Brochure for parents whose children have Oppositional Defiant Disorder (ODD)

1. What is oppositional defiant disorder (ODD)?
2. Who does oppositional defiant disorder affect?
3. Signs and symptoms
4. What causes oppositional defiant disorder (ODD)?
5. How can it appear in the family cycle?
6. How is oppositional defiant disorder diagnosed?
7. How is oppositional defiant disorder treated?
8. Training for parental management
9. Don’t forget!

1. What is oppositional defiant disorder (ODD)?

• Oppositional defiant disorder (ODD) is a behavioral disorder in which your child exhibits an ongoing pattern of uncooperative, defiant, and sometimes hostile behavior toward people in authority.
• This behavior often disrupts the child’s normal daily functioning, including his family and school relationships and activities. It’s common for children—especially two- to three-year-olds and early teens—to resist or defy authority from time to time. They may express their defiance by arguing, disobeying or talking back to adults, including parents or teachers.
• When this behavior lasts for more than six months and goes beyond what is normal for your child’s age, it could suggest that he has ODD. Most children and adolescents who have ODD have at least one other mental health condition, including: Attention-deficit/hyperactivity disorder (ADHD), Anxiety disorders, including obsessive-compulsive disorder (OCD), learning deficiencies, mood disorders such as depression, impulse control disorders.
• About 30% of children with ODD develop a more serious behavior disorder called conduct disorder. ODD behaviors can continue into adulthood if ODD is not properly diagnosed and treated.

2. Who does oppositional defiant disorder affect?

• ODD most commonly affects children and adolescents, but can also affect adults. It most commonly starts at the age of 8.
• Some children outgrow ODD or receive appropriate treatment for it, while others continue to have symptoms into adulthood. Children assigned male at birth are more likely to have ODD in their younger years than children assigned female at birth. But teenagers are equally affected.
• Your child is more likely to develop ODD if they have the following risk factors:
  – A history of child abuse or neglect.
  – A parent or caregiver who has a mood disorder or who has substance or alcohol use disorders.
  – Exposure to violence.
  – Inconsistent discipline and lack of adult supervision.
  – Instability in their family, such as divorce, frequent moving to different homes, and frequent changing of schools.
  – Financial problems in their family.
  – Parents who have or have had ODD, Attention Deficit/Hyperactivity Disorder (ADHD) or behavior problems

3. Signs and symptoms
• Anger and irritability: lose their temper easily, frequent outbursts of anger, easily annoyed by other, frequently hostile or disrespectful
• Argumentative and defiant behaviour: excessive argue with adults, blaming others for own mistakes, actively refuses to comply with rules and requests, intentionally trying to annoy others.
• Vindictiveness: seeking revenge, using language that is mean or hateful when angry,

4. What causes oppositional defiant disorder (ODD)?
• Researchers believe that the cause of oppositional defiant disorder is a complex combination of biological, genetic and environmental factors:
• Genetic factors: Research suggests that genetics account for approx. 50% of such development. Many children and adolescents with ODD have close family members with mental health conditions, including mood disorders, anxiety disorders, and personality disorders. In addition, many children and adolescents with ODD also have other mental health conditions, such as ADHD, learning deficiencies, or depression and anxiety disorders, suggesting a genetic link between the conditions.
• Biological factors: Some studies suggest that changes in certain areas of the brain can lead to behavioral disorders. In addition, ODD has been linked to problems with certain neurotransmitters, which help nerve cells in the brain communicate with each other. If these chemicals are out of balance or not working properly, messages may not get through the brain correctly, leading to symptoms.
• Environmental factors: A chaotic family life, childhood maltreatment and inconsistent parenting can all contribute to the development of ODD. In addition, peer rejection, deviant peer groups, poverty, neighbourhood violence, and other unstable social or economic factors may contribute to the development of ODD.

5. How does it appear in the family cycle?
Child is impulsive, inattentive, dysregulated -> Increased parenting discipline /demands (corrections, commands, often inconsistent) -> Problematic behavior (seeking attention, disobeying, arguing, not following directions) -> Overwhelmed parents (stress, in a negative spiral of thinking) – > Child has Explosive behavior (angry, defiant) & Emotional problems (anxious, low self-esteem) -> Less Effective Parenting (give in or give up, family time not fun anymore)

6. How is oppositional defiant disorder diagnosed?

• Mental health professionals diagnose oppositional defiant disorder (ODD) if your child meets four or more of the symptom criteria described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) for at least six months. DSM-5, published by the American Psychiatric Association, is the standard reference book for recognized mental illnesses.
• Symptoms must also be severe and disrupt daily life. Your child will likely need to see a psychologist or child psychiatrist if they show signs of ODD.
• These mental health professionals use specially designed interview and assessment tools to evaluate your child for a mental health condition. Psychiatrists and psychologists often rely on reports from a child’s parents, siblings, friends, and teachers to gain a complete understanding of their behavior. Your child’s psychologist or psychiatrist will carefully evaluate your child.
• They must distinguish oppositional defiant disorder from the following conditions, which can cause similar symptoms: Mild to moderate oppositional behaviors. Untreated attention deficit/hyperactivity disorder (ADHD). Mood disorders. Anxiety disorders and obsessive-compulsive disorder (OCD).

7. How is oppositional defiant disorder treated?
Treatment for ODD varies depending on many factors, including:

• Your child’s age.
• The severity of their symptoms.
• Your child’s ability to participate in and tolerate certain therapies.
• If your child has other conditions such as ADHD, learning differences and/or OCD.
  ODD treatment should involve your child, your family and their school. Treatment usually consists of a combination of the following:
• Parental management training
• Psychotherapy (talk therapy)
• Interventions in school
• Medication

8. Training for parental management

• Parental Management Training (PMT) is the main treatment for oppositional behaviors.
• Teaches parents ways to change their child’s behavior at home, using positive reinforcement to reduce unwanted behaviors and promote healthy behaviors.
• There are different types of training programs, usually involving several sessions over several weeks. During the sessions, parents learn to identify problem behaviors as well as positive interactions and apply punishments or reinforcements as appropriate.
• PMT (parenting management training) has been shown to significantly reduce conduct problems in multiple contexts and family settings.

9. DON’T FORGET!

• You can prevent it: Although total prevention may not be possible, recognizing and acting on symptoms when they first appear can minimize suffering for your child and family.
• Providing a nurturing, supportive and consistent home environment could help reduce symptoms and prevent episodes of defiant behaviour.
• Build on the positives: Give your child praise and positive reinforcement when he shows flexibility or cooperation.
• Take a break when necessary: If you are about to make the conflict with your child worse instead of better, take a break and walk away. This is also a good example for your child. Support your child if they decide to take a break to prevent a negative situation from escalating.
• Be consistent: Set reasonable, age-appropriate limits with consequences for misbehavior that can be applied consistently. Be consistent about the rules too.
• Take care of yourself: Maintain the interests and hobbies you enjoy and practice self-care. Try to work with and get support from the other adults who interact with your child.