Remember when your child was going through the "terrible two's"?
Did that stage seem to continue as your child got older?
Children and adolescents with Oppositional Defiant Disorder, or ODD,
are much more difficult to be with than other children their age.
They display hostile behaviors which occur more often than normal
and are usually seen before the child reaches eight years of age.

Some examples of this negative behavior:
Frequent temper tantrums
Arguments with adults
Blames others for own mistakes or behaviors
Annoying behaviors
Easily annoyed by others
Resentfulness
Vindictive behavior
Purposeful defiance of rules or requests
In school, teachers may also find these students to have low
frustration tolerance in completing assignments,
frequent temper tantrums, and blaming schoolmates for their own behavior.
They also may display other behaviors associated with
Attention Deficit Hyperactivity Disorder (ADHD) such as
short attention span and limited ability to concentrate,
restlessness, fidgeting, and hyperactivity.

What are the Symptoms?
There is usually a pattern of symptoms that parents will notice
throughout infancy, toddler years, preschool years, elementary years,
junior high school / middle school years, and adolescence.

Infancy (0 to 18 months)
Irregularities in sleeping and eating patterns
High activity level
Low tolerance of stimulation and physical affection
May be colicky, fussy and/or irritable
Difficult to calm or soothe
Difficult to hold due to restlessness and overactivity
Does not show a preference for being held or cuddled

Toddler (18 months to 3 years)
Short attention span
Impulsivity
Restlessness and overactivity
More difficult to manage than other children of the same age
Perceived by caretakers as rebellious or non-compliant

Preschool (3 to 6 years)
Low patience level
Displays aggression
Increasing difficulties with peer relationships
Gradually become more openly defiant towards adults

Elementary (6-11 years)
Behaviors may continue across home, school, and community settings.
Beginning academic problems.
Impulsivity and motor restlessness.
Variety of disruptive and aggressive behavioral difficulties.

Jr. High/Middle School (11-13 years)
Academic difficulties
Loss of interest in school
Peer relationships are generally poor
Increase in chronic lying, stealing, shoplifting
Truancy, running away, alcohol/drug abuse, sexual experiences
Increased problems with low self-esteem and depression

Adolescence (13-18 years)
Truancy from school (dropped out or expelled)
Increased involvement with, and loyalty to, delinquent peer groups
Greater isolation from other peers, family members
Stealing, shoplifting, running away, alcohol and/or drug abuse,
sexual promiscuity
Problems with low self-esteem, low self-confidence, and/or depression

Is This Disorder Common?
Estimates of the occurrence of ODD in children run from 5 to 15%
of the total population. It is more commonly seen in boys,
and about 60-70% of children with ODD also have ADHD.
The cause of this disorder is unknown.
Theories suggest that it may be related to a child’s temperament
and the family’s reaction to that temperament;
a genetic predisposition; brain chemical imbalances;
or neurological disorders.
The usual pattern of problems begins between the ages of 1 and 3.
If you think about it, a lot of these behaviors are normal at age 2;
in this disorder, the troubling behaviors persist and seem to get worse
as the child develops.

Does my Child have ODD?
Does you child show a pattern of negative, hostile, and defiant behavior
that has lasted at least 6 months? Are four or more of the
following behaviors 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 own mistakes or misbehavior
Is "touchy" or easily annoyed by others
Is often angry or resentful
Is often spiteful or vindictive
Does the disturbance cause significant problems at home, school, daycare,
or social settings? If you answered yes to these two questions,
it is possible that your child might have ODD.
This disorder is diagnosed the same way as many other
psychiatric disorders in children. Professional counselors and
therapists need to examine the child, talk with the child,
talk with the parents, and review the child's medical history.
Sometimes other medical tests are necessary to ensure a correct diagnosis.
Children must be checked for other psychiatric disorders,
since it is common that children with ODD to have other problems, as well.

ODD
Characterized by aggressiveness, rather than impulsiveness.
Child purposefully annoys people
Child does not have difficulty with concentrating or sitting still.
Behavior is purposeful, intended to "get a rise" out of others.

ADHD
Characterized by impulsiveness, rather than aggressiveness.
Annoyance is usually not purposeful.
Child fidgets, has difficulty with concentration, and has trouble sitting still.
Child often acts without thinking ahead.

A child with ODD is usually much more difficult to deal with than a child
who has ADHD. A child with ADHD may impulsively push another child too
hard on a swing and knock the child to the ground, and then generally feel
bad about it afterward. However, a child with ODD might say s/he didn’t do it,
then brag about it to friends later. ADHD sometimes goes away without
intervention, but ODD rarely does.

How are ODD and Conduct Disorder related?

Currently, the research shows that in many aspects, Conduct Disorder
is a more severe form of ODD. Thus, severe ODD may develop into
Conduct Disorder. Milder ODD usually does not "turn into" Conduct Disorder.
The common thread that separates ODD from Conduct Disorder is safety.
If a child has conduct disorder, there are more concerns for the safety
of others and their possessions. Behaviors such as fire-setting and
vandalism are common in Conduct Disorder, and often the safety of
the child with Conduct Disorder is also of great concern.
Children with ODD are generally an annoyance, but not especially dangerous.

ODD
Disobedience and opposition to authority.
Hostility is shown through deliberately annoying others or verbal aggression.
Behaviors may or may not be seen at home and in school and other community settings.
Basic rights of others or age-appropriate societal rules are not usually violated.

Conduct Disorder
Severe disobedience and opposition to authority.
Hostility is shown through physical aggression.
Behaviors are persistent both outside of the home setting.
Basic rights of others or age-appropriate societal rules are often violated.

What happens to children who have ODD when they grow up?

There are three main paths that children with this disorder will take.
First, there will be some lucky children who outgrow this disorder.
The exact percentage who outgrow it is not known, but it is probably
not the majority.

Second, ODD may turn into Conduct Disorder.
This usually happens fairly early in childhood.
That is, after 3-4 years of having ODD, if it hasn’t turned
into Conduct Disorder, it probably never will.

Third, the child may simply continue to have ODD.
Recent research suggests that this is probably the most common path.
Another common occurrence is that children who have ODD develop signs
of mood disorders or anxiety as they get older.

Parent-Help Suggestions

Children and adolescents with ODD are much more difficult to be with than
other children of their age. The destructiveness and disagreeableness
are purposeful.
They like to see you get mad. Every request can end up as a powerful struggle.
Lying becomes a way of life, and getting a reaction out of others is the
chief hobby. Perhaps hardest of all to bear, they rarely are truly sorry
and often believe nothing is their fault.
After a child with ODD "blows up", s/he is often calm and collected.
Then the parents and other family members may feel they have been provoked
into being angry. This is understandable, because they may have been tricked,
bullied, or lied to, or may have witnessed an intolerable temper tantrum by
the child with ODD.
Children and adolescents with ODD produce strong feelings in other people.
They try to provoke reactions in people, and they are often successful.
Common issues include inciting spouses to fight with each other rather than
focusing on the child, making outsiders believe that the parents are at fault
for conflicts, making vulnerable people believe that they can "save" the
child by doing everything the child wants, setting parents against
grandparents, setting teachers against parents, and even inciting the
parents to abuse the child.

Non-Medical Strategies for Managing ODD
The essence of this group of interventions is to make it impossible for
ODD to "work". It is a way of making sure all the attempts to annoy or
irritate others and to cause fighting are not successful.

1. Adults must work together.
Children with ODD are quite successful at placing the blame for their
behaviors on others, including parents and/or teachers. Thus, adults
must come together and challenge anything that the child tells you about
how others treat them. In order for this to work effectively, all parties
need to talk directly with each other without the child being present.
Talk regularly with teachers and principals about the child's school behavior.
Establish a policy at both home and school not to rely exclusively on information
your child gives you about what others have done.
Sit down with all caregivers (including baby sitters, grandparents, aunt, uncles)
to make sure they understand ODD and that they follow the above policy.
Do not include the child in these discussions with other caregivers.

2. Have a plan and try not to show any emotion when reacting to the child’s behavior.
If you react too emotionally, you may make big mistakes in dealing with the child.
Everyone needs to agree in advance on what to do when the child engages in
certain behaviors-- and then be prepared to follow through calmly.
Behavior modification strategies have been used successfully in the therapeutic
treatment of ODD, and can also be used effectively in the home.
The central premise of behavior modification (or behavior therapy)
is that behavior is maintained by its consequences. It suggests that old
behaviors resist change unless new behaviors are followed by more rewarding
consequences. Many therapists suggests that for the most part, focusing on
the positive behaviors and not reacting emotionally to the negative behaviors
is the key to getting behaviors to change.
For behavior modification to work, the program must involve certain components:
Target only a few important behaviors, rather than trying to fix everything.
For example, you may wish to focus on eliminating highly objectionable
behaviors such as hitting others, stealing, or swearing.
Be very concrete about the expected behavior. Instead of saying,
"listen when I am talking," say, "Sit down and make eye contact with me
when we are talking."
Be consistent -- no bending of the rules under any circumstances!
Rewards for good behavior should not be money or things that are bought.
Rather, grant rewards that involve activities that the child enjoys.
Rules should be simple and straightforward so as to be easily understood.
If your child can read, write the rules and consequences
(both negative and positive) into a contract and have the child sign it.

3. Decide which behaviors you are going to ignore.
Most children and adolescents with ODD are doing too many things you dislike
to include all of them in a behavior management plan. The key caregivers
have to decide ahead of time which behaviors will be targeted for change,
and which will simply be ignored.

Professional Interventions
Raising a child with ODD can be an exhausting and frustrating challenge.
Professional interventions have been devised to give parents a greater
understanding about the causes of this disorder, as well as empower them to
regain control of their child.

Parent-training and support classes
The central focus of therapy is usually behavioral, which is implemented
through parent training. Parent training and support can often be held in
a group setting. In these courses, parents learn specific behavioral
techniques which help increase the maintenance of control in the relationship
with the child. Gradual shaping of the child’s behavior toward more
age-appropriate behaviors is accomplished through the implementation of a
behavioral monitoring and reward program.

Psychotherapy
Family and individual treatment can be effective in some cases.
This method is heavily focused on the child’s behaviors and causative factors,
which may not be appropriate for all families.
However, if the child is experiencing a co-existing disorder, family and/or
individual therapy can be useful in reducing the family’s (and child’s)
concerns, stress, and relationship difficulties.

Medications
ODD is usually a co-existing disorder. If your child has another existing
condition, talk with your doctor or therapist about the right medical
interventions for your child.

When do you consider medications?
There are three reasons to consider medication:
1. If medically treatable co-existing conditions are present (e.g., ADHD, depression, anxiety, etc.).
2. If non-medical interventions have not been successful.
3. When the symptoms are very severe, and you believe your child’s safety may
be at risk due to their behavior.

Which drugs should your child take?
Ask your child's doctor or therapist about their preferences for medications,
and then do some of your own research. Look for drugs that have been proven
safe for children, have no long-term side effects, and have been found in
research studies to be effective. Each drug has certain side effects that need
to be monitored.