Identifying Oppositional Defiant Disorder

(ODD) in the Early Childhood Setting:

Early Diagnosis and Intervention
Brittany Neal

Student ID: 24233161

Word count: 1,649

Abstract:
Oppositional Defiant Disorder (ODD) affects many pre-school aged children and is a disorder
that can often lead to additional behavioural disorders or mental illnesses as the child
progresses through life and further education. This paper will discuss the prevalence of ODD
in young children, the possible causes, the symptoms that can lead to a diagnosis, how it
affects a childs behaviour and wellbeing and the importance of providing an inclusive and
supportive learning environment to conclude whether early diagnosis and intervention
through early childhood services can encourage and promote positive outcomes for children
with ODD.

Introduction
Oppositional Defiant Disorder (ODD) is a disruptive behavioural disorder that is among the
most commonly diagnosed mental health conditions in childhood (Hamilton & Armando,
2008, p.861) and refers to a category of negativistic child behaviours that impair social
functioning and learning opportunities (Gale, 2011, p.181). Quy and Stringaris (2012) state
the symptoms associated with oppositional defiant disorder as being that the individual is
often angry and resentful, argues with adults, is touchy or easily annoyed by others, loses
their temper, deliberately annoys or irritates others, blames others for his or her mistakes or
misbehaviour, actively defies or refuses to comply with adult requests or rules and is often
spiteful and vindictive (p.2).
Educators have the difficult task of creating a safe, supportive and inclusive learning
environment and the noncompliance of children with ODD can often make this task even
more challenging. According to Gale (2011), while some children are able to outgrow their
early problems, the majority continue to exhibit social difficulties and negative behaviour,
leading to academic failure and increased conflicts with peers and adults. (p.181). Rockhill,
Collett, McClellan and Speltz (2006) pose the question Does an early diagnosis of ODD
have practical benefit, leading to interventions with proven, long-term effects? (p.81). If it is
possible that early diagnosis and intervention could possibly minimise the growth in
oppositional defiance of an individual, it is crucial that educators are able to utilise the early
childhood environment to identify indicators for early diagnosis of oppositional defiant
disorder and in turn implement means of intervention that will provide opportunities for the
possibility of children with ODD engaging in their learning, developing positive
relationships, and importantly preventing further mental illness or disorders in the future.
Further research will aim to explore the significant need for early diagnosis and intervention
for children with ODD to prevent or limit further disorders or future behavioural issues as
they develop into adolescents and young adults.

Content
Oppositional Defiant Disorder is actually quite a common childhood disorder. Most studies
seem to display similar statistics with Hamilton and Armando (2008) finding that the
Diagnostic and Statistical Manual of Mental Disorders revealed approximately 3 percent of
children met criteria for oppositional defiant disorder. Similarly and more recently, Cook,
Rajendran and Williams (2015) state that ODD has been estimated to occur in about 3%
-15% of children with boys having only a marginally higher prevalence rate than girls.
(p.13). The prevalence of ODD in children is based around the fact that the symptoms
displayed by children with oppositional defiant disorder are believed to be more stable up
until the age of ten and are thought to decline from that point thereafter. It is diagnosed more
rarely in older children, partly in order to avoid labelling normative discord between children
and their parents during adolescence. (Quy & Stringaris, 2012).
Hamilton and Armando (2008) support researchers who say there is no single cause or even
greatest single risk factor for oppositional defiant disorder. (p.861). Rockhill et al. (2006)
consider the idea that a range of environmental influences such as being from a low income
family could be possible factors for the prevalence of oppositional defiant disorder in
preschool children, Gale (2011) and Cook et al. (2015) both link ODD most significantly to
parental factors during early formative years, such as parental lack of interest, little
involvement in activities, minimal supervision, harsh, inconsistent punitive reactions, and
family or marital stress (p.183) and others believe that one must understand the disorder in
the context of a biopsychosocial model in that a childs biologic vulnerabilities and
protective factors interact complexly with the protective and harmful aspects of his or her
environment to determine the likelihood of developing this disorder. (Hamilton & Armando,
2008).
Educators are not expected to diagnose oppositional defiant disorder, however educating
these teaching professionals to develop their understanding of the symptoms of ODD and
how to recognise if a child could be exhibiting key indicators may assist in receiving an
earlier diagnosis.
Firstly it is important for educators to know that oppositional defiant disorder is not
diagnosed when chronic disorders, such as mental retardation, autistic spectrum disorders, or
3

other pervasive developmental disabilities, are present, except when the severity of
behaviours is beyond what would normally be seen in children diagnosed with these
disorders. (Gale, 2011, p.183).
When identifying symptoms of oppositional defiant disorder in the early childhood setting,
the DSM-IV criteria for ODD require four or more symptoms to be present for at least six
months. These symptoms must occur at a level greater than in individuals of comparable age
or developmental stage and must cause significant impairment. (Quy & Stringaris, 2012).
Ezpeleta, Granero, de la Osa, Penelo and Demenech (2012) define distinct dimensions in the
structure of ODD in 3-year-old children; these being (1) irritable and headstrong plus
hurtful, and (2) negative affect, oppositional behaviour and antagonistic behaviour. (p.1137).
If educators can be equipped with the knowledge and skills to identify these symptoms and
the severity and duration of these symptoms, a diagnosis can be sought sooner and means for
intervention put in place to support the childs learning and development.
Children who suffer from oppositional defiant disorder face the harsh reality that they may
endure further issues later in life. ODD is considered to have two major comorbidities in
attention deficit hyperactivity disorder (ADHD) (40 percent of children with ADHD also
meet diagnostic criteria for oppositional defiant disorder (Hamilton & Armando, 2008,
p.863) and conduct disorder (CD) as well as minor comorbidities including learning
disabilities, mood disorders (depression or bipolar disorder), and anxiety disorders. Cook et
al. (2015) believes The recognition and prompt treatment of such conditions is essential, as
it may be difficult to improve the symptoms of ODD without treating the coexisting disorder;
such delay may lead to rapid deterioration in the parent child relationship and preventable
disciplinary issues in the classroom. (p.15).
The other issues that these individuals may experience are a reflection of their poor behaviour
as a result of ODD. Gale (2011) believes that when more serious conduct disorders and
antisocial behaviour are maintained and progress into adulthood, these [behaviour] patterns
have been reported to result in school dropout, vocational maladjustment, interpersonal
problems, social isolation, and criminal behaviour. In order to prevent such socially and
financially costly negative outcomes, a significant literature base has developed focused on
prevention. (p.181). Gale encourages a focus on prevention, which is critical to giving these
individuals a better chance through intervention of ODD in its early stages.

Interventions for children with oppositional defiant disorder require consistency between
families, the educational setting and professional help. Childswork/Childsplay (2011)
believes that the most effective treatment for children with ODD appears to be social
competence training, the teaching of specific emotional, behavioural, and social skills. (p.1).
This however is from a professional perspective. Educators have the challenging task of
finding ways or methods to overcome a students defiance to give them the opportunities to
learn in a safe, supportive and inclusive environment. When planning for intervention,
educators should ensure that meaningful curriculum activities, frequent positive attention,
choice, and a predictable schedule are in place (Allen & Cowdery, 2015, p.481).
Childswork/Childsplay (2011) provides more specific recommendations for teachers related
primarily to ODD, encouraging clear and specific classroom rules, positive reinforcement,
use of mild punishments and clear procedures for managing serious behaviour problems
(p.2). Early intervention can be a step in the right direction toward positive change for better
future outcomes.
Recommendations:
Inclusion depends on teachers attitudes towards pupils with special needs, on their capacity
to enhance social relations, on their view on differences in classrooms and their willingness to
deal with those differences effectively. (Allen & Cowdery, 2015, p.16). Education and
training for staff in identifying, managing and supporting children with ODD would be
extremely beneficial in helping to develop understanding of the disorder, what to look for and
how to implement effective intervention. Educators can use this as an opportunity to develop
their own teaching practice in regard to ODD, focussing on the importance of positive
reinforcement to try and stem the negative behaviours. Children with ODD isolate
themselves, but educators can use inclusive strategies to show them that they are an important
part of the team and are supported and cared about in their learning and development.
Following on from that, developing an inclusive learning environment is absolutely
imperative toward changing the mindset of children with ODD. They can often experience
increasing peer rejection because of their poor social skills and aggressiveness
(Childworks/Childsplay, 2011, p.2), however, an effective educator can establish an
environment where the peers of a student with ODD understand the childs disorder to the
point where they can see past it and find opportunities to include them in daily interactions

and activities. This creates a positive learning space where every student is valued by each
other and their educators and are engaged in their own learning.
Conclusion:
The findings from the research indicate that oppositional defiant disorder can be detected at
an early age to allow for early intervention processes to be implemented by educators. With
the aid of effective teaching practice, it is hoped that children with ODD will be able to
recognise and value positive experiences and feel encouraged and supported through these
experiences to develop changes in their attitudes and behaviours and work toward achieving
positive and successful outcomes.

References:
Allen, K. E., & Cowdery, G. E. (2015). The Exceptional Child: Inclusion in Early Childhood
Education. Mason, OH: Cengage Learning.
Childswork/Childsplay. (2011). Instant Help for Children with Oppositional Defiant Disorder.
Retrieved from http://www.fcps.edu/dss/osp/prc/resources/additional/documents/ODD.pdf
Cook, M. N., Rajendran, G., Williams, J. (2015), The Evidence Base of the Assessment and
Treatment of Attention-Deficit/Hyperactivity and Oppositional Defiant Disorder. Colorado
Journal of Psychiatry & Psychology, (1), 13-20. doi: 10.1007/s10566-011-9156-4. 56.
Ezpeleta, L., Granero, R., de la Osa, N., Penelo, E. and Domnech, J. M. (2012), Dimensions
of oppositional defiant disorder in 3-year-old preschoolers. Journal of Child Psychology and
Psychiatry, (53), 1128-1138. doi: 10.1111/j.1469-7610.2012.02545.x
Gale, B. M. (2011), Oppositional Defiant Disorder. In C. Draper & W. T. O'Donohue (Eds.),
Stepped care and e-health (pp. 181-202). New York, NY: Springer.
Hamilton, S. S., & Armando, J. (2008) Oppositional Defiant Disorder. American Family
Physician, 78(7), 861-866.
Quy, K., & Stringaris, A. (2012). Oppositional Defiant Disorder. In J. M. Rey (Ed.),
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Rockhill, C. M., Collett, B. R., McClellan, J. M., & Speltz, M. L. (2006). Oppositional
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