Oppositional Defiant Disorder

Understanding ODD

What is it?

ODD (Oppositional Defiant Disorder) is the most common psychiatrically diagnosed behavioral disorder in children that usually persists into adulthood. Children with ODD are often easily annoyed and deliberately annoying to other people. They repeatedly lose their temper, argue with adults, refuse to comply with rules and directions, and blame others for their mistakes. Stubbornness and testing limits are common, even in early childhood. They are often touchy, angry and resentful; spiteful and vindictive; speak harshly and unkind when upset, seek revenge and have frequent temper tantrums. They are manipulative and often induce discord in those around them. The primary behavioral difficulty however is their consistent pattern of refusing to follow the commands or requests by adults. Symptoms of ODD are usually seen in multiple settings, but may be more noticeable at home or at school.

All children display most of these behaviors from time to time and oppositional behavior is often a normal part of development for the two to three year old and early adolescent. However, children with ODD display these behaviors more frequently and over a long period of time (i.e. six months or more) and to the extent that these behaviors interfere with learning, school adjustment and sometimes social relationships.

Who Gets It?

Five to 15% percent of all school-age children have ODD. In younger children it is more common in boys than girls, but as they grow older, the rate is the same in males and females. Some children with ODD may go on to develop the more serious Conduct Disorder (CD) which is characterized by aggressive, criminal and violent behaviors. Thus, ODD is sometimes a precursor of Conduct Disorder. And, although much of the literature tends to lump ODD and CD together, they seem to be distinct entities. Conduct disorder has a genetic component, ODD does not.

What Causes ODD?

The causes of ODD are unknown, but biological and environmental factors may have a role. The quality of the child's family life in particular seems to be an important factor in the development of ODD. Some studies have found that certain environmental factors in the family increase the risk of disruptive behavior disorders including: poor parenting skills, domestic violence, physical abuse, sexual abuse, neglect, poverty and substance abuse by parents or caregivers. Some students develop ODD as a result of stress and frustration from divorce, death or loss of a family member. ODD may also be a way of dealing with depression or the result of inconsistent rules and behavior standards.

Diagnosing ODD

A child showing symptoms of ODD should have a comprehensive evaluation because the diagnosis of ODD is not always straight forward. Therefore it needs to be made by a psychiatrist or some other qualified mental health professional after a comprehensive evaluation. The child must be evaluated for other disorders as well since ODD usually does not exist alone. ODD commonly occurs in conjunction with anxiety disorders and depressive disorders. Fifty to sixty-five percent of children with ODD have ADHD, 35% develop some form of affective disorder, 20% have some form of mood disorder such as depression or anxiety and 15% develop some form of personality disorder. If the child has ADHD, mood disorders, or anxiety disorders, these other problems must be addressed before you can begin to work with the Oppositional Defiant Disorder component. It will be difficult to improve the symptoms of ODD without treating the coexisting disorder.

Treating ODD

The treatment of ODD may include: Parent Training Programs to help manage the child's behavior, Individual Psychotherapy to develop more effective anger management, Family Psychotherapy to improve communication, Cognitive-Behavioral Therapy to assist problem solving and decrease negativity, and Social Skills Training to increase flexibility and improve frustration tolerance. However, below are suggested behavioral and instructional classroom strategies that can be used for children with ODD.

Behavioral Strategies and Approaches for Children with ODD

Getting a reaction out of others is the chief hobby of children with ODD. They like to see you get mad. They try to provoke reactions in people and are often successful in creating power struggles. Therefore it is important to have a plan and try not to show any emotion when reacting to them. If you react too emotionally, you may make big mistakes in dealing with this child. Plan in advance what to do when this student engages in certain behaviors and be prepared to follow through calmly.

Decide which behaviors you are going to ignore. Most children with ODD are doing too many things you dislike to include all of them in a behavior management plan. Thus, target only a few important behaviors, rather than trying to fix everything.

Make this student a part of any plan to change behavior. If you don't, you'll become the enemy.
Provide consistency, structure, and clear consequences for the student’s behavior.

Praise students when they respond positively.

Establish a rapport with the ODD child. If this child perceives you as reasonable and fair, you'll be able to work more effectively with him or her.

Avoid making comments or bringing up situations that may be a source of argument for them.

Never raise your voice or argue with this student. Regardless of the situation do not get into a "yes you will" contest. Silence is a better response.
Do not take the defiance personally. Remember, you are the outlet and not the cause for the defiance- unless you are shouting, arguing or attempting to handle the student with sarcasm.
Avoid all power struggles with this student. They will get you nowhere. Thus, try to avoid verbal exchanges. State your position clearly and concisely and choose your battles wisely.

Always listen to this student. Let him/her talk. Don't interrupt until he/she finishes.
Address concerns privately. This will help to avoid power struggles as well as an audience for a potential power struggle.
In the private conference be caring but honest. Tell the student calmly what it is that is causing problems as far as you are concerned. Be sure you listen as well. In this process, insist upon one rule- that you both be respectful.
When decisions are needed, give two choices or options. State them briefly and clearly. Students with ODD are more likely to complete or perform tasks that they have chosen. This also empowers them to make other decisions.
Give the ODD student some classroom responsibilities. This will help him/her to feel apart of the class and some sense of controlled power. If he/she abuses the situation, the classroom responsibilities can be earned privileges.
When you see an ODD child getting frustrated or angry, ask if a calming down period would help. But don't force it on him/her. Rather than sending the student down to the office for this cooling down period, it may be better to establish an isolated “calming down” place in the classroom so he/she can more readily re-engaged in classroom activity following the cooling down period.
Ask parents what works at home.

Instructional Strategies and Classroom Accommodations for the ODD Student

Establish clear classroom rules. Be clear about what is nonnegotiable.

Post the daily schedule so the student will know what to expect.

Make sure academic work is at the appropriate level. When work is too hard, students become frustrated. When it is too easy, they become bored. Both reactions lead to problems in the classroom.

Pace instruction. When the student with ODD completes a designated amount of a non-preferred activity, reinforce his/her cooperation by allowing him/her to do something they prefer or find more enjoyable or less difficult.

Systematically teach social skills, including anger management, conflict resolution and how to be assertive in an appropriate manner. Discuss strategies that the student may use to calm him/ or herself down when they feel their anger escalating. Do this when the student is calm.

Select materials that encourage student interaction. Students with ODD need to learn to talk to their peers and to adults in an appropriate manner. All cooperative learning activities must be carefully structured, however.

Minimize downtime and plan transitions carefully. Students with ODD do best when kept busy.

Allow the ODD student to redo assignments to improve their score or final grade.

Structure activities so the student with ODD is not always left out or is the last person picked.

OTHER ODD Resources

http://www.conductdisorders.com/

http://www.aacap.org/publications/factsfam/72.htm

http://www.aacap.org/publications/factsfam/conduct.htm

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