What is Oppositional Defiant Disorder?

Oppositional Defiant Disorder is a neurological disorder thought to be caused by a combination of Oppositional Defiant Disorderbiological, psychological, and social factors. ODD tends to occur in families with a history of Attention Deficit Hyperactivity Disorder (ADHD), substance abuse disorders, or mood disorders such as depression or bipolar disorder. Brain imaging studies also suggest that children with ODD may have subtle differences in the part of the brain responsible for reasoning, judgment and impulse control. Psychological studies have demonstrated that children who display aggressive behavior have trouble accurately identifying and interpreting social cues from peers; specifically, aggressive children tend to see hostile intent in neutral situations. These children also generate fewer solutions to problems and expect to be rewarded for their aggressive responses. Lack of structure or parental supervision, inconsistent discipline practices, and exposure to abuse or community violence have also been identified as factors which may contribute to the development of ODD.

What are some symptoms of ODD?

Some symptoms of ODD include:

  • A pattern of uncooperative defiant and hostile behavior toward authority figures
  • Loss of temper
  • Arguing with adults
  • Actively defying adult rules
  • Refusing adult requests
  • Deliberately annoying others
  • Constantly procrastinating
  • Fussy, colicky, or difficult to soothe as infants

How does ODD progress?

For many children, Oppositional Defiant Disorder does improve over time. Follow up studies have shown that the signs and symptoms of ODD resolve within three years in approximately 67% of children diagnosed with the disorder. However, research has also shown that approximately 30% of children with ODD eventually develop conduct disorder. The risk is three times greater for children who were diagnosed at a very young (i.e. preschool) age. Preschool children with ODD are also likely to exhibit additional disorders several years later, including ADHD, anxiety, or mood disorders. Studies seem to point to the fact that approximately 10% of children diagnosed with ODD will eventually develop some form of personality disorder, like Anti-Social Personality Disorder.

How can I help treat my child’s disorder?

There is no single treatment for children or adolescents with Oppositional Defiant Disorder (ODD). The most effective treatment plan will be individualized to the needs of each child and family. Specific treatment modalities may be helpful for a particular child depending on his or her age, the severity of the presenting problems, and the goals, resources, and circumstances of the family. Treatment must be delivered for an adequate duration (usually several months or longer) and may require multiple episodes either continuously or as periodic “booster” sessions. Treatment will often include both individual therapy and family therapy. Cognitive Behavioral Therapy can help children control their aggression and modulate their behavior. Social skills training has been effective, when coupled with other therapy, in helping children smooth out their difficult social behaviors that result from their angry, defiant approaches to rules. Social skills training incorporates reinforcement strategies and rewards for appropriate behavior to help a child learn to generalize positive behavior. Treatment may also include the use of medication–although medication alone would rarely be considered an adequate or appropriate intervention for children with ODD.

Treatment for children with Oppositional Defiant Disorder includes an individual approach in the form of problem-solving skills training and family interventions in the form of parent management training. An individual approach can be created specifically for the individual child’s needs, geared toward his age, and focused on helping him acquire new problem solving skills.

Our approach at North Shore Pediatric Therapy

At North Shore Pediatric Therapy, our applied behavior analysts will conduct evaluations in the real-world settings in which your child’s inappropriate behaviors are occurring. The behavior analyst will observe what precipitates the aberrant behavior and the consequences that follow. The analyst will then determine the function of the behavior and teach your child an appropriate replacement behavior which serves the same function. A specific behavior plan will be written and a systematic reinforcement schedule will be implemented to consistently reinforce the appropriate replacement behavior(s) and the decrease in the aberrant behavior(s).

(Source: American Academy of Child and Adolescent Psychiatry)