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Identifying Oppositional Defiant Disorder

In my work with children and families at a non-profit agency I often run into the same diagnoses: ADHD, Depression, Bipolar, and Oppositional Defiant Disorder (ODD). The diagnosis of ODD is the one that appears to be the most difficult to assess and treat due to the nature of parents to label their child as “bad”. Another obstacle to the treatment of this diagnosis is that many social service agencies, teachers, and schools do not really understand the diagnosis. Even more shocking is that many underestimate the link to more severe disorders, so it goes untreated until it reaches the point of Conduct Disorder and, eventually, Antisocial Personality Disorder. Let’s take a look at what ODD really is and how you can help a family through the treatment of this disorder.

What’s ODD?

Oppositional defiant disorder (ODD) is defined as a pattern of hostile and defiant behavior permeated by the following symptoms:

  • losing one’s temper,
  • arguing with adults,
  • refusal to comply with adults’ rules,
  • deliberately annoying others,
  • blaming others for one’s mistakes,
  • being easily annoyed,
  • being angry or annoyed more often than not, and
  • being vengeful

Funny thing about this broad definition and symptoms list is that it sounds like most kids! But, every child cannot have ODD, right? So, how do you get to the bottom of how to identify if a child meets the criteria for this diagnosis? Great questions. Let’s take a systems perspective [looking at the person in their current environment] to see how this diagnosis looks in real life.

Cultural Factors

Low-income households, family instability (including economic stress, parental mental illness), harsh discipline, inconsistent parenting practices, multiple moves, and divorce: all these factors contribute to the development of this disorder. When assessing a child to determine if he fits this diagnosis, you cannot overlook his environment. It would be great if we all lived in a vacuum. But, unfortunately, many things come together to make a child act out. Going straight for an ODD diagnosis without factoring in these risk factors can lead to misdiagnosing the child.

Social-Emotional Factors

Not only can a child be affected by their physical environment, they can also be influenced in their social and emotional settings. Unfortunately, children with ODD often get misdiagnosed with ADHD due to both diagnoses share similar symptoms. However, ODD has a causes significant impairments to a child’s social environment because they cannot control their tempers. These children develop substantially deficient relationships with parents, teachers, and peers which continue to influence how they are interacting with their environment. Essentially, this interferes with the child’s ability obtain positive attention leading the child to further act out to obtain the negative attention he craves. Children who suffer from ODD often get sent away from social events, placed in classes where they are alone (or, with others who share the same social detriments), and generally fall through the cracks because no one knows how to effectively work with them. This breeds a child without proper social skills and further leads them to develop conduct and antisocial tendencies.

So, is there any hope for the child who suffers with ODD? Is he bound to the confines of a life where his behaviors push him further and further from peers, caregivers, and teachers?

Of course not!! One of the many practices that have been shown to work well with the ODD diagnosis is family therapy.

Family Therapy versus Individual Therapy

The effectiveness of family therapy outweighs the execution of individual therapy because the child is already isolated due to his defiant, aggressive behavior. Individual therapy would only exacerbate these behaviors because he would not develop the social skills needed to regulate his symptoms. In family therapy, the child develops skill such as empathetic communication with others to get his needs met. Another huge reason for family therapy is due to the fact that ODD develops as a result of the inconsistent family system. Essentially, as the family develops healthy attachments and effective communication the child begins to mange his defiance and aggression through the support of the newly established family system.

What does this look like?

In family therapy with a child who is battling ODD, the basic idea is to get the family to buy into the process of changing their current dysfunctional system. The goals in family therapy includes:

•         Developing the parent as the leader of the family system

•         Challenging the unhealthy closeness of the family members so that each has his own voice

•         Establishing family member roles for healthy, productive contributions, and,

•         Constructing family coping skills to help the family manage future issues

Essentially, you are changing the very foundation of a family so that the child’s behaviors can be contained and managed with support instead of aggression from the parent.

The Bottom Line

ODD is difficult to diagnoses given its similarity to typical childhood defiant behavior. The key is to assess the child’s environment and how the behaviors are illustrated in these environments. The diagnosis is not a death sentence, and can be managed by families with the proper guidance from a therapeutic relationship with clinical social worker or counselor.

Mercedes Stanley, MSW is a clinical therapist at the Los Angeles Child Guidance Clinic in Los Angeles, CA working with families and children with severe emotional disturbances (SED). She is also the founder of a parenting skills program, The Parenting Skill. She received her MSW from the University of Southern California and BA in Psychology from UCLA.

Sources:

Shepard, S.A. & Dickstein, S. (2009). Preventative intervention for early childhood behavioral problems: An ecological perspective. Child Adolescent Psychiatry, 18(3), 687–706.

Steiner,  H. & Remsing,  L. (2007). Practice parameter for the assessment and treatment of children and adolescents with oppositional defiant disorder.  Journal of American Academy of Child Adolescent Psychiatry, 46(1), 126–141.