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Understanding Oppositional Defiant Disorder (ODD)

First things first: In every family household, some degree of parent-child conflict is inevitable and a sign of healthy child development. From early toddlerhood to late adolescence, children are growing a rapidly evolving awareness of themselves and the world around them. As children become more attuned to their own goals and identities, they may naturally feel less inclined to accept expectations and rules laid out for them by their parents. Further, some children, by their very nature, are exceptionally strong-willed or emotionally reactive. Consequently, every parent will deal with moments when children push boundaries, argue, negotiate, melt down, storm off, or simply refuse to cooperate. These parent-child interactions can be unpleasant and draining; however, for the vast majority of families, butting heads is the exception rather than the rule. It does not define the daily household dynamic or impact a family’s capacity to function in a healthy way.

In a handful of cases, however, parents may discover themselves struggling to cope with a more pervasive and escalated degree of conflict with their children every day. These parents may find that anger, defiance, and vindictiveness toward others characterize an alarming number of their children’s behaviors. These parents may feel consistently overwhelmed, exhausted, and helpless in trying to elicit compliance and goodwill from their children. Although the calculated prevalence varies widely, it is estimated that, in anywhere from 3 to 11 per cent of cases, parents may be dealing with a child who has Oppositional Defiant Disorder (ODD).

What is ODD?

ODD is a behavioral disorder that is characterized by persistent displays of irritability, defiance, blame, anger, and hostility directed toward non-sibling individuals. As authority figures are frequently in the position of placing demands on children, it is often parents, teachers, and other adults who experience the brunt of oppositional behavior from these children. These behavioral patterns last at least six months and cause substantial dysfunction at school and at home. ODD is typically diagnosed before adolescence and most frequently will begin to manifest during the preschool years. In many cases, ODD co-occurs with other disorders, including Attention Deficit/Hyperactivity Disorder (ADHD), conduct disorder and, to a lesser degree, underlying mood disorders including anxiety and depression. 

More specifically, what behaviors should I be looking for?

According to the DSM-V, the Diagnostic and Statistical Manual of Mental Disorders, a doctor or a psychologist can formally diagnose ODD when a child displays symptoms of irritable mood, defiant behavior, and vindictiveness.

Although each child is different, parents, teachers, coaches, and even peers may notice specific behaviors as follows:

  • Frequent outbursts that are atypical for the child’s age

  • Significant challenges with regulating emotions and managing anger

  • Often seems irritable and annoyed

  • Frequent arguments with authority figures and non-sibling peers

  • Refusal to comply with requests from others

  • Refusal to accept rules, boundaries, and consequences set by others

  • Deliberate attempts to annoy others

  • Blaming others for errors or misbehaviors

  • Spiteful and seeks revenge on others

  • High levels of impulsivity and task avoidance, especially if ADHD is also present

When unidentified and untreated, ODD can result in social isolation, strained and negative relationships with adult caregivers, teachers, and peers, and limited success and progress in school and workplace environments.

My child might have ODD. Whom should I talk to?

ODD can leave parents feeling exhausted, desperate, and at a loss for what to do next. If you suspect your child may have ODD, the first step is to meet with your doctor or a psychologist. Identifying the issue and developing an informed treatment plan are critical. The good news is that ODD can be effectively treated; most children who receive treatment will no longer exhibit the majority of behavioral symptoms when they enter adulthood.

In broad terms, an effective ODD treatment plan will include parent training in which parents develop a consistent, non-negotiable, and clearly expressed set of behavioral expectations, rewards, and consequences. A second pillar of an ODD treatment program includes emotional and social skill-building for the child. Because children with ODD often struggle to regulate emotional impulses, self-soothe, and demonstrate pro-social behaviors toward others, they require coaching and strategies to support healthy emotional and social development. 

Is there a list of parenting tools that I can use?

Parent training. As mentioned, one of the most important steps that parents can take is pursuing parent training through a specialized psychologist. Because a child’s hostility and defiance can easily throw families into chaos, it can be challenging for parents to identify and enforce strategies that consistently work.

Through parent training, parents will learn the following:

1. How to set clear and non-negotiable behavioral expectations that are explained to the child, leaving no room for negotiation or argument, and how to provide clear visual lists outlining daily routines to bolster success.

2. How to use praise and a reward system to reinforce desirable behaviors. Because of their challenging behaviors, children with ODD frequently elicit exclusively negative feedback from adults. Unfortunately, a history of negative interactions with adults makes children with ODD even less inclined to comply with adult requests. In addition to praising positive choices, parents are encouraged to create a system in which children are awarded points that they can use toward activities that they enjoy (e.g., iPad time). Rewards are most effective when they carry value to children and when parents are able to fully control access.

3. How to be selective in use of consequences. Children with ODD respond more favorably to earning valuable rewards than receiving consequences and positive reinforcement creates a stronger parent-child bond. Nonetheless, there may be times when consequences are necessary. Parents will need to select consequence that they can enforce, as inconsistent consequences can increase a child’s opposition.

4. Counseling. Counseling has a lot to offer families struggling with ODD. Children with ODD may benefit from developing emotional awareness, self-soothing strategies, and a stronger set of social skills. In addition to working with a psychologist on parent training, parents are encouraged to obtain their own support to work through the stresses, challenges, frustrations, and successes of raising a child with ODD.

5. How to communicate with teachers. Because teachers also experience significant opposition from children with ODD, they are sometimes the first individuals to flag a potential issue. Further, elements of treatment, including reward systems, are often just as valuable in the classroom as they are at home. As such, parents are encouraged to keep open lines of communication with their child’s teacher to better understand how their child is functioning within the school environment and to collaborate when implementing a reward system.

6. Know when to walk away. Children with ODD are often most comfortable when provoking those around them. Each time you get roped into an argument or negotiation with your child, you are satisfying their desire for a reaction. In many cases, the clearest and firmest way to communicate your response is simply to walk away from the battle. Refusing to engage with your child’s opposition will immediately reinforce your control over the situation.

7. How to be a united front. In two-parent households, children with ODD will often attempt to exploit miscommunications or inconsistencies between parenting styles to further their own wants. Ensure that both parents are on the same page about behavioral expectations and that parents provide full support for one another’s parenting choices in the presence of the child. Disagreements and discussions should happen behind closed doors.

8. How to nurture the relationship. As previously noted, children with ODD grow accustomed to strained relationships with those around them. To deepen a positive connection with your child, spend 15 to 20 minutes each day participating in a child-led activity and focus on gently praising and appreciating positive choices that your child is making throughout the interaction.

9. Be patient. When parents begin to implement a strict behavioral plan and regain control, children with ODD will initially push back with more vigor than ever before! However, after it becomes clear that parents are not willing to waver, children will eventually recognize that they stand to gain through cooperation with parental rules. So it may get worse before it gets better, but it will get better!

10. Self-care. Raising a child with ODD can be overwhelming and it takes exceptional planning and consistency to implement the strategies outlined. Remember to prioritize your own self-care. Looking after yourself will maximize the patience and emotional capacity you have available to support your child; never overlook your own physical and mental well-being.

Soraya Lakhani is a Registered Psychologist, and the Clinical Director of Yellow Kite Child Psychology (yellowkite.ca) located in Calgary. Soraya is a thought leader on parenting and child psychology, and her work has frequently appeared on CBC, Global, and other major media outlets. 

Calgary’s Child Magazine © 2017 Calgary’s Child