Oppositional Defiant Disorder (ODD) is the diagnostic term used to describe the condition for children who refuse to follow directions, talk back to adults, have temper tantrums, blame others for their problems, and frequently lose their temper. Your child may have this disorder if these problems occurs at home and at school. It is frequently seen in children with ADHD. This type of behavior is most likely to continue when it is successful at getting the child his way, even when it works only once in a while. Oppositional Defiant Disorder is the childhood version of the "wildcat strike" in which the worker (the child) refuses to work for the boss (the parent).
What should I do if my child is behaving this way?
A careful evaluation is needed to make sure that (especially in younger children) that there isn't a medical condition causing irritability or behavior problems. Also other psychiatric conditions may present with disruptive behaviors in children. However, a typical finding in ODD is that the child only has problems when not getting what he wants or when things don't go his way (in his own perception).
Oppositional behaviors may also accompany learning disabilities as the child tries to avoid the frustration of homework they are not good at or don't understand. It is important in these situations to identify the learning problem so that appropriate teaching techniques can be used to help your child (in addition to interventions to address the pattern of avoidance).
What type of treatment is available for ODD?
Find a psychiatrist/ therapist who will work closely with you to help you know what to do (and not do) at home and what the school needs to do (and not do) to help your child. Individual therapy for children is widely practiced for this disorder but is a waste of your money and time. Specific behavior plans with rewards for desired behavior need to be put in place along with effective ways of communicating with your child to help him learn skills of compliance and responsibility. (Yes these are learned skills! Just like with bike riding the skills come easily to some children and other children need more help from adults and practice). The idea is that over time, longer periods of compliance are expected in order to earn a reward until the behavior is automatic and only verbal praise and occasional rewards are sufficient. (I didn't say until nothing is needed. After all if our boss stopped rewarding us completely - i.e. didn't pay us our wage or salary and give us some good feed back about our work we wouldn't want to work for him either and we, too, would quit or go on strike).
Warren J. Steinmuller, MD
Child, Adolescent, and Adult Psychiatry and Psychotherapy 225 E. Kingston Avenue
Charlotte, North Carolina 28203
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