Oppositional Defiant Disorder Treatment

By Anthony Kane, MD

-Introduction

Oppositional defiant disorder (ODD) is a psychiatric behavior disorder that is characterized by aggressiveness and a tendency to purposefully bother and irritate others. These behaviors cause significant difficulties with family and friends and at school or work.

-Description

Oppositional defiant children show a consistent pattern of refusing to follow commands or requests by adults. These children repeatedly lose their temper, argue with adults, and refuse to comply with rules and directions. They are easily annoyed and blame others for their mistakes. Children with ODD show a pattern of stubbornness and frequently test limits, even in early childhood.

These children can be manipulative and often induce discord in those around them. Commonly they turn attention away from themselves by inciting parents and other family members to fight with one and other.

-Behavioral Symptoms

Normal children occasionally have episodes of defiant behavior, particularly during ages of transition such as 2 to 3 or the teenage years where the child uses defiance in an attempt to assert himself. Children who are tired, hungry, or upset may be defiant. Oppositional defiant behavior is a matter of degree and frequency. Children with Oppositional Defiant Disorder display difficult behavior to the extent that it can interfere with learning, school adjustment, and, sometimes, with the child's social relationships.

Common behaviors seen in Oppositional Defiant Disorder include:

-Losing one?s temper
-Arguing with adults
-Actively defying requests
-Refusing to follow rules
-Deliberately annoying other people
-Blaming others for one's own mistakes or misbehavior
-Being touchy, easily annoyed
-Being easily angered, resentful, spiteful, or vindictive.
-Speaking harshly, or unkind when upset
-Seeking revenge
-Having frequent temper tantrums

Many parents report that their ODD children were rigid and demanding from an early age.

-Diagnosis

The diagnosis of ODD is not always straight forward and needs to be made by a psychiatrist or some other qualified mental health professional after a comprehensive evaluation.

If you feel your child may have ODD, there is a quick ODD Screening Test at http://addadhdadvances.com/ODDtest.html

-Causes

It is not clear what causes Oppositional Defiant Disorder. There are currently two theories.

The developmental theory suggests that ODD is really a result of incomplete development. For some reason, ODD children never complete the developmental tasks that normal children master during the toddler years. They get stuck in the 2-3 year old defiant stage and never really grow out of it.

The learning theory suggests that Oppositional Defiant Disorder comes as a response to negative interactions. The techniques used by parents and authority figures on these children bring about the oppositional defiant behavior.

-Co-morbidity

Oppositional Defiant Disorder usually does not occur alone.

50-65% of ODD children also have:

-ADD ADHD
-35% of these children develop some form of affective disorder
-20% have some form of mood disorder, such as
-Bipolar Disorder or anxiety
-15% develop some form of personality disorder
-Many of these children have learning disorders

Any child with Oppositional Defiant Disorder must be evaluated for other disorders as well. If your child has ODD it is imperative to find out what are the co-existing problems. This is the key to treating the condition, as we shall soon discuss.

-Prognosis

So what happens to these children? There are four possible paths.

-Some will grow out of it. Half of the preschoolers that are labeled ODD are normal by the age of 8. However, in older ODD children, 75% will still fulfill the diagnostic criteria later in life.

-The ODD may turn into something else. 5-10% of preschoolers with ODD have their diagnosis changed from ODD to ADHD. In some children, the defiant behavior gets worse and these children eventually are diagnosed with Conduct Disorder at http://addadhdadvances.com/CDtest.html. This progression usually happens fairly early. If a child has ODD for 3-4 years and he hasn't developed Conduct Disorder, then he won?t ever develop it.

-The child may continue to have ODD without any thing else. This is unusual. By the time preschoolers with ODD are 8 years old, only 5% have ODD and nothing else.

-The child develops other disorders in addition to ODD. This is very common.

-Treatment: Medical Intervention

There have been some recent studies that have examined the effects of certain medications on Oppositional Defiant Disorder. All the research is preliminary and just suggests that certain treatments may help.

One study examined the use of Ritalin to treat children with both ADHD and ODD. This study found that 90% of the children treated with Ritalin no longer had the ODD by the end of the study. The researchers skewed the results a bit because a number of children were dropped from the study because they wouldn't comply with the treatment regimen. Still if these children are included as treatment failures the study still showed a 75% success rate.

There have been two studies examining the effect of Strattera on children with both ADHD and ODD. One study showed that Strattera helped with ODD, one study showed it did not help.

There was a large Canadian study that showed that Risperdal helped with aggressive behavior in children with below normal intelligence. It did not matter if the child had ADHD or not.

There was study showing that 80% of children with explosive behavior improved when given the mood stabilizer, divalproex.

There was another pilot study examining the use of Omega-3 oils and vitamin E in ODD children. Both helped the ODD behavior to some degree.

-Treatment: Psychological Intervention

Parent management training is still viewed as the main treatment for Oppositional Defiant Disorder. Our program, How to Improve Your Child's Behavior, located at http://addadhdadvances.com/betterbehavior.html which is available online, or some other parent training program is still considered essential if you want to help your child. Also, the younger your child is when you enroll in such a program, the better the results.

-Conclusion: Advice to Parents

Currently, there is still far too little research on this very common disorder.

Medically, the most important consideration is to treat other disorders that come along with ODD. Considering that Ritalin may help alleviate the problem in 75-90% of ODD children who have ADHD, and considering that most children with ODD also have some degree of ADHD, I feel that it is very worth your while to try your ODD child on Ritalin unless you know for sure that he does not have ADHD. The other treatments may also be worth a try depending upon the nature of your child.

I feel that using Omega-3 supplements and a vitamin E supplement should be tried in all children. This is because most children are deficient in these nutrients. Even if it does not help with the ODD, it should make your child healthier.

Parent training is still the most effective means of dealing with Oppositional Defiant Disorder. The two main drawbacks of most of these programs are the expense and the availability.

Some practitioners charge $100 or more per visit and considering the program will take several months costs add up. Insurance usually will not pay for such programs. Many parents complain to me that they can not afford the program that their child so desperately needs.

In addition, these programs are not available everywhere. Over the years, numerous parents have told me that where they live there are no programs for Oppositional Defiant Children.

I created How to Improve Your Child's Behavior to address these two problems. It allows parents to help their children regardless of where they live and at a cost that is less than one office visit. Even though it was an experiment to try to administer such a program online and to date no one else is doing this, over the past two years How to Improve Your Child's Behavior has proven time and again to help parents gain control of their defiant children.

Get more information on Oppositional Defiant Disorder- ODD Help at http://addadhdadvances.com/betterbehavior.html

It is tough to live with children who have ODD. However, if you make sure that your child has his other problems addressed and you improve your parenting skills by enrolling in a parent training program, you can do a great deal to improve your child?s condition and his future.

Anthony Kane, MD
ADD ADHD Advances
http://addadhdadvances.com

About the Author

Anthony Kane, MD is a physician and international lecturer. Get help for your ADD/ADHD child, including child behavior advice, information on the latest ADHD treatment, and help with Oppositional Defiant Disorder at http://addadhdadvances.com.

Comments

Mon, 21 Apr 2008 at 7:01 AM, by Guest
very helpful thank you

Mon, 8 Dec 2008 at 9:17 PM, by Guest
When i read this article as a future teacher it really angers me on ho we make excuses for students behavior. The child lacks discipline at home by the means of spanking and care from the parents. A child's natrual tendancy is to rebel, but it is the parents responsibilty to step in and become real parents. Let's stop blaming it on some type of disorder and face reality. It doesn't take a psychologist to figure that out, it takes common sense. If we continue to label every "possible issue" we think is wrong, we only make that child worse along with society. Simply put, the cure is a paddle to the bottom done out of love for that child.

Sat, 25 Apr 2009 at 1:53 PM, by Guest
to: December 8th Guest commmenter
I surely hope you will not be teaching my child with that attitude. You should be ashamed, corporal punishment is wrong!

Sat, 25 Apr 2009 at 1:54 PM, by Guest
To dec 8th's guest- I'd like your email address I want to tell you about a little boy I know..

To everyone else- its obvious dec 8th's guest is narrow minded and has been sheltered. Not every child's problem can be solved by spanking. Some children DO NOT respond to spanking!! Some children have a family history of mental disease, some have mothers who did drugs and alcohol during their pregnancy. Sometimes it goes beyond a natural tendency to rebel and is something much more complicated. It scares me to think this person is going to be a future teacher!! EVERYONE WHO read that comment let me tell you THE CURE is not always a paddle- sometimes I agree, a spanking is very effective. For me, when I was a child spanking worked. Some children can get 3 licks with a leather belt every afternoon IF they have misbehaved and it DOES NOT MAKE A DIFFERENCE.
Not every child- especially in today's society has 2 healthy and happy parents, a dog named Spot, a picket fence, straight As on their report card. This is the 21st century, we have created a world with lots of problems. And if you don't think those problems effect and will be passed on to our children then you don't understand the way of the world.
And as far it goes for anyone with a child with developmental/behavior problems- to each his own, good luck, I'm praying for you.
I sympathize! The worse thing you can do is let your child make his problems an excuse. My stepson doesn't know the terms and diagnosis and I don't plan on telling him. HE does however know he is the one who makes the choices and suffers the consequences. He knows there is no one to blame but himself when he chooses to do what is wrong.
The key is to be a step ahead of your kids. To be supportive, to help them find their way.
And to the future teacher- look up the word empathy! And please PLEASE don't go into teaching.. Because this is not the mindset

Sun, 1 Nov 2009 at 12:41 PM, by Guest
Yes, that's right...Hitting will teach to behave...C'mon. Hitting teaches that "hitting" is an acceptable behavior. Either way you cut it, screaming and hitting are abusive bahaviors and are not solutions to problems in the long term. They are done out of anger and frustration and are NOT a solution, EVER.
The people who hit or scream lack the problem solving skills necessary to help a child - and ultimately themselves, into understanding and finding a long term solution.

Sun, 8 Aug 2010 at 9:56 PM, by Guest
You being a teacher that tells a parent to spank their child, which is considered child abuse wow all that education and that's the best you got. I am impressed not really so don't go patting yourself on the back.

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