Coborbidities: Oppositional Defiant Disorder


It is very normal for children to be oppositional sometimes. This can be explained by hunger, fatigue, stress or emotional distress. Children do argue, talk back, and defy parents, teachers or other trusted adults. This typically starts when a child is 2 or 3. 

What is Oppositional Defiance Disorder?

Oppositional Defiant Disorder can cause people to engage in a pattern of uncooperative, defiant and hostile behaviors targeted at parents, teachers, other authority figures or peers that can interfere with day to day life. It is mostly diagnosed in childhood.

Signs of ODD :

  • frequent meltdowns or tantrums
  • excessive arguing with adults
  • often question rules
  • active defiance and refusal to comply with adult requests and rules
  • deliberate attempts to annoy or upset people
  • blaming other for his or her behavior
  • often being touchy or easily annoyed by others
  • frequent anger and/or resentment
  • spiteful attitude and seeks revenge
These signs are seen in different settings but can be more noticeable at home or at school. 1-16% of children have ODD. There is no known cause of ODD. Parents report their child who has ODD is more rigid and demanding than siblings from young age. Biology, psychology and social may all play a role. People who have ODD have the potential to be abusive due to uncontrolled anger. 

Who is more likely to have ODD?

People who also have:
  • Mood or anxiety disorders
  • conduct disorder
  • ADHD

Two Theories on the Cause of ODD

Developmental Theory

This theory says that the issues start when the children are toddlers. Children and teens with ODD may have had trouble learning to become independent from a parent or other main person who they were emotionally attached. Their behavior may be normal developmental issues that are lasting past the toddler years. 

Learning Theory

This theory states that the negative signs of ODD are learned attitudes. They mirror effects of negative reinforcement methods used by parents and others with authority. The use of negative reincement increases ODD signs. 
The developmental theory is more widely accepted. 

How is it diagnosed?

People who show signs of ODD should have a comprehensive evaluation by a psychiatrist. It is important to look for other neurodivergencies such as ADHD, learning disabilities, cluster B mood disorders, and anxiety disorders. 

Managing ODD

  • Parent management training to help parents and others properly interact with the child
  • individual psychotherapy to develop more effective anger management
  • Family psychotherapy to improve communication and mutual understanding
  • Cognitive behavior therapy- a child learns to better solve problems and communicate and learns how to control impulses and anger. 
  • Peer group therapy- A child develops better social and interpersonal skills
Medication can be helpful to stabilize the individual along with comorbidities such as ADHD, anxiety and cluster B mood disorders. 

Tips for parents and other loved ones:

  • Always build on the positives, give positive feedback
  • Take a timeout or a break if you are becoming escalated and will make the conflict worse. This way you are modeling for your child. Support your child if they need a time out
  • Pick your battles. A child with ODD has trouble avoiding power struggles. Remain calm
  • Maintain your own interests outside of your child. This is so you do not get lost during parenting. Work with other adults such as teachers, coaches and spouse for support
  • Manage your own stress with healthy life choices like excercise and relaxation. Take breaks as needed
  • Children with ODD will respond to positive parenting techniques.
  • Working with a pediatric psychiatrist is your best resource. 
  • Keep all appointments with the healthcare provider

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