Oppositional defiant disorder (ODD) is a condition that generally appears in childhood. It is characterized by defiant, hostile behavior that is not developmentally appropriate. Parents and caregivers who are concerned about a child's disruptive behavior or defiance may wish to seek out a mental health professional, as therapy can often help treat ODD and may both prevent a child's behavior from worsening and reduce the risk that other mental health issues will develop.
Understanding ODD
At certain ages, children may be naturally quite rebellious. Adolescence, for example, may be characterized by frequent bouts of anger and misbehavior, and toddlers generally go through a phase in which they exert their individuality by refusing to follow rules and exhibiting contrary behavior. However, both of these types of rebellious behavior are often simply part of the normal individuation process. They are not diagnosable behavioral conditions, although they may be frustrating and will often require some parental skills with boundaries, patience, discipline, and good communication.
Symptoms of ODD
According to the DSM, a child's defiant behavior must not be typical of the child's current developmental stage in order to meet criteria for ODD. Recurrent tantrums in a 2-year-old, for example, would not indicate a diagnosis of ODD, while they might in an 8-year-old who exhibited the same behavior. Symptoms of the condition include:
- Anger, hostility, or an irritable mood.
- A refusal to listen to reasonable directions and obey the rules of parents, caregivers, and other authority figures.
- The deliberate provocation of others, and purposeful attempts to irritate others.
- Frequent tantrums, and difficulty with self-control.
- Vindictive or spiteful behavior.
Defiant children may show remorse some of the time: making promises, asking forgiveness, and appearing to try to do better. Though some may be sincere, sometimes such promises may be manipulative, and many children revert to the defiant behavior. Often, oppositional children do not display any signs of remorse. Some children with ODD seem to have no regard for the consequences of their behavior, for themselves or for other people, and they may report emotional numbness and unhappiness.
Anxiety, posttraumatic stress, and depression can cause symptoms in children that are similar to the symptoms of ODD; a mental health professional can help rule out other conditions that present similarly.
Causes of ODD
No single factor can predict whether a child will develop a pattern of oppositional behavior, as many different factors may contribute to a child's persistent acting out. ODD is considered by some to be a reaction to a chaotic environment.
Children who have a history of abuse, neglect, or trauma may exhibit oppositional behavior as a response to their experiences. Experiencing any kind of traumatic event increases a child's likelihood of acting out, because the child must cope with challenging feelings, thoughts, and memories. If these feelings are not dealt with, ODD may result. Inconsistent child-rearing or overly harsh forms of discipline are also considered to be significant factors in the development of the condition, and oppositional behavior may also develop when parents do not succeed in teaching boundaries or other social skills. Research shows that the children of parents who are incarcerated or addicted to drugs or alcohol are more likely to develop the ODD, and women who use drugs or alcohol during pregnancy may increase the odds of oppositional behavior in their children.
Oppositional defiant behavior can also be the symptom of an underlying mental health condition, such as ADHD. People with ODD are also at greater risk for developing conduct disorder, anxiety, and depression.
In some instances, it may not be possible to determine the cause of a child's oppositional behavior, and this may make treatment more difficult.
Therapy for ODD
Defiant behavior can be frustrating in the home and potentially devastating in school, as it can lead to suspension and expulsion, and, at the very least, may negatively affect a child's social relationships and ability to learn. If untreated, oppositional behavior can escalate as the child ages. In the teenage years or during adulthood, oppositional or defiant behavior may have significant and lasting consequences socially, legally, occupationally, and psychologically. A correlation between childhood ODD and the later development of a conduct disorder has also been seen in research, and early treatment of ODD may help prevent this development.
When treating a child who exhibits oppositional behavior, especially one who is diagnosed with ODD, a mental health professional will typically consider and address all of the factors that may be contributing to the child's misbehavior. Most children who exhibit oppositional behavior on an ongoing basis have a difficult time with emotional expression and may benefit from learning about emotions, which may render them more able to understand their emotional response and teach them how to verbally express their feelings instead of relying solely on physical outbursts.
Children who struggle with emotional regulation also tend to have trouble controlling their anger, in which case anger management therapy may be beneficial. Some of the strategies that are taught in anger management include relaxation, goal setting, problem solving, trigger identification, and recognition of consequences.
Individual therapy is also helpful when children cannot maintain control over their behavior. Therapists may use behavior modification techniques such as rewards and consequences, or they may employ play therapy, family therapy, or other techniques, depending on the needs of the particular child. In therapy, a child can often learn behavior modification and communication skills that may allow them to better interact with peers, family members, and authority figures. With the help of a therapist, a child and his or her caregivers may also be able to more deeply explore any personal issues that contribute to the child's defiant behavior.
When a child exhibits defiant and oppositional behavior, the entire family can be affected, and family therapy may be warranted. Oppositional behavior can cause stress in relationships between intimate partners, parents, and siblings, and in order to effectively manage oppositional behavior, the family members can often benefit from exploring ways to address and cope with their own feelings in order to better support the child during treatment. In family therapy, parenting skills may be addressed, along with alteration of the family environment, should it be chaotic.
A therapist may prescribe medication, such as antidepressants or stimulants, to help treat the symptoms of ODD, especially if the condition occurs with attention-deficit hyperactivity.
Case Examples
- Art and play therapy for an oppositional foster child: Gerald, 12, is brought to therapy by a foster parent. He is sweet and cooperative some of the time, but he frequently talks back to adults rudely, purposefully breaks rules, sneaks out of the house, speaks angrily to those around him, and refuses to take responsibility for his chores. His foster mother reports that Gerald was neglected by his mother and that he has been in several foster homes. His current foster family would like to adopt him, but they worry that they will not be able to manage his behavior, which seems to be getting worse. The therapist begins by engaging in play with Gerald—art projects, games, and toy army battles. As the therapist develops a relationship with Gerald, the foster parents are brought into some of the sessions, where Gerald is encouraged to write, draw, and talk about his experiences in other foster homes and to communicate these experiences through various means of performance--puppet shows, a play involving everyone in the room, a story with the army men. After several therapy sessions, Gerald begins to show real trust for his foster parents, and his anger becomes more manageable. His behavior, while far from perfect, improves enough to make adoption possible.
- Wild high school senior: Alice, 17, is staying out past her curfew, cutting class, refusing to eat meals with her family, and drinking alcohol on weekends. She shouts and swears at her parents when they try to speak to her about her behavior, which has gone on for all eight months of her senior year of high school. The parents seek a therapist, but Alice will not go. The therapist talks to the parents about their options, and while they do not wish to emancipate her, they are not sure how much longer they can try to help her if her behavior continues in the same manner. The therapist explores the couple’s relationship, history, and parenting style and continues to work with the parents, helping them to manage their own stress and address some long-standing intimacy issues. After several weeks, Alice's parents report to the therapist that some of Alice's oppositional behavior has improved, and that she has agreed to enter therapy. During conversations in therapy, Alice's parents become aware of the many ways they have sent mixed messages to her, and she becomes aware of the pain she is causing in her family. Her bad behavior continues to subside.
References:
- American Psychological Association. (2009). APA concise dictionary of psychology. Washington, DC: American Psychological Association.
- Harwood, R., Miller, S. A., & Vasta, R. (2008). Child psychology: Development in a changing society. Hoboken, NJ: John Wiley & Sons.
- Oppositional Defiant Disorder. (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Arlington, VA: American Psychiatric Association.
