Oppositional Defiant Disorder in Children: What To Know

Several years ago, I was in the middle of a difficult divorce, and my mom had recently died. My young daughter was struggling to handle it all, and her behavior became increasingly troublesome. I knew that she needed help learning how to control her behaviors, and, to be honest, I needed some guidance on how to help her.

Based on a recommendation, I chose a psychologist who developed a specific program for children like my daughter. She diagnosed my daughter with attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD). The ADHD diagnosis was not surprising, but I'd never heard of ODD, and it didn't sound good.

What Is Oppositional Defiant Disorder?

When a child is angry, irritable, argumentative, defiant, or vindictive for at least six months, they may receive a diagnosis of ODD. These kids will often lose their temper, be easily annoyed, and seem angry and resentful. Plus, they'll argue with adults, intentionally defy or refuse to do what they're told, and blame others for their mistakes or misbehaviors.

"When I think of the child with ODD, I think of children who don't always adhere to rules," says Jennifer Pritt, Ph.D., a child and adolescent psychologist whose practice is based in Mount Kisco, New York. "When they receive a different reaction from others, it fuels a need or desire to get that attention and reaction. They lack the inhibition and impulse control to be able to stop and think about their behavior or the consequences. Some of these children also have ADHD, but ODD goes a little bit deeper because the reactions that they get from others drives the way they behave."

One of the most important things to know about ODD is that it's not the parent's fault. There are many reasons a child may have ODD. Trauma, such as divorce and death, is a common cause, and it was the reason for my daughter's ODD. Other children may experience ODD as a result of struggling academically at school—their poor behavior draws attention away from their struggles. Or sometimes, there's no rhyme or reason for ODD, and they simply like the reaction they receive when people respond to them in a certain way.

Oppositional Defiant Disorder Can Be Tough for Parents

Let's face it, who wants to admit that their child's irritable, argumentative, defiant behavior is so bad that they've received an actual diagnosis? Although it affects up to 11% of children, the name of the diagnosis can be scary, and the stigma hasn't changed. Plus, not all parents are ready to admit that their child has a diagnosable behavior problem.

"I tend to see two different kinds of parents," says Erina White, Ph.D., MPH, MSW, a therapist and clinical researcher at Boston Children's Hospital, who also holds faculty appointments at Harvard Medical School, University of New Hampshire, and Simmons School of Social Work. "One type knows that there's something wrong, and they want to figure it out. For them, the labeling piece is important. For other parents, it's very, very scary to think that their kid might be different, and they are grieving the loss of the dreams they had for their child. Just like with every loss, sometimes denial can feel really good, and you can spend a lot of time in that place, which is okay. It's important to be kind and patient and loving to yourself because it is a loss for a parent, regardless of which type you are."

Plus, a lot of people blame the parents for a child's behavior, not understanding that ODD isn't due to a specific parenting style or action, according to Dr. Pritt. So it's difficult to seek or share a diagnosis when parents believe that others will blame them. But, once the parents finally receive a diagnosis, Dr. Pritt witnesses a sense of relief.

"If it's not diagnosed and treated earlier on, it can become more of a conduct disorder or even a personality disorder," explains Dr. Pritt. "It's even tougher to treat teenagers because it affects how they develop relationships with their peers, and their behavior can become even more concerning, including drug involvement."

Oppositional Defiant Disorder Symptoms

It is important to note that it is natural for kids to resist authority sometimes. After all, kids will naturally bump up against boundaries as they go through different phases. But kids with ODD will typically express a behavior pattern that is hostile, negative, and defiant. This pattern is also more severe when compared with other kids. It's one thing to have a meltdown, but if your child's meltdowns are disruptive to family and school life and are usually directed toward authority figures like parents, teachers, and coaches, then it may be time for a screening.

According to the American Academy of Child and Adolescent Psychiatry (AACAP), kids who exhibit some or all of the following symptoms need to be screened for ODD:

• Frequent tantrums and meltdowns
• Excessively arguing, especially with adults or authority figures
• Refusal to follow rules or intentionally breaking rules
• Constantly questioning rules and boundaries
• Spitefulness, seeking revenge, or vindictiveness
• Blaming others for their mistakes
• Easily aggravated or irritable with other people

Oppositional Defiant Disorder Treatment

The program I selected for my daughter involved a 45-minute session with her and the therapist and then a 45-minute session with the parents and the therapist. During my daughter's sessions, she watched cartoons, played games, and learned how to recognize when her emotions began to escalate. Then she learned a variety of different skills she could use to control her emotions and her impulses.

During the parent sessions, the therapist explained the reasons for my daughter's behavior, why they worked, and instructions on how to help her learn and use each skill. It was a lot of work for everyone, but the results were life-changing.

This research-based cognitive approach involves children and parents working together. It was up to me to remind my daughter to regularly practice at home. We would often role-play so she could practice a skill, and I reminded her to use a skill each time she began to escalate, something that's very hard to do without a lot of practice. Some of the skills we still use regularly include taking a few slow, deep breaths or tensing/tightening your entire body for several seconds and then relaxing.

Dr. Pritt recommends that parents give their children a specific "anger time" where they can let it all out. Depending on the space available, let your child run, scream, rip up paper, or whatever they prefer (of course, as long as it's safe). But before and after their "anger time," they must practice the skill. It helps teach them that there is a way to regulate themselves.

According to Dr. White, there are two major ways to change ODD behaviors. One is what my daughter learned, which she believes is "amazing, but also really hard," and the other only involves the frequent, repetitive practice of the skills.

"With this, a child learns and practices skills so often that these skills become their default," says Dr. White. "The tricky thing is that you have to practice a lot when you are calm. There are some great tools and programs to help with this, such as Mightier, that help kids learn these skills through play. With these sorts of games, you get to feel what it's like when you're upset and then practice bringing your heart rate back down over and over again."

Regardless of which method you choose, both Dr. Pritt and Dr. White emphasize that they have never met a child who wants to be bad. They all want to be good, even though they might behave poorly. When you teach them the skills they need, it will help them throughout their lives.