Oppositional Defiant Disorder (ODD)
Children who present with oppositional behaviour and noncompliant behaviour that is chronic and frequent may meet the diagnostic criteria for Oppositional Defiant Disorder (ODD). Children with ODD demonstrate a pattern of negativistic, hostile, and defiant behaviour lasting at least 6 months, during which four (or more) of the following are present:
- often loses temper
- often argues with adults
- often actively defies or refuses to comply with adults’ requests or rules
- often deliberately annoys people
- often blames others for his or her mistakes or behaviour
- is often touchy or easily annoyed by others
- is often angry and resentful
- is often spiteful or vindictive
Note: Consider a criterion met only if the behaviour occurs more frequently than is typically observed in individuals of comparable age and developmental level.
The disturbance in behaviour causes clinically significant impairment in social, academic, and occupational functioning.
The behaviours do not occur exclusively during the course of a Psychotic or Mood Disorder.
Criteria are not met for Conduct Disorder, and if the individual is age 18 years or older, criteria are not met for Antisocial Personality Disorder.
Note that ODD is a developmental antecedent to Conduct Disorder (CD) which is a more serious diagnosis that involves a persistent pattern of serious behaviours that violate social norms or rules and include aggression to people and animals, destruction of property, deceitfulness or theft, and serious violation of rules (truancy from school, running away, staying out at night – often occurs prior to the age of 13 years). However, child onset CD occurs before ODD diagnostically, and not all children with ODD develop CD.
It is important to establish a meaningful relationship with a child who has ODD. The likelihood of a child being compliant to a parent and/or teacher increases significantly if the child has a compliant stance. A compliant stance refers to the likelihood that a child will comply with and adhere to expectations. This is, in part, based on how positive his or her relationship is with a parent and/or teacher. Children who have a more positive relationship with an adult where they feel respected, heard, and liked, are more likely to want to please and more likely to respond to redirection and direct requests for behaviour.
Children who present with ODD have a hard time accepting responsibility for their actions. This is an inherent feature of ODD. It is important to not discuss (reason, negotiate, or rationalize) with a child during negative situations and make them accept responsibility or state an apology in the moment. This type of response is likely to spiral the situation. Also, reasoning provides a lot of 1:1 attention to the child which can perpetuate the negative behaviour as it likely can be a strong reinforcer. Receiving a parent or teacher’s attention (even when negative) can be a powerful reinforcer that keeps the negative behaviour going.
Picking battles and giving one warning or a time frame for compliance is a key feature for dealing with ODD. Never issue a request for behaviour if you cannot follow thru with a consequence, and decide ahead of time which behaviours you may actively ignore.
At our clinic, we feel it is important to use a positively structured behaviour program that reinforces prosocial and compliant behaviour and provides negative consequences for antisocial or noncompliant behaviour.
Once improvements in behaviour occur, it is typical for teachers and parents to relax with the rules and to stop using behaviour programs. It is important that this type of intervention not be stopped too early just because a child is showing gains. It is necessary to wait until you are certain that the child has internalized the rules of conduct. Also, developmentally, children with ODD will present with a variety of issues over time so there may be a need to review and adjust expectations and rewards accordingly. At our clinic, we will help support you to teach your child self regulation skills and engage in adaptive behavioural choices over time.