Lynda realized there was something different about her son around the time he began crawling. In preschool, Jesse was often in trouble for fighting. At age four, he threatened to call the police and have his mom arrested for child abuse when she refused to take him to a restaurant. In kindergarten, he was suspended for throwing a shoe and a chair at his teacher. At home, he hurled a toy box through a window and kicked holes through walls.
"I was constantly screaming and sobbing," Lynda says. "I was a total wreck. I went to counseling to find out how not to hate my son." Finally, following a difficult third grade year, Lynda arranged to have Jesse tested for behavior disorders. The diagnosis?
Oppositional defiant disorder (ODD).
Oppositional defiant disorder, also called ODD, is a type of disruptive behavior disorder in children. It is characterized by negative, hostile, and defiant behavior that lasts at least six months. Children with ODD often: Lose their temperArgue with adultsDefy or refuse to comply with adults' requests or rulesAnnoy people on purposeBlame others for mistakes or misbehaviorAre sensitive or easily annoyed by othersAre angry and resentfulAre spiteful or vindictive
It is important to rule out other conditions such as mood disorder, conduct disorder, or attention deficit hyperactivity disorder (ADHD).
Children with ODD often do have learning problems, and many meet criteria for ADHD. Conditions like bipolar disorder may be associated with symptoms similar to ODD, but may have different treatment approaches. Keep in mind that if your child is not responding to treatment, the diagnosis may not be correct or there may be co-occurring conditions, like ODD and ADHD.
If you have concerns about your child's behavior, ask the pediatrician for a referral to a child psychologist or psychiatrist.
Parenting a child with ODD can be difficult for parents and requires a different set of skills. Parents need support and understanding from others in order to help their child.
Traditional parenting that uses reason and logic may only result in anger and frustration in a child with ODD. This then leads to arguments with a child who does not want to play by the rules, and are most natural when in conflict with someone. Parents must teach their children that the only way to access the good things in life is by playing by the rules. Children must be given clear pictures of how they are expected to behave and interact within the family. They must understand that failure to comply will result in losing access to those things they value most, which will then have to be earned back.
There are parent training programs that have shown to be effective in treating ODD. In these types of programs, you learn how to use techniques like positive reinforcement and time outs to manage your child's behavior. Other types of treatments that are available for you and your child include: psychotherapy, family therapy, training to learn problem solving skills, and social skills training.
In some cases, the doctor may recommend medication to treat severe symptoms of ODD, especially if your child also has ADHD. Examples of medications that may be prescribed in these cases include anti-psychotic medication or stimulants.
Since Jesse's diagnosis, Lynda has gotten Jesse counseling, arranged for interventions in school, and created a good support system at home. "He is becoming part of the world now, instead of being the center of his universe," says Lynda.
Jesse, now 11, remembers a time when it was hard to find things to do that would not get him in trouble. Today, he is a skateboarder and frequently a role model for others in the classroom. He says, "It feels good that I can be an example to other kids who are having a harder time than me."
Children with oppositional defiant disorder. American Academy of Child Adolescent Psychiatry website. Available at: http://www.aacap.org/cs/root/facts_for_families/children_with_odd. Updated June 2009. Accessed April 14, 2010.
Oppositional defiant disorder. Boston Children's Hospital website. Available at: http://www.childrenshospital.org/health-topics/conditions/oppositional-defiant-disorder. Accessed April 3, 2014.
Oppositional defiant disorder. Child Mind Institute website. Available at: http://www.childmind.org/en/health/disorder-guide/oppositional-defiant-disorder. Accessed April 3, 2014.
Oppositional defiant disorder. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated June 8, 2010. Accessed July 5, 2012. .
Last reviewed April 2014 by Michael Woods, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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