Oppositional Defiant Disorder (ODD)

Parent Handout
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
* Often questioning rules
* 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
* Spiteful attitude and revenge seeking

The symptoms are usually seen in multiple settings, but may be more noticeable at home or at school.
One to sixteen percent of all school-age children and adolescents have ODD. The causes of ODD are
unknown, but many parents report that their child with ODD was more rigid and demanding that the
child’s siblings from an early age. Biological, psychological and social 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-deficit hyperactivity 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 conduct disorder.

Treatment of ODD may include: Parent Management Training Programs to help parents and others
manage the child’s behavior, Individual Psychotherapy to develop more effective anger management,
Family Psychotherapy to improve communication and mutual understanding, Cognitive Problem-Solving
Skills Training and Therapies to assist with problem solving skills and decrease negativity, and Social
Skills Training to increase flexibility and improve social skills and frustration tolerance with peers.

Medication may be helpful in controlling some of the more distressing symptoms of ODD as well as the
symptoms related to coexistent conditions such as ADHD, anxiety and mood disorders.

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 healthy life choices such as exercise and relaxation. Use respite care
and other breaks 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 or qualified mental
health professional that can diagnose and treat ODD and any coexisting psychiatric condition. Following
is some more technical information.

ODD
Oppositional defiant disorder is described by the Diagnostic and Statistical Manual of Mental Disorders as
an ongoing pattern of disobedient, hostile and defiant behavior toward authority figures which goes
beyond the bounds of normal childhood behavior. People who have it may appear very stubborn.
Contents

DSM criteria

To meet DSM-IV-TR criteria, certain factors must be taken into account. First, the defiance must interfere
with the child’s ability to function in school, home, or the community. Second, the defiance cannot be the
result of another disorder, such as the more serious conduct disorder, depression, anxiety, or a sleep
disorder such as DSPS. Third, the child's problem behaviors have been happening for at least six
months. The diagnostic criteria for this disorder are as follows:

Diagnostic Criteria

1. A pattern of negativistic, hostile, and defiant behavior lasting at least 6 months, during which four (or
more) of the following are present:
Note: Consider a criterion met only if the behavior occurs more frequently than is typically observed in
individuals of comparable age and developmental level.
1. often loses temper
2. often argues with adults
3. often actively defies or refuses to comply with adults' requests or rules
4. often deliberately annoys people
5. often blames others for his or her mistakes or misbehavior
6. is often touchy or easily annoyed by others
7. is often angry and resentful
8. is often spiteful or vindictive
2. The disturbance in behavior causes clinically significant impairment in social, academic, or
occupational functioning.
3. The behaviors do not occur exclusively during the course of a psychotic or mood disorder.
4. Criteria are not met for conduct disorder, and, if the individual is age 18 years or older, criteria are not
met for antisocial personality disorder.

If the child meets at least four of these criteria, and they are interfering with the child’s ability to function,
then he or she technically meets the definition of Oppositional Defiant Disorder.
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Prevalence

The DSM-IV-TR cites a prevalence of 2-16%, "depending on the nature of the population sample and
methods of ascertainment."[2]

Prognosis

Childhood oppositional defiant disorder is strongly associated with later developing conduct disorder.
Untreated, about 52% of children with ODD will continue to meet the DSM-IV criteria up to three years
later and about half of those 52% will progress into Conduct Disorder.

Controversy

According to The American Journal of Psychiatry, there are several sources of controversy around the
diagnosis of ODD. One concerns the fact that the DSM-IV criteria differ slightly from those of the World
Health Organization's criteria, as outlined in the ICD-10. Diagnosis of ODD is further complicated by the
high occurrence of co morbidity with other disorders such as ADHD, though a 2002 study provided
additional support for the validity of ODD as an entity distinct from Conduct disorder.

In another study, the utility of the DSM-IV criteria to diagnose preschoolers has been questioned because
the criteria were developed using school-age children and adolescents. The authors concluded that the
criteria could be used effectively when developmental level was factored into assessment.

Information in this handout was provided by;

www.aacap.org/cs/ODD.ResourceCenter
www.wikipedia.com
 Resources

Online Article on ODD interventions by

Carolyn H. Webster-Stratton
http://www.son.washington.edu/centers/parenting-
clinic/opendocs/Earlyintervention1996.pdf

Struggle for Control [DVD Video] : Child and

Youth Behavior Disorders / Directed by
Melanie Wood.

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and expertise in child and youth mental health. Typically, staff and clients have access to
consulting psychiatrists. Staff work to build community capacity and provide services to children
and their families, including intake, screening and referral, assessment and planning, treatment,
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Contact Information
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Local Support
Queen Alexandra Centre for Children's Health, Victoria
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physical, intellectual, social, or emotional challenges who require assessment, treatment,
consultation, long-term and short-term follow-up or coordination of services.
Services include: speech and language therapy; autism intervention; occupational therapy;
outreach and outpatient services for infants and children with physical and developmental
disabilities; physical, professional and educational resources; rehabilitation engineering and
research centre for orthotics, prosthetics, and seating; and a psychiatric unit for children and
adolescents.

Contact: Queen Alexandra Centre 2400 Arbutus

for Children's Health Road
Phone: 250-477-1826 Victoria BC

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Federation of Invisible Disabilities

VICTORIA SUPPORT GROUP
• The Victoria Support Group is organized by parents of children with invisible disabilities
(LD, ADD etc.) to help other parents learn about resources that are available to them, to
discuss their concerns, to exchange information and to offer/receive emotional support.
• Meetings are held in Victoria at the Pearkes Arena on the second Monday of the month,
in the Bell-Irving room and often feature guest speakers.
• For more information call Lisa at (250) 479-1192 or Robin Herron at (250) 744-1630.