How to handle oppositional defiant disorder
Oppositional defiant disorder (ODD) - Diagnosis and treatment
Diagnosis
To determine whether your child has oppositional defiant disorder, the mental health professional will likely do a comprehensive psychological evaluation. Because ODD often occurs along with other behavioral or mental health problems, symptoms of ODD may be difficult to distinguish from those related to other problems.
Your child's evaluation will likely include an assessment of:
- Overall health
- Frequency and intensity of behaviors
- Emotions and behavior across multiple settings and relationships
- Family situations and interactions
- Strategies that have been helpful — or not helpful — in managing problem behaviors
- Presence of other mental health, learning or communication disorders
Treatment
Treatment for oppositional defiant disorder primarily involves family-based interventions, but it may include other types of psychotherapy and training for your child — as well as for parents. Treatment often lasts several months or longer. It's important to treat any co-occurring problems, such as a learning disorder, because they can create or worsen ODD symptoms if left untreated.
Medications alone generally aren't used for ODD unless your child also has another mental health disorder. If your child has coexisting disorders, such as ADHD, anxiety or depression, medications may help improve these symptoms.
The cornerstones of treatment for ODD usually include:
- Parent training. A mental health professional with experience treating ODD may help you develop parenting skills that are more consistent, positive and less frustrating for you and your child. In some cases, your child may participate in this training with you, so everyone in your family develops 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 parents while they interact with their child. In one approach, the therapist sits behind a one-way mirror and, using an "ear bug" audio device, guides parents through strategies that reinforce their child's positive behavior. As a result, parents learn more-effective parenting techniques, the quality of the parent-child relationship improves, and problem behaviors decrease. - Individual and family therapy. Individual therapy for your child may help him or her learn to manage anger and express feelings in a healthier way. Family therapy may help improve your communication and relationships and help members of your family learn how to work together.
- Cognitive problem-solving training. This type of therapy is aimed at helping your child identify and change thought patterns that lead to behavior problems. Collaborative problem-solving — in which you and your child work together to come up with solutions that work for both of you — can help improve ODD-related problems.
- Social skills training. Your child may also benefit from therapy that will help him or her be more flexible and learn how to interact more positively and effectively 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 characteristics to promote desired behaviors
Although some parenting techniques may seem like common sense, learning to use them consistently in the face of opposition isn't easy, especially if there are other stressors at home. Learning these skills will require routine practice and patience.
Most important in treatment is for you to 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.
More Information
- Family therapy
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Lifestyle and home remedies
At home, you can begin chipping away at problem behaviors of oppositional defiant disorder by practicing these strategies:
- Recognize and praise your child's positive behaviors. Be as specific as possible, such as, "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. Demonstrating appropriate interactions and modeling socially appropriate behavior 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 and effective instructions and enforcing consistent reasonable consequences.
Discuss setting these limits during times when you're not confronting each other. - Set up a routine by developing a consistent daily schedule for your child. Asking your child to help develop that routine may be beneficial.
- Build in time together by developing a consistent weekly schedule that involves you and your child spending time together.
- Work together with your partner or others in your household to ensure consistent and appropriate discipline procedures. Also enlist support from teachers, coaches and other adults who spend time with your child.
- Assign a household chore that's essential and that won't get done unless the child does it. Initially, it's important to set your child up for success with tasks that are relatively easy to achieve and gradually blend in more important and challenging expectations. Give clear, easy-to-follow instructions.
- Be prepared for challenges early on.
At first, your child probably won't be cooperative or appreciate your changed response to his or her behavior. Expect behavior to temporarily worsen in the face of new expectations. Remaining consistent in the face of increasingly challenging behavior is the key to success at this early stage.
With perseverance and consistency, the initial hard work often pays off with improved behavior and relationships.
Coping and support
It's challenging to be the parent of a child with oppositional defiant disorder. Ask questions and try to effectively communicate your concerns and needs to the treatment team. Consider getting counseling for yourself and your family to learn coping strategies to help manage your own distress. Also seek and build supportive relationships and learn stress management methods to help get through difficult times.
These coping and support strategies can lead to better outcomes for your child because you'll be more prepared to deal with problem behaviors.
Preparing for your appointment
You may start by seeing your child's doctor. After an initial evaluation, he or she may refer you to a mental health professional who can help make a diagnosis and create the appropriate treatment plan for your child.
When possible, both parents should be present with the child. Or, take a trusted family member or friend along. Someone who accompanies you may remember something that you missed or forgot.
What you can do
Before your appointment, make a list of:
- Signs and symptoms your child has been experiencing, and for how long.
- Your family's key personal information, including factors that you suspect may have contributed to changes in your child's behavior. Include any stressors and transitions that your child or close family members recently experienced, such as parental separation or divorce and differences in expectations and parenting styles.
- Your child's school performance, including grades and patterns of academic strengths and weaknesses.
Include any learning disorder assessments and any special education services. - Your child's key medical information, including other physical or mental health disorders with which your child has been diagnosed.
- Any medication, vitamins, herbal products and other supplements your child is taking, including the dosages.
- Questions to ask the doctor so that you can make the most of your appointment.
Questions to ask the doctor at your child's initial appointment include:
- What do you believe is causing my child's symptoms?
- Are there any other possible causes?
- How will you determine the diagnosis?
- Should my child see a mental health professional?
Questions to ask if your child is referred to a mental health professional include:
- Does my child have oppositional defiant disorder or another mental health disorder?
- Is this condition likely temporary or long lasting?
- What factors do you think might be contributing to my child's problem?
- What treatment approach do you recommend?
- Does my child need to be screened for any other mental health disorders?
- Is my child at increased risk of any long-term complications from this condition?
- Do you recommend any changes at home or school to improve my child's behavior?
- Should I tell my child's teachers about this diagnosis?
- What else can my family and I do to help my child?
- Do you recommend family therapy?
Don't hesitate to ask additional questions during your appointment.
What to expect from your doctor
Be ready to answer your doctor's questions. That way you'll have more time to go over any points you want to talk about in-depth. Here are examples of questions that your doctor may ask.
- What are your concerns about your child's behavior?
- When did you first notice these problems?
- Have your child's teachers or other caregivers reported similar behaviors in your child?
- How often over the last six months has your child had an angry and irritable mood, shown argumentative and defiant behavior, or been vindictive?
- In what settings does your child demonstrate these behaviors?
- Do any particular situations seem to trigger negative or defiant behavior in your child?
- How have you been handling your child's disruptive behavior?
- How do you typically discipline your child?
- How would you describe your child's home and family life?
- What stressors has the family been dealing with?
- Has your child been diagnosed with any other medical or mental health conditions?
By Mayo Clinic Staff
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How to Discipline a Child with Oppositional Defiant Disorder: ODD Help
1 of 12
Oppositional Defiant Disorder (ODD) in Children
Every parent of a child with attention deficit hyperactivity disorder (ADHD or ADD) knows what it’s like to troubleshoot behavior problems — your child saying no to requests or blurting out disrespectful retorts.
Children with ADHD and oppositional defiant disorder (ODD) take defiant behavior to the extreme. They have a pattern of angry, violent, and disruptive behaviors toward parents, caretakers, and other authority figures. These children require smart, specific oppositional defiant disorder strategies — and more than their fair share of patience.
“Choose your battles carefully, and find humor in every situation.” -Robin, Colorado
2 of 12
ODD and ADHD: Stats and Facts
Forty percent of children with ADHD also develop ODD. Before puberty, ODD is more common in boys; after puberty, it is equally common in both genders. About half of all preschoolers diagnosed with ODD outgrow the problem by age eight. Older kids with ODD are less likely to outgrow it. Oppositional defiant disorder may persist into adulthood.
"It is imperative to believe in yourself and to see your child as an asset to the world.
” -Ruth Ann, Ohio
3 of 12
ODD and ADHD: The Links
A child’s oppositional behaviors aren’t intentional. Experts think that ODD is linked to intense impulsivity. Not being able to control impulses, combined with the stress and frustration of trying to get on top of ADHD symptoms every day, lead some children to lash out, physically and verbally.
[Symptom Test: Oppositional Defiant Disorder in Children]
A child with ODD and ADHD will need specialized attention and a smart strategy to parent.4 of 12
How to Diagnose a Child with Oppositional Defiant Disorder
Every child will act out and test his boundaries. It may be hard to know whether a child is normally defiant or has ODD. Consult a therapist trained in childhood behavioral problems. He should also screen for anxiety and mood disorders — each of which may cause oppositional behavior.
Left untreated, ODD can evolve into conduct disorder, a more serious behavioral problem.
“Disengage when he is out of control, wait for the 'crazy' to stop, and re-approach.” -Cheryl, New Jersey
A sad child lies on the gravel of a school playground.5 of 12
How to Treat a Child with Oppositional Defiant Disorder
Treatment strategies for co-existing ODD and ADHD start with controlling ADHD symptoms. When a child’s hyperactivity, impulsiveness, and inattention are reduced, there is usually an improvement in ODD symptoms. Stimulant medications have been shown to decrease ADHD symptoms, as well as those of ODD, by up to 50 percent.
6 of 12
How to Discipline a Child with Oppositional Defiant Disorder
If a child with ODD doesn’t respond well to stimulants, some doctors prescribe the non-stimulant atomoxetine (brand name: Strattera). In one study, researchers found that the medication significantly reduced ODD and ADHD symptoms.
However, higher doses of the medication were needed to control symptoms.
[Free Download: Why Is My Child So Defiant?]
Adult man screams at a child. Father is angry at his son. Silhouettes of parent and child. Education, punishment, suppression, abuse, growing up.7 of 12
Change a Child’s Behavior — by Changing Yours
The treatment of choice for ODD is parent management training. Parents are taught to change their reactions to a child’s behavior — good and bad. Training involves using carrots and sticks — giving well-defined rewards and praise when your child cooperates, and consequences for misbehavior. Therapists will also work with a parent and child together to solve specific challenges.
“I am strong-willed as well, so it has been a battle of the wills. But instead of trying to change my daughter, I changed myself. It wasn’t easy, but when she became defiant, I said to myself, “I will not buy a ticket to this show.
” I ignored her, no matter how she tried to pull me in. She stopped almost immediately.” -Ramona, Florida
8 of 12
ODD Discipline in Three Steps
ODD experts find the following strategy effective for parents: Ask your child with ODD calmly to do something. If he doesn’t respond to you in two minutes, gently tell him, “I’m asking you a second time. Do you know what I’m asking you to do — and the consequences if you don’t? Please make a smart decision.”
If you have to ask a third time, he suffers the pre-arranged consequence — no TV or video games for an hour. Whatever it is, the consequence should fit the misbehavior for it to matter to your child.
“Including my teenage son in the conversation and allowing him to help formulate a plan gives him ownership of his behavior.” -Stephanie, New York
mother and boy with ADHD talking about his behavior, using the one-minute “think through” tool9 of 12
Get Everyone on the Same Page
For behavior therapy to work, all of the caring adults in the child's life should use the same discipline strategies that you do.
Grandparents, teachers, nannies, and other adults who spend time alone with your child with oppositional defiant disorder must understand which carrots and sticks you use and, above all, use them consistently. If one of them gives into your child’s bad behavior, it can undermine your discipline program.
“Both parents need to support each other and be on the same page.” -An ADDitude Reader
Mindfulness also helps when dealing with angry outbursts. Children with ADHD or ODD can be rude, defiant, and sometimes downright obnoxious. How do parents keep their cool? Mindfulness teaches you that the only person you can control in any confrontation is yourself. If you regroup and focus on your breathing before you react, you’ll find yourself […]10 of 12
Do Not Take ODD Personally
It is difficult for a parent to remain calm when a child with ODD is verbally abusing her, but don’t overreact. Yelling or spanking may worsen a child’s oppositional behaviors.
Stay calm and emotionally neutral amid your child’s defiance.
Oppositional kids have radar for adult hostility. If they pick up your anger, they’re going to match it. Figure out your coping strategy ahead of time so that you can remain calm when triggered by your child's behaviors.
Parents with Children Playing Game at Home. Flat Cartoon Mother, Father and Two Daughter Different Ages Spending Time Together in Living Room. Happy Parenthood and Childhood. Vector Illustration11 of 12
Practice Positive Parenting
Helping parents learn to praise good behavior is one of the toughest challenges therapists face. Many parents are so focused on bad behavior that they stop reinforcing positive ones. A few tips for dealing with ODD in children:
- Specify the praiseworthy behavior
- Be enthusiastic while not overdoing it
- Finish up with a non-verbal gesture — a kiss on the cheek or a hug
12 of 12
Be Creative and Be Consistent
The more creatively you tailor your program of rewards and punishments to your child’s specific abilities and needs, the better.
Her needs change as she grows. Creativity is important, but consistency is vital to success. Consistency in the way you treat your child — setting rules, conveying expectations — is the key to parenting a child with ODD.
[Read This Now: Facts About Oppositional Defiant Disorder and ADHD]
Too naughty child: ODD oppositional defiant disorder
Sometimes even the most well-behaved child rebels, or refuses to comply with the most harmless request. However, almost half of all parents of children with ADHD face serious behavioral and discipline problems on an almost daily basis.
This is because approximately 40% of children with ADHD develop oppositional defiant disorder (ODD). This condition is expressed by chronic aggression, frequent outbursts of anger and a tendency to argue, ignore demands and bother.
This material will help you understand your naughty child:
How far can this go? Consider real examples from the lives of children diagnosed with ADHD accompanied by ODD:
-
A 4-year-old girl who happily annoys her parents by turning up the TV volume as soon as she wakes up.
-
A 7-year-old boy who yells "No" to every demand and swears at his parents.
-
An 11-year-old boy who punches a hole in a wall and then physically assaults his mother.
"I call them little terrorists," says Douglas Riley, PhD, author of The Defiant Child and child psychologist in Newport News, Virginia. “These kids are most comfortable when they are in the middle of a conflict. Once you start arguing with them, you are on their territory. made a mistake."
The stress of a child with ODD affects the whole family. This can seriously affect marital relationships. This is partly because friends and family tend to condemn the child's behavior as bad parenting. An inconsistent disciplinary approach may play a role in the development of RIA, but it is rarely the only reason. Unfortunately, the reality is that discipline strategies that work with normal children simply don't work with children with ODD.
Fortunately, psychologists have developed effective behavioral therapies to keep even the most rebellious child in check. This is not always easy, but it is possible with the help of specialized psychotherapy.
Causes
No one knows why oppositional behavior is so common in children with ADHD. However, in many cases associated with impulsivity, oppositional behavior turns out to be a manifestation of ADHD.
"Many children with ADHD who are diagnosed with ODD do exhibit an oppositional trait, such as non-compliance," says Houston-based child psychologist Carol Brady. "They are outrageous not because they are deliberately oppositional, but because they cannot control their impulses."
Another point of view is that oppositional behavior is a way to cope with feelings of irritation and psycho-emotional pain associated with the presence of ADHD.
"Under stress, a certain percentage of children become depressed for whatever reason, whether they have ADHD or divorced parents," says Larry Silver, MD, a psychiatrist at Georgetown University School of Medicine in Washington, "In others are blamed for everything, the child does not take responsibility for what goes wrong.
Dr. Douglas Riley agrees: "Children with ADHD know from a young age that they are different from other children," he says. “They see themselves as a big problem child. In some cases, the reason may be due to severe learning difficulties (often despite being above average intelligence). So, instead of feeling stupid, their defensive reaction is to feel cool. They're honing their opposition stance."
About half of all preschoolers diagnosed with ODD outgrow the problem by age 8. Older children are less likely to outgrow ODD. If left untreated, oppositional behavior can develop into disorders with even more serious behavioral problems such as physical abuse, theft, running away from home, arson, and other extremely destructive and often illegal behavior.
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Treatment
Any child with ADHD who exhibits signs of oppositional behavior requires appropriate treatment.
The first step is to make sure the child's ADHD is under control. Since oppositional behavior is often associated with stress, you should address the source of stress, ADHD symptoms, before moving on to behavioral issues.
Dr. Douglas Riley says: "If a child is so impulsive or distracted that he cannot focus on the therapy we use to treat oppositional behavior, he will not get very far. And for many children with ADHD and ODD, stimulant medications are kind of miraculous. Most of the time, the bad behavior just disappears."
But drug treatment is rarely enough to control OVR. If ODD is mild or infrequent in a child, self-administered behavior change procedures may be a good option. But if the oppositional behavior is severe enough to interfere with life at home or at school, then it is best to consult a family psychologist who specializes in child behavioral problems.
Create harmony
A therapist/specialist must protect your child from anxiety, depression and bipolar disorder.
All of these phenomena can lead to oppositional behavior and each needs its own form of treatment. The therapist may also recommend cognitive therapy for the child to help them deal effectively with difficult situations.
Practice mindfulness
The purpose of teaching mindfulness to our children is to give them the skills to develop their awareness of their inner and outer experiences; to teach them to determine whether their thoughts are "fair thoughts"; understand how emotions appear; notice when they lose attention; learn to control impulses.
Carrot and stick
In most cases, one of the points of therapy for OVR is teaching parents to manage their child's behavior. A family therapist teaches parents how to change the way their child's behavior is influenced. Between weekly sessions, parents practice what they have learned and report their progress to the therapist.
"The carrot and stick rule is becoming a parenting skill," says Carol Brady, child psychologist.
"Gingerbread - your job is to encourage and reward the child for cooperation. Whip - you apply the indicated punishment for bad behavior - as a rule, it means temporary suspension of the naughty child from the activity (time out) or deprivation of the reward."
Teaching parents to manage behavior is very effective, in four out of five cases the child's behavior improves dramatically. Parents who receive training tend to see an improvement in the situation in the family, including improved behavior in their other children.
At the same time, some parents are reluctant to understand that they need training. “They need to learn how to stop at the right time and not get into the battlefield with the child, not descend to the level of squabbles,” says Dr. Larry Silver. assert its authority by creating well-defined rewards and punishments, and then implementing them consistently and impartially.0009 The most important rule is that parents do not take oppositional behavior personally, remain calm and friendly.
Oppositional children have a radar for adult hostility. If they feel your anger, they will resist it.
A "two open requirements" approach is recommended. The first time you ask your child to do something, give him two minutes to respond. If he doesn't listen, calmly tell him, "Now I'm asking you for the second time to hang up your coat. Do you understand what I'm asking you to do and what the consequences are if you don't? Please make a smart decision." . If you have to repeat the request a third time, then the predetermined consequences should immediately take effect - the TV is turned off for an hour or video games are taken away.
Positive side
Rewarding good behavior or punishing bad behavior is not a revolutionary concept, but with oppositional children this is easier said than done. Parents need to control their urge to yell or spank, and learn to replace negative punishments with things like time out or loss of privileges.
Many parents of children with ODD are so focused on the negative that they have stopped encouraging positive behavior.
However, encouraging positive behavior is the heart and soul of the parenting process.
"Invariably, parents come to treatment with the idea of suppressing, eliminating, or reducing a behavioral problem," writes Alan Kazdin, Ph.D., in Parent Management Training (Physician's Handbook). Instead, parent education emphasizes the concept of "positives". "For example, parents ask what to do if they want their child to stop screaming, slamming doors loudly, or breaking things. The objection to such behavior would be to insist on speaking quietly, gently closing the door behind you, handling things carefully."
Dr. Alan Kazdin states that helping parents learn to praise good behavior is one of the most difficult tasks facing the therapist. He says that parents are often “hesitant to praise or encourage the behavior mainly because they believe the behavior should not require any intervention. “My child knows how to clean his room, he just refuses to do it” – typical parent comment.
Express delight
When parents express praise, they should be enthusiastic.
"An unenthusiastic 'Well Done' statement is unlikely to change a child's behavior," says Alan Kazdin, Ph.D. Praise should give a special character to praiseworthy behavior, ideally include some kind of non-verbal gesture. For example, you can say, "That's great, you played so quietly while I was on the phone!" and then kiss the baby. Appropriate rewards and punishments vary from child to child. The more creatively you tailor the program to your child's specific abilities and needs, the better. But, as Russell Barkley, Ph.D., professor of psychiatry at the Medical University of South Carolina at Charleston, writes in Your Defiant Child:
"Creativity is the key to raising children, but it is no match for consistency. Consistency is how you approach your child - you set rules and express expectations, pay attention, encourage good behavior and apply punishment for bad behavior is the key to normalize your child's actions."
Never lose sight of the fact that usually oppositional children show many abilities once their behavior is under control.
"Opposition kids are also often quite interesting and colorful," says child psychologist Douglas Riley. "They tend to be optimistic, strong personalities with their own way of looking at the world. After you deal with their defiance, you will find many pleasant discoveries.
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Oppositional defiant disorder
Alexander Borisychev, a psychiatrist and neurologist at the DocDeti clinic, wrote an article on the topic of oppositional defiant disorder.
Almost all parents face difficult behavior in a child. This also applies to situational stories when the baby is hungry or did not sleep well, and entire periods when it is difficult to agree with the child (often this happens at 2-3 years old).
But separately it is worth noting the states when the habitual way of the whole family is significantly and for a long time violated. Usually, parents describe that it is impossible to agree on anything with a child almost always. Family life turns into a constant dispute between parents and the child. Homework, cleaning the room, helping parents is an impossible mission, or after this was achieved, the parents remember with shame by what means they achieved this.
One possible reason for this behavior is oppositional defiant disorder.
Oppositional defiant disorder (ODD) is a persistent pattern of deliberately defiant, naughty, provocative, or aggressive behavior that occurs more frequently than children of a similar age and developmental level and is present not only when interacting with siblings.
The former is characterized by a persistent angry/irritable mood with occasional violent outbursts of anger.
For the second - stubborn, wayward and defiant behavior.
The causes of this condition are not completely known, but it is assumed that it depends on genetics and temperament:
- impulsivity
- Irritability
- Low tolerance for frustration
- The presence of traits of insensitivity and callousness.
It should be understood that childhood abuse can also affect this disorder.
OVR is quite common:
- from 2 to 11% in the population
- There is evidence that up to 16%
- In certain groups up to 40% (in adolescents with bipolar disorder).
It is noted that boys experience this disorder more often, but in adolescents and young adults it becomes less noticeable.
The most pronounced period of OVR falls on the age of 5 to 10 years, then the symptoms, as a rule, smooth out.
It is worth suspecting OVR if the child has at least 4 symptoms most of the days for six months:
1. Loss of self-control
2. Resentment and anger
3. Irritability
4. Argue with adults
5. Actively resists or refuses to comply with the rules and requests set by adults.
6. Purposefully annoying others
7. Blames others for your mistakes.
8. Can be vicious and vengeful.
Therapy for this condition is based on behavioral approaches.
The most important question that adults should ask themselves is: “Why does this behavior need a particular child?”
By answering it, you can get to accompanying states, working with which can significantly reduce complex behavior.
