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All children
are oppositional from time to time, particularly when tired,
hungry, stressed or upset. They may argue, talk back, disobey,
and defy parents, teachers, and other adults. Oppositional
behavior is often a normal part of development for two to
three year olds and early adolescents. However, openly uncooperative
and hostile behavior becomes a serious concern when it is
so frequent and consistent that it stands out when compared
with other children of the same age and developmental level
and when it affects the child's social, family, and academic
life.
In children
with Oppositional Defiant Disorder (ODD), there is an ongoing
pattern of uncooperative, defiant, and hostile behavior toward
authority figures that seriously interferes with the youngster's
day to day functioning. Symptoms of ODD may include:
- frequent
temper tantrums
- excessive
arguing with adults
- active
defiance and refusal to comply with adult requests and rules
- deliberate
attempts to annoy or upset people
- blaming
others for his or her mistakes or misbehavior
- often
being touchy or easily annoyed by others
- frequent
anger and resentment
- mean
and hateful talking when upset
- seeking
revenge
The symptoms
are usually seen in multiple settings, but may be more noticeable
at home or at school. Five to fifteen percent of all school-age
children have ODD. The causes of ODD are unknown, but many
parents report that their child with ODD was more rigid and
demanding than the child's siblings from an early age. Biological
and environmental factors may have a role.
A child
presenting with ODD symptoms should have a comprehensive evaluation.
It is important to look for other disorders which may be present;
such as, attention-deficithyperactive disorder (ADHD), learning
disabilities, mood disorders (depression, bipolar disorder)
and anxiety disorders. It may be difficult to improve the
symptoms of ODD without treating the coexisting disorder.
Some children with ODD may go on to develop called conduct
disorder.
Treatment
of ODD may include: Parent Training Programs to help manage
the child's behavior, Individual Psychotherapy to develop
more effective anger management, Family Psychotherapy to improve
communication, Cognitive-Behavioral Therapy to assist problem
solving and decrease negativity, and Social Skills Training
to increase flexibility and improve frustration tolerance
with peers.
A child
with ODD can be very difficult for parents. These parents
need support and understanding. Parents can help their child
with ODD in the following ways:
- Always
build on the positives, give the child praise and positive
reinforcement when he shows flexibility or cooperation.
- Take
a time-out or break if you are about to make the conflict
with your child worse, not better. This is good modeling
for your child. Support your child if he decides to take
a time-out to prevent overreacting.
- Pick
your battles. Since the child with ODD has trouble avoiding
power struggles, prioritize the things you want your child
to do. If you give your child a time-out in his room for
misbehavior, don't add time for arguing. Say "your time
will start when you go to your room."
- Set
up reasonable, age appropriate limits with consequences
that can be enforced consistently.
- Maintain
interests other than your child with ODD, so that managing
your child doesn't take all your time and energy. Try to
work with and obtain support from the other adults (teachers,
coaches, and spouse) dealing with your child.
- Manage
your own stress with exercise and relaxation. Use respite
care as needed.
Many children
with ODD will respond to the positive parenting techniques.
Parents may ask their pediatrician or family physician to
refer them to a child and adolescent psychiatrist, who can
diagnose and treat ODD and any coexisting psychiatric condition.
For additional/related
information see other Facts for Families: #6 "Children
Who Can't Pay Attention/ADHD," #16 "Learning Disabilities,"
#4 "The Depressed Child," #38 "Manic-Depressive Illness in
Teens," #52 "Comprehensive Psychiatric Evaluation," #33 "Conduct
Disorder," #65 "Children=s Threats," and #66 "Helping Teenagers
with Stress."
Article
#72 Updated 12/99
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