Oppositional Defiant Disorder in Children: Symptoms and Treatment

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Child with Oppositional Defiant Disorder

Introduction

All kids can be oppositional from time to time especially when they are hungry, tired, upset, or stressed. They may talk back, argue, defy, and disobey their parents or other adults or persons in authority. Oppositional behavior is a normal part of the developmental stage and adolescence. However, if the hostile, uncooperative, and oppositional behavior occurs frequently and consistently that it stands out compared to other kids of the same developmental level and age and it’s already affecting the child’s social, academic, and family life, then it becomes a serious concern.

Oppositional Defiant Disorder (ODD) is a childhood behavioral disorder that is characterized by a recurrent pattern of defiant, angry, hostile, uncooperative, violent, and disobedient behaviors directed at parents, adults, or other persons in authority and negatively impacts a child in his/her day to day activities at home and in school. ODD is also defined by children displaying angry and irritable moods, and also vindictive and argumentative behaviors. Kids with ODD often argue, easily lose their tempers, refuse to follow directions, resist rules and discipline, and have a low tolerance for frustration. The defining feature of the disorder is the fight against being controlled. For kids with ODD, it can seem like nothing can be done to make them happy.

ODD is one of the most common psychiatric disorders in childhood. ODD affects approximately 1-15% of all children of school age. ODD is more common in boys but it is equally common in both genders after puberty. ODD occurs in about 11% of boys and 9% in girls. Girls have a tendency to display different symptoms of ODD compared to the symptoms showed by boys. Around 40% of children with ADHD are thought to have ODD. Half of the preschoolers that are diagnosed with ODD usually outgrow the condition by age 8. Around two-thirds of children diagnosed with ODD are estimated to overcome the majority of their behavioral disturbances as they grow older. In some studies, it shows that about 70% of children previously suffering from ODD no longer have the symptoms of ODD by the age of 18.

The cause of ODD is still unknown but it is believed to be brought about by a combination of biological, social, and psychological factors. It can be a result of unpleasant experiences in early childhood such as abuse, poor parenting, negligence, separation of parents, etc. Environmental factors such as crime-stricken and poverty may also contribute to the development of the disorder.

Symptoms of Oppositional Defiant Disorder

Symptoms of ODD usually show before a child turns 8. The symptoms appear in multiple settings but can be more prominent in one setting more than the others. Symptoms of ODD may include:

  • Excessive arguing with adults or people in authority even about the smallest of things
  • Frequent temper outbursts, anger, and resentment
  • An overall negative and irritable attitude
  • Being uncooperative on purpose
  • Often questioning of rules
  • Chronic aggression
  • Blaming others for his/her errors or misbehavior
  • Defiance
  • Refusal to comply with rules and ignore requests from adults
  • Easily annoyed by others
  • Deliberate attempt to upset or annoy others
  • Revenge-seeking and spiteful attitude
  • Mean and hateful talking when upset

There is no clear line between normal defiance and ODD. It is up to the parents to make a decision whether to seek professional help for a defiant child or just let him/her be. Nevertheless, a child that show signs and symptoms of ODD should be evaluated carefully to check for other disorders that may be present alongside ODD such as learning disabilities, attention deficit hyperactivity disorder (ADHD), anxiety disorders, or mood disorders (bipolar disorder, depression). It will be difficult to reduce the symptoms of ODD without treating the comorbidities or coexisting disorder. If ODD is left untreated in children, ODD can evolve into more serious behavioral problems and conduct disorder.

Management of Oppositional Defiant Disorder

General Measures

  • Psychoeducation and provision of educational materials – This can educate the parents about ODD and other disorders and help them understand their child’s defiant behavior
  • Treatment of coexisting disorders through medication – Treating coexisting disorders can sometimes improve and control the symptoms of ODD.
  • Reduction of stressful circumstances – Try implementing positive parenting techniques such as praising the child or rewarding him/her when he/she shows cooperation and flexibility.
  • Interventions at school – Teachers and other kids at school can help a child with ODD by encouraging him/her to follow the rules and by being more understanding of his/her behavior instead of treating him/her differently.

Biological Treatment

  • Antipsychotic drugs such as carbamazepine or lithium can be used to control aggression but only use these drugs as advised by the doctor
  • Stimulants can help minimize the symptoms of ADHD
  • SSRI can control coexisting mood disorders

Psychological Measures

  • Family psychotherapy – This helps improve mutual understanding and communication.
  • Parent management training programs – These programs help parents in managing the child’s behavior.
  • Anger management skills – Individual psychotherapy can be done on the child to develop more effective anger management.
  • Social Skills Training – This helps the child improve his/her social skills and frustration tolerance with others and increase flexibility.
  • Cognitive Problem-Solving Skills Training and Therapies – This helps decrease negativity and assists with problem-solving.