OPPOSITIONAL DEFIANT DISORDER; WHAT IS THIS?

INTRODUCTION
Even the best-behaved children can be difficult and challenging at times. But oppositional
defiant disorder (ODD) includes a frequent and ongoing pattern of anger, irritability, arguing and
defiance toward parents and other authority figures. ODD also includes being spiteful and
seeking revenge, a behavior called vindictiveness.

These emotional and behavioral issues cause serious problems with family life, social activities,
school and work. But as a parent, you don't have to try to manage a child with ODD alone. Your
health care provider, a mental health professional and a child development expert can help.

Treatment of ODD involves learning skills to help build positive family interactions and to
manage problem behaviors. Other therapy, and possibly medicines, may be needed to treat
related mental health conditions.

Symptoms

Sometimes it's difficult to recognize the difference between a strong-willed or emotional child
and one with oppositional defiant disorder. It's common for children to show oppositional
behavior at certain stages of development.

Symptoms of ODD generally begin during preschool years. Sometimes ODD may develop later,
but almost always before the early teen years. Oppositional and defiant behaviors are frequent
and ongoing. They cause severe problems with relationships, social activities, school and work,
for both the child and the family.

Emotional and behavioral symptoms of ODD generally last at least six months. They include
angry and irritable mood, argumentative and defiant behavior, and hurtful and revengeful
behavior.

Angry and irritable mood

 Often and easily loses temper.

  Is frequently touchy and easily annoyed by others.

 Is often angry and resentful.

Argumentative and defiant behavior

 Often argues with adults or people in authority.

 Often actively defies or refuses to follow adults' requests or rules.

 Often annoys or upsets people on purpose.

 Often blames others for their own mistakes or misbehavior.

Hurtful and revengeful behavior

 Says mean and hateful things when upset.

 Tries to hurt the feelings of others and seeks revenge, also called being vindictive.

 Has shown vindictive behavior at least twice in the past six months.

Severity

ODD can be mild, moderate or severe:

 Mild. Symptoms occur only in one setting, such as only at home, school, work or with
peers.

 Moderate. Some symptoms occur in at least two settings.

 Severe. Some symptoms occur in three or more settings.

For some children, symptoms may first be seen only at home. But with time, problem behavior
also may happen in other settings, such as school, social activities and with friends.
Causes

There's no known clear cause of oppositional defiant disorder. Causes may include a
combination of genetic and environmental factors:

 Genetics. A child's natural personality or character — also called temperament — may

contribute to developing ODD. Differences in the way nerves and the brain function also
may play a role.

 Environment. Problems with parenting that may involve a lack of supervision,

inconsistent or harsh discipline, or abuse or neglect may contribute to developing ODD.

Risk factors

Oppositional defiant disorder is a complex problem. Possible risk factors for ODD include:

 Temperament — a child who has a temperament that includes difficulty managing

emotions, such as reacting with strong emotions to situations or having trouble tolerating
frustration.

 Parenting issues — a child who experiences abuse or neglect, harsh or inconsistent

discipline, or a lack of proper supervision.

 Other family issues — a child who lives with parent or family relationships that are
unstable or has a parent with a mental health condition or substance use disorder.

 Environment — problem behaviors that are reinforced through attention from peers and
inconsistent discipline from other authority figures, such as teachers.
Complications

Children and teenagers with oppositional defiant disorder may have trouble at home with parents
and siblings, in school with teachers, and at work with supervisors and other authority figures.
Children and teens with ODD may struggle to make and keep friends and relationships.

ODD also may lead to other problems, such as:

 Poor school and work performance.

 Antisocial behavior.

 Legal problems.

 Impulse control problems.

 Substance use disorder.

 Suicide.

Many children and teens with ODD also have other mental health conditions, such as:

 Attention-deficit/hyperactivity disorder (ADHD).

 Conduct disorder.

 Depression.

 Anxiety disorders.

 Learning and communication disorders.

Treating these other mental health conditions may help reduce ODD symptoms. It may be
difficult to treat ODD if these other conditions are not evaluated and treated appropriately.
Prevention

There's no sure way to prevent oppositional defiant disorder. But positive parenting and early
treatment can help improve behavior and prevent the situation from getting worse. The earlier
that ODD can be managed, the better.

Treatment can help restore your child's self-esteem and rebuild a positive relationship between
you and your child. Your child's relationships with other important adults in their life — such as
teachers and care providers — also will benefit from early treatment.

Objectives

 To assess practices used in the care of patients with ODD

 To identify the problems faced during the care process
 To bring out solutions to the problems faced.
 PART ONE
Practices used in the care of patients

Behaviour management plans for oppositional defiant disorder (ODD)

Managing oppositional defiant disorder (ODD) in children is about first accepting that your child
behaves in challenging ways more often than other children their age.

The next step is working with health professionals to develop a behaviour management plan,
which can make the behaviour easier to handle – for you and your child.

A good plan will help your child:

 learn how to improve their behaviour and understand its effects on other people
 manage strong emotions like anger and anxiety
 improve the way they solve problems, communicate and get on with other children.

These things will help your child make and keep friends, say what they think without getting
angry, accept no for an answer, and play well with others.

A good behaviour management plan will also help you cope with your child’s challenging
behaviour. It will help you:

 understand the causes of your child’s behaviour

 work out how you can increase your child’s positive behaviour and manage their
challenging behaviour
 support your child in managing strong emotions and improving social skills
 work on strengthening your family relationships.
Treatment

Treatment for oppositional defiant disorder primarily involves family-based interventions. But
treatment may include other types of talk therapy and training for your child — as well as for
parents. Treatment often lasts several months or longer. It's important to also treat any other
problems, such as a mental health condition or learning disorder, because they can cause or
worsen ODD symptoms if left untreated.

Medicines alone generally aren't used for ODD unless your child also has another mental health
condition. If your child also has other conditions, such as ADHD, anxiety disorders or
depression, medicines may help improve these symptoms.

Treatment for ODD usually includes:

 Parenting skills training. A mental health professional with experience treating ODD can
help you develop parenting skills that are more consistent, positive and less frustrating for
you and your child. In some cases, your child may join you in this training, so everyone in
your family develops a consistent approach and shared goals for how to handle problems.
Involving other authority figures, such as teachers, in the training may be an important part
of treatment.

 Parent-child interaction therapy (PCIT). During PCIT, a therapist coaches you while
you interact with your child. In one approach, the therapist sits behind a one-way mirror.
Using an "ear bug" audio device, the therapist guides you through strategies that reinforce
your child's positive behavior. As a result, you can learn more-effective parenting
techniques, improve the quality of your relationship with your child and reduce problem
behaviors.

 Individual and family therapy. Individual therapy for your child may help them learn to
manage anger and express feelings in a healthier way. Family therapy may help improve
 your communication and relationships and help your family members learn how to work
together.

 Problem-solving training. Cognitive problem-solving therapy can help your child identify
and change thought patterns that lead to behavior problems. In a type of therapy called
collaborative problem-solving, you and your child work together to come up with solutions
that work for both of you.

 Social skills training. Your child also may benefit from therapy that will help them be
more flexible and learn how to interact in a more positive and effective way with peers.

As part of parent training, you may learn how to manage your child's behavior by:

 Giving clear instructions and following through with appropriate consequences when
needed.

 Recognizing and praising your child's good behaviors and positive traits to encourage
desired behaviors.

Although some parenting techniques may seem like common sense, learning to use them
consistently in the face of opposition isn't easy. It's especially hard if there are other stressors at
home. Learning these skills requires routine practice and patience.

Most importantly, during treatment, show consistent, unconditional love and acceptance of your
child — even during difficult and disruptive situations. Don't be too hard on yourself. This
process can be tough for even the most patient parents.

Lifestyle and home remedies

At home, you can work on improving problem behaviors of oppositional defiant disorder by
practicing these strategies:

 Recognize and praise your child's positive behaviors as close to the time you see them as
possible. Be as specific as possible. For example, "I really liked the way you helped pick
up your toys tonight." Providing rewards for positive behavior also may help, especially
with younger children.

 Model the behavior you want your child to have. Watching you interact well with others
can help your child improve social skills.

 Pick your battles and avoid power struggles. Almost everything can turn into a power
struggle if you let it.

 Set limits by giving clear instructions and using consistent reasonable consequences.
Discuss setting these limits during times when you're not arguing with each other.

 Set up a routine by developing a regular daily schedule for your child. Ask your child to
help develop that routine.

 Build in time together by planning a weekly schedule that includes you and your child
doing things together.

 Work together with your partner or others in your household to ensure consistent and
appropriate discipline procedures. Also ask for support from teachers, coaches and other
adults who spend time with your child.

 Assign a household chore that's needed and that won't get done unless your child does it.
At first, it's important to set your child up for success with tasks that are fairly easy to do
well. Gradually blend in more-important and challenging jobs. Give clear, easy-to-follow
instructions. Use this as an opportunity to reinforce positive behavior.

 Be prepared for challenges early on. At first, your child probably won't cooperate or
appreciate your changed response to their behavior. Expect behavior to worsen at first after
you tell them the new things you now expect. At this early stage, staying consistent even if
the problem behavior worsens, is the key to success.
With regular and consistent effort, using these methods can result in improved behavior and
relationships.

PART TWO
Problems faced in the care of patients with ODD
 Parents aren’t the only ones challenged by defiance and anger related to ODD. These
symptoms might also show up at school, or only at school, in some cases.
ODD often improves as a child gets older, especially when symptoms are mild or moderate. Both
family support and therapy can make a major difference in whether ODD improves.

 Without professional treatment and supportive parenting, ODD symptoms often get worse.
People with the condition may:

 find it challenging to maintain social relationships

 have regular conflicts and other problems at school

 have difficulty succeeding at school or work

 Teens and adults with ODD may experience substance use disorders at higher rates and have
a higher risk of attempting suicide.

PART THREE
Solutions to Problems Faced

Along with therapy and other supportive approaches, a few key changes can help improve ODD
symptoms.
Parents can support their children by:

 increasing positive reinforcements and reducing negative reinforcements

 providing consistent consequences for misbehavior

 using predictable and immediate parenting responses

 modeling positive interactions in the household

 taking steps to reduce environmental or situational triggers, like overstimulation, lack of

sleep, or stressful routine changes

Teens and older adults might find it helpful to:

 get more comfortable accepting responsibility for mistakes and impulsive actions

 work with a therapist to learn skills for managing emotions and navigating conflict, plus
get support for any co-occurring symptoms

 practice mindfulness and deep breathing techniques to help calm anger in the moment

 try new stress-relieving activities, like exercising, spending time with friends, or enjoying
hobbies

 create a self-care routine to better support overall well-being

Oppositional defiant disorder in the classroom.

Teachers can use the following strategies to help students with ODD stay in the classroom:

 Collaborate with parents to find the most effective behavior modification techniques.
  Provide clear expectations and rules. Keep classroom rules in a visible place and offer
reminders when needed.

 Recognize that any changes in the school day, including a fire drill or the order of
lessons, can upset students with ODD.

 Hold students accountable for their actions and provide consistent consequences.

 Work to establish trust through clear and consistent communication.

 Offer encouragement and praise for positive changes.

CONCLUSION

Oppositional defiant disorder is a behavior disorder most commonly diagnosed in children and
teens. In children, symptoms of ODD can include hostility toward peers, argumentative or
confrontational behaviors toward adults, and frequent emotional outbursts or temper tantrums.
 If left untreated, ODD can become worse. Severe symptoms may interfere with your child’s
ability to participate in school or extracurricular activities. In their teen years, it can lead to a
conduct disorder and antisocial behavior.

That’s why early treatment is so important. Therapy can help your child learn to respond better
to their emotions and better shape their communications with you, their teachers, their siblings,
and other authority figures.

REFERENCES

1. Oppositional defiant disorder. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5-
TR. 5th ed. American Psychiatric Association; 2022. https://dsm.psychiatryonline.org. Accessed
Oct. 11, 2022.
2. Oppositional defiant disorder. American Academy of Child and Adolescent Psychiatry.
https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Children-
With-Oppositional-Defiant-Disorder-072.aspx. Accessed Oct. 12, 2022.

3. Oppositional defiant disorder (ODD). Merck Manual Professional Version.

https://www.merckmanuals.com/professional/pediatrics/mental-disorders-in-children-and-
adolescents/oppositional-defiant-disorder-odd. Accessed Oct. 12, 2022.

4. Ferri FF. Oppositional defiant disorder (ODD). In: Ferri's Clinical Advisor 2023. Elsevier; 2023.
https://www.clinicalkey.com. Accessed Oct. 12, 2022.

5. Kliegman RM, et al. Disruptive, impulse control, and conduct disorders. In: Nelson Textbook of
Pediatrics. 21st ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed Oct. 12, 2022.

6. Oppositional defiant disorder. American Association for Marriage and Family Therapy.
https://www.aamft.org/Consumer_Updates/Oppositional_Defiant_Disorder.aspx. Accessed Oct.
12, 2022.

7. Dulcan MK, ed. Oppositional defiant disorder and conduct disorder. In: Dulcan's Textbook of
Child and Adolescent Psychiatry. 3rd ed. American Psychiatric Association Publishing; 2021.
https://psychiatryonline.org. Accessed Oct. 12, 2022.

8. Kaur M, et al. Oppositional defiant disorder: Evidence-based review of behavioral treatment

programs. Annals of Clinical Psychiatry. 2022; doi:10.12788/acp.0056.

9. Sawchuk CN (expert opinion). Mayo Clinic. Nov. 25, 2022.

10. Treatment settings. National Alliance on Mental Illness.

https://www.nami.org/Learn-More/Treatment/Treatment-Settings. Accessed April 10, 2019.