Oppositional Defiant Disorder (ODD)

Oppositional Defiant Disorder (ODD) manifests itself in children who show physical or verbal aggression with tantrums and refusal to follow instructions. It is treatable by a clinician skilled in one of several Behavioral Parent Training programs.

ODD is a pattern of behavior for over six months that has three parts: a child or teen being argumentative in general or defiant when given instructions; the child being very angry and irritable most of the time; and, at times, the child becoming vindictive and deliberately trying to make others angry. It can seem from the outside that the child is totally fine one minute and blows up the next minute. This appearance sometimes misleads people to think the child has bipolar disorder; however, ODD and explosive or drastic mood swings are not bipolar.

ODD not only causes frustration in the moment for the parent and child, it also spreads through the family’s entire social life at all levels. Parents of kids with ODD often do not want to go to stores or restaurants anymore to avoid having their child act out in public. Parents may hear that other parents don’t want to set up play dates anymore. Schools may send these children home early because of the disruption they cause, or they may refuse to enroll these kids altogether. Kids with ODD often have little or no friends, and the friendships they do develop may be very conflicted.

ODD typically emerges in younger children (before age five). Without treatment, up to 25 percent of kids may lose ODD traits on their own; however, it persists for many years in 50 percent of kids, and the other 25 percent have behavior that starts to become cruel or even criminal in nature. With a total of 75 percent of kids with ODD having years of difficult or even criminal behavior ahead of them, seeking treatment by a qualified therapist who goes beyond anger management counseling to also include some form of behavioral parent training is critically important.

There are a number of risk factors related to development of ODD (Barkley, 2013). Individual factors from the child include having ADHD, a mood/anxiety disorder or just an irritable temperament from birth. Parent factors, such as having ADHD themselves, irritable temperament, high stress due to a number of reasons and/or being young parents, also may contribute to development of ODD in the child. Family social environmental factors include living in an area with a high crime rate, delinquent peers, conflicted marriages or conflicted extended family.

One of the most important factors is how parents raise their children. Inconsistent parenting, highly negative parenting (or by contrast, low negative but also low discipline parenting), inappropriate expectations, as well as lack of monitoring of the child, and/or low positivity in parenting are all risk factors. At least one parent and the child engage in the Coercive Family Cycle (Patterson, 1982), in which a parent gives an instruction (possibly a harsh instruction or nearly impossible instruction), then the child reacts negatively and both continue with negative reactions (yelling, harsh tone and possibly escalation to destruction) until one or the other gives up. It is not healthy for the child, even if it “works” in the moment. In the worst case scenario, the child gets away without having to do what she has been told to do, and her actions are reinforced. In the best of the worst scenarios, the adult is able to force compliance, but then the child learns the social lesson that to be respected in the family and society a child has to be big, loud, angry and bad.

By contrast, Behavioral Parent Training (BPT) aims to make an impact by changing the parenting factors. The goals of BPT are to improve warmth between parents and kids and to build reasonable and enforceable limits. Warmth can be provided by making sure that there’s always positive interaction time and that when the child follows the instructions, good things happen—like acknowledgement and normal daily privileges. Limits include expectations to complete schoolwork, to clean up to whatever extent reasonable in relation to the child’s age and to recognize that any destructiveness and rude or obnoxious behavior leads to consequences. The consequences for negative behavior shouldn’t be harsh, but instead should be consistent and assure everyone’s safety.

BPT does have limits, however. It only addresses the parenting factors. At times, the child’s individual factors (irritability, impulsivity) have to be addressed as well, possibly in conjunction with Cognitive Behavioral Therapy or anger management. However, anger management alone is insufficient. A course of treatment may take three to six months or even longer, depending on how longstanding the issues are, for example. Therapy may be effortful and difficult at times, yet no more and perhaps less difficult than having these behaviors affect the family for years or decades.

Behavioral Parent Training offers real hope to families that may allow parents to enjoy their kids again and vice versa. If you would like to talk to a Keystone therapist about BPT, make an appointment online.

Address: 6867 Southpoint Drive North, Jacksonville, FL 32216
Phone: 904.619.6071 | Fax: 904.212.0309 | Email: info@keystonebehavioral.com
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