“We all walk on egg shells…I’m afraid to even talk about the weather for fear my comment about a how pretty it is outside will turn in to another disaster.” – Unknown

As those of us who are parents, teachers, or have spent any extensive time around children all know even the most well-behaved kids can be difficult and challenging at times.  All children, from time-to-time, can become oppositional, especially when they are tired, hungry, or upset.  Indeed, some oppositional behavior in young children (2-3 years old) and early adolescents is considered part of normal development.  However, for the child or adolescent who demonstrate an unshakable pattern of anger, arguing, tantrums and other disruptive behavior towards their parents and others in positions of authority, the problem may well be the presence of oppositional defiant disorder (ODD).  According to the Diagnostic and Statistical Manual of Mental Disorders, a manual published by the American Psychiatric Association and is used by mental health providers to diagnose mental conditions, ODD is an ongoing pattern of anger guided disobedience, along with hostilely defiant behavior toward authority figures which goes beyond the bounds of normal childhood behavior.

The signs and symptoms of oppositional defiant disorder most often begin before the age of eight, and almost always will have presented prior to becoming a teenager.  When ODD develops there is an enduring pattern of defiance, uncooperativeness and hostility which significantly interferes with the child’s day-to-day functioning.  It tends to begin gradually and continues to get worse over many months or years.  Symptoms of oppositional defiant disorder may include:

• Frequent and routine temper tantrums
• Unwarranted and extreme arguing with adults
• Spiteful and revengeful behavior
• Refusal and defiance to comply with rules or adult requests
• Often demonstrating anger and resentment
• Blaming others for their mistakes and misbehavior
• Aggression towards peers
• Deliberately attempting to annoy people
• Causes continual trouble at school
• Easily annoyed and a “hairpin trigger”
• Academic challenges
• Difficulty maintaining friendships
• Mean-spirited comments when upset

It can, of course, be rather difficult to distinguish the difference between a child or adolescent who is highly emotional and/or strong-willed, and one who has ODD.  So in order for a child to be diagnosed with oppositional defiant disorder these behaviors must interfere considerably with their social and/or academic functioning, and create significant distress for the family.  And, they must continue for at least six months.

The signs and symptoms of oppositional defiant disorder can also be difficult to differentiate from other mental health problems, and actually often occurs along with:

• Anxiety disorders
• Depression
• Attention-deficit hyperactivity disorder (ADHD)
• Learning disabilities
• Bipolar disorder
• Tourette syndrome

It is critically important that any other co-occurring disorders be effectively diagnosed and treated as they can dramatically worsen the irritability, anger, defiance and aggression.

Although the cause of oppositional defiant disorder is not clearly known it is strongly believed that it is a combination of biological, environmental, social and inherited factors.  Children of parents with a history of run-ins with the law, as well as those of alcoholics, run an almost 1-in-5 chance of developing ODD.

Some of the possible risk factors in developing oppositional defiant disorder include:

• Cruel and/or inconsistent discipline
• Abuse and/or neglect
• Parents with a history of behavior problems, ODD, or Attention Deficit Hyperactivity Disorder (ADHD)
• Lack of supervision
• Parents with a severely problematic marriage
• Deficient positive parental involvement
• Instability in the family (e.g. divorce, numerous moves, changes in schools)

Treatment of oppositional defiant disorder most often involves different types of training and psychotherapy not only for the afflicted child, but for the parents and others that are involved in managing the behaviors.   Treatment interventions may include:

• Individual psychotherapy to assist the child in developing more effective and appropriate anger management skills.
• Family psychotherapy to enhance communication and understanding.
• Parent-child interaction therapy (PCIT) whereby therapists coach parents while they are actually involved in interacting with the child whereby parents learn more effective parenting skills.
• Social skills training designed to help the child learn to interact more positively with peers, and develop increase frustration tolerance.
• Cognitive problem solving skills training to help develop more effective problem resolution by helping the child identify patterns that lead to behavior problems, and diminish the negativity which accompanies ODD.
• Parent management training to assist parents and other caretakers in developing a skill set that will more effectively manage the child’s behaviors.  Such training may include:
  • Avoiding power struggles.
  • Recognizing and praising your child’s positive and appropriate behaviors.
  • Remaining dispassionate and composed when faced with your child’s oppositional behaviors.
  • Administering effective timeouts.
  • Learning to take your own timeouts when needed.
  • Modeling behaviors you want your child to emulate.
  • Developing a consistent daily schedule for your child which includes routines involving you and your child spending time together.
  • Restricting age appropriate limits and consequences to those you know can, and will, be consistently enforced.
  • Proposing acceptable options to your child thereby providing them with some level of control.
  • Learning to make healthy life choices in order to manage your own stress such as routine exercise, nutritional food intake, and utilizing respite care as needed.

Although much of these parent management skills may appear to be common sense, actually learning to implement them in the face of extreme oppositional behaviors on the part of the child that you love can be particularly challenging.

Medication may be helpful in controlling some of the more distressing symptoms of ODD as well as the symptoms of any related coexisting conditions.  However, medications alone generally are not used for ODD unless another disorder co-exists.  According to the American Academy of Child and Adolescent Psychiatry treatment interventions for oppositional defiant disorder should be customized to the individual child.

As many children with oppositional defiant disorder will indeed respond to professional intervention and more effective parenting techniques if your child suffers from the signs and symptoms of ODD reach out to their pediatrician or family physician.  They will likely refer you to a child and/or adolescent psychiatrist, or other well qualified mental health professional, in order to confirm the diagnosis of ODD as well as the presence of any coexisting psychiatric condition before initiating treatment.