Oppositional Defiant Disorder In Children

What is oppositional defiant disorder?

  • Oppositional (opo-ZISH-un-al) defiant (de-FEYE-ant) disorder, also called ODD, is a common behavior problem seen in children and teenagers. There are usually two periods (ages) when a child normally shows signs of oppositional (acting against) behavior. The first occurs between 18 and 24 months of age, and is also called the terrible two period. The second happens in the teenage years when a child is trying to establish his own identity. They may express their defiance by disobeying or answering back to their parents, teachers, or other adults. A child may also be defiant when he is tired, hungry, or upset. This normal oppositional behavior lasts for less than six months and usually does not cause major problems.

  • With ODD, your child's oppositional behavior occurs more often than normal and lasts longer than six months. He may be very stubborn, aggressive, hostile, or openly troublesome most of the time. Your child may also regularly throw tantrums or purposely bother or irritate you, his teachers, and other adults. This behavior may make it difficult for your child to do well at home or in school. ODD may also cause your child to have problems getting along with his family, friends, relatives, and teachers. You may notice that your child's behavior may seem different from other children of his age. ODD is most commonly noticed at age 8 and is more common in boys. With treatment, understanding, and care, your child's ODD may be controlled, and his quality of life improved.

What are the causes of ODD?

The exact cause of ODD is not known. Caregivers believe that there may be a problem with how your child's brain works. There may be defects in certain parts of his brain that may cause behavior problems. Your child may have had a history of head injury, such as brain damage or epilepsy (repeated convulsions). The following are other possible causes and conditions that may increase your child's chance of having ODD:

  • Abnormal amount of hormones or neurotransmitters (special chemicals) in the body.

  • Having a close family member with ODD or another mental illness, such as mood or personality disorders.

  • Having parents who are stressed or who are having problems with their marriage, finances (money), or health.

  • Having parents who smoke cigarettes or use drugs, especially during pregnancy.

  • Mental problems, such as attention deficit and hyperactivity disorder (ADHD), depression, or learning and memory problems.

  • Poor or harsh ways of treating children, such as when a child lacks supervision or is physically abused.

What are the signs and symptoms of ODD?

The first signs of ODD usually appear between 4 to 7 years of age. Your child may regularly or often show any of the following:

  • Actively defying (going against) or refusing to follow adults' requests, orders, or rules.

  • Anger, easily losing his temper, throwing tantrums, and resentfulness.

  • Annoying or upsetting people on purpose.

  • Arguing with adults or other children.

  • Being spiteful or seeking revenge.

  • Being touchy or easily annoyed by others.

  • Blaming others for his mistakes or misbehavior.

How is ODD diagnosed?

There is no lab test that can diagnose ODD. Caregivers use a guide to diagnose ODD. Your child has ODD if he has at least four signs and symptoms of ODD. These symptoms are often beyond what would be expected for your child's age. The symptoms must also be present for at least six months and not be caused by other problems. These symptoms must be severe (bad) enough to cause problems in two or more settings. Settings may include those in school or at home.

How is ODD treated?

The aim of treatment is to help your child learn how to control his own behavior. Caregivers will also work with you so you may know how to cope with your child's ODD. Your child may need any of the following:

  • Therapies: Ask your child's caregiver for more information about the following therapies.

    • Behavioral therapy: With a therapist, your child will learn how to control his actions and improve his behavior. This is done by teaching him how to change his behavior by looking at the results of his actions. He may learn that certain behaviors have good or bad results. These results may make him feel either good or bad about himself. Good behaviors will be rewarded and encouraged, while unwanted or bad behaviors will be discouraged.

    • Parent management training: Special training, such as parenting techniques, may help improve your relationship with your child. This training is taught by a special caregiver. You may also watch videos or read books on how to be a good and effective parent to your child.

    • Psychotherapy: This is a type of counseling that is usually done in a series of meetings or talks. Psychotherapy may be attended by you, your child, and your family. These meetings can help everyone better understand ODD. Your caregiver may also include your child's teachers or people that are close to him during these talks.

  • Medicines: Your child may have any of the following:

    • Anti-depressants: These medicines are given to decrease or prevent anger and symptoms of depression. They can also be used to treat other behavior problems.

    • Blood pressure medicines: These medicines are usually used to control high blood pressure. They may also be used to help your child feel calmer, more focused, and less irritable.

    • Stimulants: These medicines are given to help your child pay attention, concentrate better, and help improve his behavior.

Where can I find support and more information?

Accepting that your child has ODD may be hard. Talk to your child's caregiver, your family, or friends about your feelings. Talk to your child, or have those who are close to your child, talk to him about how things are at home and at school. Your child's caregiver can help you and your family better understand how to support a child with ODD. You and your family may also want to join a support group. This is a group of people who may also have children with ODD. Contact the following for more information:

  • National Institute of Mental Health (NIMH), Public Information & Communication Branch
    6001 Executive Boulevard, Room 8184, MSC 9663
    Bethesda , MD 20892-9663
    Phone: 1- 301 - 443-4513
    Phone: 1- 866 - 615-6464
    Web Address: http://www.nimh.nih.gov/

Care Agreement

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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