Oppositional defiant disorder (ODD)

What is oppositional defiant disorder (ODD)

Oppositional defiant disorder (ODD) is a psychiatric disorder found in children and reaches far beyond them simply not listening to what people are telling them to do. Characterised by a series of negative and disruptive behaviours, as well as antisocial or aggressive acts that usually involve people in authority, the condition is particularly common in children with attention deficit hyperactivity disorder (ADHD).

All children and teenagers can display defiant behaviours when they feel upset, stressed or tired, often causing them to disobey rules, talk back, and generally disregard the authority of adults. However, if these negative behaviours happen frequently and stand out in comparison to peers of their own age and developmental ability, this might be a sign that they have ODD.

What causes ODD?

There's currently no known cause of ODD, although it's believed that early onset of the condition points to the possibility that there is a genetic element to development of the disorder. It's common for a child diagnosed with ODD to have other immediate family members with mental health conditions, such as mood disorders and personality disorders, which may indicate a pre-disposition to developing the disorder.

The chemicals in your child’s brain that regulate mood and behaviour, known as neurotransmitters, may also contribute to the likelihood of developing ODD. An imbalance of these chemicals is believed to affect communication with other parts of the brain, which may cause symptoms of ODD and erratic behaviour.

The environmental influences your child may be exposed to at an early age are not believed to directly cause ODD, although they can add to the difficulties of managing poor behaviour. Family dysfunction and difficulties at school may effectively speed up the process of a negative pattern of frequent and extreme negative behaviour developing.

Diagnosis and association with attention deficit hyperactivity disorder (ADHD)

Diagnosis of ODD often overlaps with related disorders such as ADHD, with around 30 to 50% of children with ADHD also believed to have ODD. This can be explained by the similar symptoms shown in both conditions, where impulsive behaviours and resulting negative feedback from authority figures can cause an increasing desire to become defiant in response to requests and orders.

If your child struggles with calming themselves as a toddler or young child in the face of adversity, such as if they have lost a favourite toy or they have been told they can’t have a particular object or type of food, this can be a further indicator that your child is pre-disposed to developing symptoms of ODD. This difficultly in controlling their emotions in response to frustration may be in contrast to the emotional control expected of children their own age.

Further risk factors for children developing ODD include:

• Exposure to violence
• Exposure to substance abuse
• Abuse or neglect
• Inconsistencies in discipline from caregivers in response to behaviour

If you suspect that your child may be experiencing the symptoms of ODD, or if they have been recently diagnosed with the disorder, help and support is available at Priory. Using a treatment plan that reflects the needs of your child and the severity of their behavioural symptoms, our specialist consultants and therapists will help you work towards reducing the impact ODD has on your child’s life and on you as parents.

Treatment options for ODD

Treating ODD will often involve a series of behavioural therapy sessions, which may also be used in combination with medication, should an improvement in symptoms not be observed with initial treatment.

Due to ODD tending to coincide with other mental health conditions such as ADHD, conduct disorder, anxiety disorders, depressive disorders and bipolar disorder, therapy and medication will also focus on associated conditions and work around any existing treatments your child may be receiving. Treatments will also consider the age of your child, alongside the severity of their symptoms and their willingness or ability to effectively participate specific therapies.

Common types of treatment for ODD for your child may talking therpaies and counselling, with medication also a consideration.

Talking therapies and counselling

Evidence-based psychotherapy as a form of counselling is often the primary method of treatment if your child has been diagnosed with ODD. Cognitive behavioural therapy (CBT) can be particularly useful in terms of its active, problem-solving approach to re-align your child’s negative thinking patterns, which results in consistently defiant behaviours. CBT will also teach your child techniques to understand and control their feelings of anger and frustration when they arise.

Family therapy may also be used to help the entire family unit understand the condition and how it is best managed in terms of communication and interactions between yourselves as parents and your child. This may also include a specialised therapy technique known as parent management training, which helps you as parents to positively influence your child’s behaviours through conversation and body language. This also includes setting achievable goals and reinforcing positive attitudes.

Medication

hile there are no medications available with specific properties for treating ODD, your child may already be taking medication for related disorders such as ADHD. If your child isn’t taking medication to control symptoms of associated conditions, then a consultant may recommend that they are prescribed medication such as the psychostimulants that are used to treat ADHD, which can help them manage extreme feelings of frustration and aggression, and improve the effectiveness of counselling running alongside pharmaceutical treatment.

Treating your child for ODD can be a long-term process, although with time, the demanding behaviours of ODD can steadily improve as you learn more about how your child thinks and responds to specific situations. Helping your child acknowledge their behaviour is an important first step, after which, addressing issues of control and using appropriate praise to improve behaviour can go some way to improve quality of life both for your child and the rest of the family unit.

Specialist outpatient treatment

At Priory, we understand that having a child with ODD can be distressing, although our nationwide network of hospitals and wellbeing centres can offer specialist treatment on a primarily outpatient basis to help them manage and control their behaviours. One-to-one therapy sessions, family therapy, group therapy and medication can all play a role in improving the symptoms of ODD. These sessions can enable your child to learn coping techniques to improve their quality of life, as well as allowing you, as parents, to understand more about the condition and how you can best support your child.

ODD can adversely impact many aspects of your child’s life, including relationships with family and friends, as well as their performance in education. If your child has ODD, they may only display patterns of behaviour in-keeping with the condition in one setting, such as at home. However, if their symptoms are more severe, they may appear excessively argumentative, angry or irritable in a number of scenarios.

The pattern of defiant behaviour and hostility towards people in authority can affect their daily routine. It can disrupt lessons in school and place considerable pressure on you as parents at home, where reasonable parenting methods are continually met with opposition and uncooperative behaviour. The key difference between bad behaviour seen in some children, and a diagnosis of ODD, is that ODD will typically cause your child to struggle to control their impulses. This can lead to them rebelling against rules or blaming others for their own mistakes, leading to regular defiant or provocative behaviour. This can get to the point where they may refuse a request even before they have heard what is being asked of them.