A certain amount of defiant behavior is to be expected in a child---especially in the toddler years and teens, when separation and individuation are crucial developmental tasks. However, when defiance toward parents and other authority figures becomes a pattern of excessive and persistent rule-breaking and refusal to comply, the child may be diagnosed with a psychiatric disorder known as oppositional defiant disorder, or ODD.
Defining Oppositional Defiant Disorder
According to the American Psychiatric Association, ODD is "a pattern of negativistic, hostile and defiant behavior lasting at least six months." More specifically, a child with ODD often argues with adults, loses his temper, defies adults' rules or requests, annoys people on purpose and blames other people for his poor behavior. He is often vindictive, spiteful, angry, resentful and easily irritated by others. To receive a diagnosis of ODD, the child's disruptive behavior must be causing significant problems at home, at school or with peers.
Cause
The cause of ODD is not known. The American Academy of Child & Adolescent Psychiatry, or AACAP, suggests that the disorder may originate in mutual frustration between the child and parent during the child's infancy. Once established, a conflict-based relationship persists as the child grows older, aggravated by the parents' responses to the child's defiance. "The more a child reacts in defiant, provocative ways, the more negative feedback she elicits from the parents. In an attempt to achieve compliance, the parents or authority figures remind, lecture, berate, physically punish, and nag the child. But far from diminishing oppositional behavior, these kinds of responses toward the child tend to increase the rate and intensity of non-compliance. Ultimately, it becomes a tug-of-war and a battle of wills."
Breaking the Cycle
One key to reducing the defiant behavior is to provide parents with techniques aimed at ending the battle of wills between parent and child. According to Alan Kazdin, Ph.D., director of the Yale University Parenting Center and Child Conduct Clinic, emphasis should be on praising a child's good behavior while providing minimal punishment for bad behavior. "Praise is a great tool, one of the strongest ways to influence your child's actions," Kazdin states, whereas punishment "is not very effective."
Therapies
In addition to parenting skills training, various types of therapy are used to treat ODD, according to the AACAP. Individual psychotherapy can help children and teens with ODD better manage their anger. Family therapy can help the whole family identify and correct problematic patterns of communication. Cognitive-behavioral therapy is used to help children and teens learn ways to more effectively solve problems, thereby reducing the feelings of frustration and stress that so often lead to angry outbursts.
Medication
No medications have been developed to treat ODD. However, many children and teens with ODD have a co-occurring disorder such as attention-deficit hyperactivity disorder, or ADHD. These patients often find that the medication they take for their other disorders helps reduce their symptoms of ODD. According to S. Sutton Hamilton, M.D., and John Armando, L.C.S.W., in the "American Family Physician" journal, ADHD drugs such as Ritalin and Aderall provide relief from symptoms of ODD.
References
- "Diagnostic Criteria from DSM-IV"; American Psychiatric Association; 1994
- American Academy of Child & Adolescent Psychiatry: Your Adolescent---Oppositional Defiant Disorder
- Alan E. Kazdin, Ph.D.: A Conversation with Alan Kazdin
- American Academy of Child & Adolescent Psychiatry: Children With Oppositional Defiant Disorder
- "American Family Physician": Oppositional Defiant Disorder
