Oppositional Defiant Disorder in Children

We’ve all seen it before. A young child stands up to their parents. Perhaps mother wants daughter to finish her meal before napping or engaging in play. The child is defiant and refuses to cooperate. Perhaps father wants son to stay out of the garage where tools and such might pose a danger. The child is defiant and refuses to cooperate. Now let’s be honest here. Who of us has not rebelled against mashed potatoes in favor of play. Or who of us has not wandered into areas of the homestead we were warned to avoid. And in some cases, our defiance might have been regarded as “sassy, strong willed, or head strong.” There’s nothing wrong with those descriptors; after all, independence is valued in our culture.

But there is a defiance line that is crossed by some children, and when crossed, defiance becomes problematic. When defiant behavior lasts longer than six months and is greater than the normal defiance exhibited by children of a similar age, the child might be diagnosed with ODD – opposition defiant disorder. If a child displays an ongoing pattern of anger, argumentative behavior and resistance towards those in authority, normal functioning is impaired and professional help should be sought.

Unlike other emotional and behavioral disorders in children, ODD does not result in aggression towards people or animals, property destruction or theft. It does, however, result in annoyance to others, resentment of others, blaming others, loss of temper, disregard for rules, and spiteful behavior. If these symptoms are observed in home only, the diagnosis would be mild ODD. If seen in two settings, the diagnosis would be moderate and if three, the diagnosis would be severe.

An exact pin-pointed cause for oppositional defiant disorder does not exist. Like many other emotional and behavioral disorders in children and adults, the cause is believed to emanate from a combination of genetics, biological and environmental influences. Neurologically speaking, children with ODD have an overactive “behavioral activation system” and an underactive “behavioral inhibition system.” Logically this explains why children with ODD show weakness in controlling impulses, judging and reasoning.

Genetics may play a role with ODD as evidenced by studies involving adoption and twins. 50% of the antisocial behavior in the studies pointed to heredity as a cause for both male and female participants. Of equal importance are studies that show a tendency of ODD where family members are known to suffer from mood disorders, ADHD and substance abuse.

Not to be overlooked are environmental factors including negative parenting, dysfunctional family structure (caused by mental illness or substance abuse), improper discipline, insecure parents, weak bonds with parents and low socioeconomic status. Beginning at about age 8, ODD is more common with boys in younger children and in older children, boys and girls show equal occurrence.

If you believe your child may have ODD it is recommended that you first visit your pediatrician or family doctor. If after a comprehensive physical exam an explanation cannot be found to explain behavior, your doctor will most likely refer you to a trained, certified child psychologist. At this point your child will be evaluated for signs of other mental illness such as ADHD or depression.

The age of your child and severity of symptoms will determine the treatment path. Psychotherapy may be used to teach your child to control anger and communicate more effectively. Positive parenting, including the ability to effectively discipline, support and encourage the child, may be reviewed. While no specific drug has been developed to treat ODD, other medications, such as those used to treat depression, may be helpful. Your child psychologist will guide you through these and many other therapy choices.

Colin B. Denney, Ph.D., is the Director of the Pacific Psychology Services Center in Honolulu, Hawaii, he is a Child Psychologist Honolulu.