By Brenda Fry and Rachel Hynes.
Many parents will experience their teenagers being argumentative, defiant, angry and disobedient to varying degrees during the adolescent years. For some children, though, these behaviours are intense and long-lasting enough to be classified as oppositional defiant disorder, or ODD.
ODD affects children and teenagers and is characterised by an “ongoing pattern of anger-guided disobedience, hostility, and defiant behavior toward authority figures which goes beyond the bounds of normal childhood behavior”.
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It is reported that up to 16% of children and adolescents have ODD, and it is twice as common in boys in younger years but experienced equally by boys and girls in teenage years.
Oppositional defiant disorder – Jayden’s story
19-year-old Jayden was diagnosed with ODD at the age of 12, but his behavioral problems began much earlier.
At 18 months his mother Juanita thought the terrible twos had arrived early, and then at around six years of age there was an escalation of issues. “He became destructive, punching or kicking a hole in the wall several times, once breaking a window,” said Juanita.
In grade 4, his teacher advised Juanita that Jayden was experiencing some learning problems. Juanita consulted a pediatrician and the school guidance counselor to discuss the situation and options. Because of a family history of addiction on both sides of Juanita’s family, she had been concerned about medicating her son. Juanita made some changes to Jayden’s diet, which she believed helped to some extent, but “buried her head in the sand about the rest”.
At the age of 12, Jayden again saw a psychologist. He was diagnosed with ODD and attention deficit hyperactivity disorder (ADHD) and referred to a pediatrician.
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Jayden was put on Ritalin for the ADHD, but Juanita feels that no real assistance was offered in relation to her son’s ODD. She turned to reading as much as she could about Jayden’s condition.
How is oppositional defiance disorder diagnosed?
Some of the characteristics used in the diagnosis for ODD are:
- persistent stubbornness and refusal to comply with instructions or unwillingness to compromise with adults or peers
- deliberate and persistent testing of the limits
- failing to accept responsibility for one’s own actions and blaming others for one’s own mistakes
- deliberately annoying others
- frequently losing one’s temper.
The latest Diagnostic and Statistical Manual of Mental Disorders (DSM-V) provides a list of behaviours under three categories:
- Angry/irritable mood
- Argumentative/defiant behavior
These categories were included in the latest DSM to demonstrate that ODD has both emotional and behavioral symptoms. The behaviours must be present for at least six months, be directed towards at least one non-sibling, and have a significant impact on home/family life, schooling and other social interactions.
The latest DSM added criteria on the frequency of symptoms, to help distinguish between normal range behaviour and ODD. A severity rating has also been added, and a child can be diagnosed with mild, moderate or severe ODD.
It is not uncommon for ODD to be diagnosed along with Attention Deficit Hyperactivity Disorder.
It is believed there are two pathways to ODD in teenagers – one is the disorder that begins in early childhood and without intervention or treatment continues into adolescence, and the other is late onset often associated with family stresses such as unemployment or divorce (future outcomes are usually better for this group due to the often better relationships and support in earlier childhood).
Treating oppositional defiance disorder
Treatments recommended by health experts for ODD include cognitive behavioral therapy (CBT), parent training, family therapy, group therapy and natural therapy. There is no medication specifically for ODD. It has been documented that in some cases where children are treated with medication for other disorders, the characteristics of the ODD are exacerbated.
Parenting and family therapy centres around managing the child or teenager’s behaviour.
- Improve positive parenting skills
- Enhance skills in problem solving, conflict resolution and communication
For the child
- Development of effective communication, problem solving and anger management skills
For the family
- Family counselling and support to deal with the stresses in their relationships and the home environment
In the classroom
- Encourage the teacher or school counsellor to provide social skills sessions to improve peer relationships
Fraser A. Oppositional Defiance Disorder. Australian Family Physician2008;37,(4)
Natural therapy as a form of treatment commonly refers to changes in the diet, due to the rising number of allergies or intolerances in children and the impact on their behavior.
Juanita started Jayden on the “failsafe diet” (Free of Additives and Low in Salicylates, Amines and Flavour Enhancers), and believed that it worked well to calm his behaviour. An issue, however, was Jayden eating food outside the diet when he was unsupervised. Juanita noticed his behaviour changed on these occasions.
To any parent who suspects ODD in their child, Juanita suggests you “seek as much assistance as you can, as early as you can. Listen to the teachers. I wish I had.”
The important first step is to get a proper diagnosis from a health professional, and work with them on a plan for your family and child.
Online support for parents and children with ODD
Aussies ODD & ADHD support group (Facebook group)
ODD Parents Room (Yahoo group)
MD Junction Oppositional Defiant Disorder Support Group
Sources of information used in this article, other than those linked to above, include: