Oppositional Defiant Disorder or Problem Child

It is not easy to raise children. Pushing boundaries, getting on parent’s nerves, and hormonal mood swings are all a part of growing up. At a certain point, however, there may be signs that a child is not just acting out for attention or to test their limits.

In some cases, these children may have oppositional defiant disorder. For these children, these outbursts are more serious, frequent, and, in some cases, may need the help of a therapist.

What is Oppositional Defiant Disorder?

Oppositional defiant disorder (ODD) is usually diagnosed in early childhood during elementary school years, but it is occasionally diagnosed when a child becomes a pre-teen, although such a late diagnosis is rare.¹

ODD Symptoms

A child must have several of the following symptoms for at least six months and will typically present these symptoms in at least two separate environments such as at home and school. ODD symptoms include:

Excessive anger and irritability
Frequently losing their temper
Easily annoyed
Arguing with and disrespecting authority figures
Disregard or ignore rules
Deliberately annoying people
Refuses to take responsibility for their actions
Being vindictive or cruel

It is important to note that nearly all children will exhibit most of these signs at some point in their developmental phase and that it is completely normal. The hallmark of ODD is that the behavior persists despite any attempts to counter or dissuade it and that traditional discipline does not affect the behavior.

How Common is Oppositional Defiant Disorder?

It is believed that between 2-16% of children have ODD. Oppositional defiant disorder can be difficult to diagnose, and in many cases can occur with other mental health conditions such as ADHD, anxiety, or depression.²

Because ODD shares symptoms with so many other mental health conditions, it can be difficult to place an exact number of diagnoses. However, in younger children, ODD is more common in boys than it is in girls.

What Causes ODD?

Although there is no clear cause that directly correlates to oppositional defiant disorder, it may be the result of a combination of factors including genetics and environment.³ Possible risk factors include:

Temperament – A heavily emotional child may have more difficultly learning to regulate emotions.
Parenting Issues – Abusive or neglectful parents are more likely to have children with ODD, as are authoritarian parents that impose harsh and unfair rules and punishments.
Other family issues – Frequent arguing or turmoil in a house, having a parent with a substance use disorder, having a parent with an untreated mental health condition.
Environment –By rewarding or ignoring problem behavior, caregivers can make ODD worse.

How to Diagnosis ODD

ODD is always diagnosed by a therapist or doctor and usually during childhood, although there have been rare cases of oppositional defiant disorder in adults. Per the listing of oppositional defiant disorder in DMS 5 and oppositional defiant disorder in ICD 10, to receive a diagnosis, a child must exhibit at least four of the above symptoms for at least six months.

To be diagnosed with ODD, these symptoms must reoccur frequently throughout that time and must involve another individual.⁴ This other person cannot be their sibling as these behaviors are common for siblings to exhibit toward each other.

Oppositional defiant disorder treatment is most effective when the child receives an early diagnosis. It is vital to bring a child to a doctor or therapist as soon as symptoms of ODD are noticed, particularly if they have a pattern.

A doctor should also check for any potential co-existing mental health conditions such as ADHD, which is present in an estimated 30-50% of children with ODD. This check ensures that proper treatment and therapy are provided and will not worsen a condition.

Problems Associated with Oppositional Defiant Disorder

ODD is considered a behavioral disorder because it directly interferes with a child’s day-to-day life. Some of the ways ODD can disrupt a child’s life include:⁵

School Performance – Not listening or respecting their teacher, refusing to do homework or schoolwork, fighting with classmates, etc.
Work Performance – Left untreated, OOD can turn into conduct disorder which is a more serious form of aggression that can carry on into adulthood. This disorder causes delinquent behavior and frequent breaking of laws and rules which can make it difficult to function and thrive as an adult.
Social Issues – Behavior is often inappropriate in social settings. They may argue, fight, make inappropriate comments or jokes, etc.
Impulse Control – May often do the opposite of what is recommended simply because they want to annoy someone, prone to breaking laws and rules so may be tempted toward illegal activity, believe punishments shouldn’t apply to them, and that nothing is their fault.
Substance Use Issues – Frequently a result of poor impulse control, people with ODD tend to abuse substances.

Co-Occurring Mental Disorders

It is common for children that have oppositional defiant disorder to also have other existing mental health conditions. These most commonly present as anxiety, depression, or ADHD, and some children may have a combination of them or all of them.

Treating ODD

Oppositional defiant disorder treatment is extremely important. Treatment is most effective when the behavioral condition is diagnosed early and when treatment is tailored specifically to a child’s situation. What may work for one child or family may not be effective for another.

Therapies

Therapy can be an effective treatment option provided that the parents, caregivers, and other involved adults work with the therapist and child to achieve a positive outcome.⁶ Some effective therapy options are:

Cognitive-behavioral therapy – This therapy helps the child understand what behaviors and reactions are acceptable and unacceptable and helps to teach a child new and healthy coping mechanisms as well as ways to better express their emotions.
Family therapy – This therapy can be effective, especially when combined with parent management training. By teaching the parents to be more involved, communicative, and less reactionary to their child’s outbursts, they can help their child correct bad behavior before it becomes permanent.
Peer group therapy – Helps a child learn how to properly interact with their peers and teaches valuable social skills.

Medications

There are currently no medications that are approved for use in treating ODD. Medication may be prescribed by a doctor if a child has another condition such as anxiety or ADHD however, which may help with the symptoms of ODD.

Preventative Measures

It is impossible to completely prevent ODD in children as doctors are still unsure as to what exactly causes the condition. However, children with peaceful, loving homes where their emotional and physical needs are met less frequently develop behavioral problems.

Resources

https://childmind.org/ article/what-is-odd-oppositional-defiant-disorder/
https://my.clevelandclinic. org/health/diseases/9905-oppositional-defiant-disorder
https://www.mayoclinic.org /diseases-conditions/oppositional-defiant-disorder/symptoms-causes/syc-20375831
https://childmind.org/guide/ oppositional-defiant-disorder/diagnosis/
https://www.cdc.gov/ childrensmentalhealth/ behavior.html
https://www.aacap.org/AACAP/ Families_and_Youth/ Facts_for_Families/FFF-Guide/Children-With-Oppositional-Defiant-Disorder-072.aspx