily frustrated, and have a low self-esteem. They also may abuse drugs and alcohol.

 

==> My Out-of-Control Child: Parenting Children With Oppositional Defiant Disorder

Causes of Oppositional Defiant Disorder—

The exact cause of ODD is not known, but it is believed that a combination of biological, genetic, and environmental factors may contribute to the condition.

Genetics: Many kids and adolescents with ODD have close family members with mental illnesses, including mood disorders, anxiety disorders, and personality disorders. This suggests that a vulnerability to develop ODD may be inherited.

Environmental: Factors such as a dysfunctional family life, a family history of mental illnesses and/or substance abuse, and inconsistent discipline by moms and dads may contribute to the development of behavior disorders.

Biological: Some studies suggest that defects in or injuries to certain areas of the brain can lead to serious behavioral problems in kids. In addition, ODD has been linked to abnormal amounts of special chemicals in the brain called neurotransmitters. Neurotransmitters help nerve cells in the brain communicate with each other. If these chemicals are out of balance or not working properly, messages may not make it through the brain correctly, leading to symptoms of ODD, and other mental illnesses. Further, many kids and adolescents with ODD also have other mental illnesses, such as ADHD, learning disorders, depression, or an anxiety disorder, which may contribute to their behavior problems.

How Common Is Oppositional Defiant Disorder?

Estimates suggest that 2%-16% of kids and adolescents have ODD. In younger kids, ODD is more common in boys. In older kids, it occurs about equally in boys and in girls. It typically begins by age 8.

How Oppositional Defiant Disorder is Diagnosed—

Mental illnesses in young people are diagnosed based on signs and symptoms that suggest a particular illness like ODD. If symptoms are present, the doctor will begin an evaluation by performing a complete medical history and physical exam. Although there are no lab tests to specifically diagnose ODD, the doctor may use various tests -- such as X-rays and blood tests -- to rule out physical illness or medication side effects as the cause of the symptoms. The doctor also will look for signs of other conditions that often occur along with ODD, such as ADHD and depression.

If the doctor cannot find a physical cause for the symptoms, he or she may refer the youngster to a child and adolescent psychiatrist or psychologist, mental health professionals who are specially trained to diagnose and treat mental illnesses in kids and adolescents. Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate a youngster for a mental illness. The doctor bases his or her diagnosis on reports of the child's symptoms and his or her observation of the child's attitude and behavior. The doctor often must rely on reports from the child's moms and dads, teachers, and other adults because kids often have trouble explaining their problems or understanding their symptoms.

 

==> My Out-of-Control Child: Parenting Children With Oppositional Defiant Disorder

How Oppositional Defiant Disorder is Treated—

Treatment for ODD is determined based on many factors, including the youngster's age, the severity of symptoms, and the child's ability to participate in and tolerate specific therapies. Treatment usually consists of a combination of the following:

• Medication: While there is no medication formally approved to treat ODD, various drugs may be used to treat some of its distressing symptoms, as well as any other mental illnesses that may be present, such as ADHD or depression.
• Psychotherapy: Psychotherapy (a type of counseling) is aimed at helping the youngster develop more effective ways to express and control anger. A type of therapy called cognitive-behavioral therapy aims to reshape the child's thinking (cognition) to improve behavior. Family therapy may be used to help improve family interactions and communication among family members. A specialized therapy technique called parent management training (PMT) teaches moms and dads ways to positively alter their youngster's behavior.

Outlook for Kids with Oppositional Defiant Disorder—

If your youngster is showing signs of ODD, it is very important that you seek care from a qualified doctor immediately. Without treatment, kids with ODD may experience rejection by classmates and other peers because of their poor social skills and aggressive and annoying behavior. In addition, a youngster with ODD has a greater chance of developing a more serious behavioral disorder called conduct disorder. Treatment is usually very effective when started early.

Prevention—

Although it may not be possible to prevent ODD, recognizing and acting on symptoms when they first appear can minimize distress to the youngster and family, and prevent many of the problems associated with the illness. Family members also can learn steps to take if signs of relapse (return of symptoms) appear. In addition, providing a nurturing, supportive, and consistent home environment with a balance of love and discipline may help reduce symptoms and prevent episodes of defiant behavior.

==> My Out-of-Control Child: Parenting Children With Oppositional Defiant Disorder

Teenagers and School Behavior Problems: Tips for Parents

"My 13-year-old daughter has been acting-up quite a lot at school - especially in the lunch room. She has had 3 referrals in just the last week and may get suspended if she gets any more this month. Any advice would be appreciated. Thanks."

While kids can display a wide range of behavior problems in school, from disruptive talking in the classroom to fighting and name-calling on the playground, the reasons for bad behavior are usually simple. If your daughter is acting out a lot in school, my assumption is either that she's having strong feelings and needs a hand with getting those feelings out, or that something in school is really not working for her. As a parent, you can do a number of things at home to help your child deal with her feelings. You can also change the situation in school so your child has a better time there.

How to help your child at school:

Assess the situation— Start by spending time in your daughter's classroom (volunteer as an aide for a day or two) to see what's going on. Or have a child therapist, school psychologist, or learning specialist evaluate your daughter in the classroom. You could even ask a friend or relative — your child's favorite uncle, say — to go to her school for a day. Look at the teacher's teaching style and your child's learning style: Is a mismatch in the teacher-child relationship causing your daughter to feel misunderstood or angry? Go out to the playground at recess: Is your daughter being teased or frightened and then acting out in an attempt to get someone to notice she's in trouble? You may learn a lot by spending a day in your child's environment and paying attention to her interactions with the people around her.

Check out your child's relationship with her teacher— This basic dynamic can make or break a child's experience in the classroom. Often when a child is having behavior problems in school, it comes down to a feeling that the teacher doesn't like her. To be able to learn and to act well, it's really important to kids to feel liked. Often it's enough just to bring the problem to the teacher's attention, but if your daughter somehow pushes the teacher's buttons in a way that makes it difficult for the teacher to like her, as a last resort you can look into moving your child to a different classroom. Or see if an adult who likes your daughter (such as a teacher's aide) can be added to the classroom; sometimes this is enough to smooth out troublesome behavior.

 

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Get outside help— If you think it's necessary, get recommendations for a good therapist for your child. Interview possible candidates on the phone, and tell them you're looking for someone who can help your daughter work through the emotional issues that are making her act out at school. Tell them you're not interested in a medication approach, but are looking for someone who can work with your child's teacher and the school system and give the teacher ideas on how to handle her behavior.

Give your child a break— Sometimes the daily grind of going to a place where she is not succeeding can push a child into behavior problems. If you can, try taking a day off from school and work every once in a while to do something with your child that she really enjoys, whether it's playing a Monopoly marathon, spending the day at the beach, or just hanging out in the backyard listening to the radio. Take advantage of the times when she is home sick to get close and pay special attention to her.

Help your child remember that you care about her— Knowing that she is loved can pull a child out of a downward spiral. It can sometimes work to give your daughter a special reminder of you, something she can put in her pocket, like a little note that says ‘I love you and you're great’ – or put a picture in her lunchbox of the two of you hugging.

Strategize— I also suggest setting up conferences that include you, your daughter, and her teacher. Brainstorm together about how to make school go well for your daughter. You may want to devise a signal your child can give her teacher, such as raising two fingers, when she's feeling frustrated and restless and is about to start acting out; at these times, the teacher could give her something special to do, such as taking papers to the principal's office. Or the teacher could think of a signal, such as a tap on your daughter's shoulder, to remind her to behave without embarrassing her in front of the class.

 

Tell your child that she can decide where her mind goes— If your child is having a miserable time at school, she can think of you, or of the fun she's going to have after school, rather than stay trapped in bad feelings. A great example of this idea is in Harry Potter and the Prisoner of Azkaban, where Harry encounters some monsters called dementors who suck all the happiness out of their victims. The antidote that a powerful wizard gives Harry is to think of the best time he ever had; this allows him to gain power over the monsters.

Work with the teacher— Just having to sit still during class is a big challenge for some kids. The teacher may be open to letting your child move around or do other activities if you talk to him about it. When one of my sons was making the transition from kindergarten, where he had a lot of space to move and play while he learned, to the older grades, he had a really hard time with sitting still and not talking. One of his educators told him that while she was talking or reading it was fine for him to draw, and once he was able to do that, he stopped getting in trouble.

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