Oppositional Defiant Disorder (ODD) and AD/HD

ODD is defined by aggressiveness and a tendency to purposefully bother and irritate others. While it is true that anybody can be aggressive and irritating from time to time, to be diagnosed as ODD, a person must display a pattern of negativistic, hostile, and defiant behavior lasting at least six months.

What are the symptoms of ODD?

A pattern of negativistic, hostile, and defiant behavior lasting at least 6 months, during which four (or more) of the following are present:

• often loses temper
• often argues with adults
• often actively defies or refuses to comply with adults' requests or rules
• often deliberately annoys people
• often blames others for his or her mistakes or misbehavior
• is often touchy or easily annoyed by others
• is often angry and resentful
• is often spiteful or vindictive

Note : Consider a criterion met only if the behavior occurs more frequently than is typically observed in individuals of comparable age and developmental level.

The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.

The behaviors do not occur exclusively during the course of a Psychotic or Mood Disorder (such as depression).

Criteria are not met for Conduct Disorder, and, if the individual is age 18 years or older, criteria are not met for Antisocial Personality Disorder.

Criteria summarized from:

American Psychiatric Association. (1994). Diagnostic and statistical manualof mental disorders, fourth edition . Washington, DC: American Psychiatric Association.

See ODD: What is it? for more information or ODD Symptoms for a list of symptoms. (Note: links will open new browser windows. Close the new window to return to additudemag.com)

How many kids have ODD?

Some sources estimate that 5% of all children may qualify for the diagnosis.

Do all children with AD/HD have ODD?

Not all ADD/ADHD kids qualify for the ODD diagnosis. However, the percentages are high - some studies put estimates as high as 65% of AD/HD kids with ODD. A recent article in Attention!, the quarterly magazine published by CHADD, cites a study of 600 7 to 9 year olds in which 40% of the ADD children also had ODD, with 15%, or 1 in 7, having more serious conduct disorders.

Can children outgrow ODD?

It appears that some children will outgrow some aspects of ODD. For example, a defiant teen may grow into a more easy to get along with adult. However, other behaviors may be life long. An aggressive two year old will very likely be an aggressive adult.

What should I ask the doctor, psychologist or therapist when I take my child for a visit?

First ask if they have worked with children who have ODD and what methods of treatment they prefer. See How Should I Evaluate a Prospective Therapist? for more information.

How should I treat my ODD child?

• Always build on the positives, give the child praise and positive reinforcement when he shows flexibility or cooperation. Recognize the "little victories".
• Learn to control yourself. Take a time-out or break if you are about to make the conflict with your child worse, not better.
• Pick your battles. Since the child with ODD has trouble avoiding power struggles, prioritize the things you want your child to do.
• Set up reasonable, age appropriate limits with consequences that can be enforced consistently. Resist the temptation to rescue the child from naturally occuring consequences.
• Don't go it alone. Work with and get support from the other adults (teachers, coaches, and spouse) who deal with your child. Look for area support groups and/or parenting classes for parents of difficult children.
• Avoid burnout. Maintain interests other than your child with ODD, so that managing your child doesn't take all your time and energy. Manage your own stress with exercise and relaxation. Use respite care as needed.

See Dealing with Oppositional Behavior for information and Oppositional Defiant Support Group for support.

Are medications used to treat ODD?

Medications are sometimes used. Talk with a child psychiatrist who is familiar with ODD children.

Is other treatment required?

The ODD child should see either a psychiatrist, psychologist or a therapist who is familiar with the disorder. Counseling should involve both the child and the family, with an emphasis on ways to cope with such behavior.

If the child becomes dangerous to himself or others, hospitalization may be necessary. Patients who present a danger outside the hospital can be involuntarily hospitalized for up to 3 days by the police or a doctor for observation.

What happens to a child hospitalized for ODD? What can I expect?

Having your child hospitalized for a psychiatric problem can be a traumatic experience. Hospitalization typically is on an emergency basis, often following some kind of severe incident. Parents are often exhausted, traumatized and scared.

Do your best to answer all questions at the hospital as well as you can. Doctors will probably ask for a medical history, any present medications, and an explanation of the event that lead to the decision to bring the child to the hospital. If your child stays overnight, then you should go home and get some rest. DO NOT FEEL GUILTY ABOUT THE FACT THAT YOUR HOME IS MORE PEACEFUL WITHOUT THE CHILD. Use this time to pull yourself together, to nurture your spouse and any other children in the house, and just to enjoy some peace for a while.

During hospitalization, the child may encounter the following procedures.

• Group Therapy run by medical staff.
• Individual Therapy with a mental health care professional
• Family Meetings to prepare the patient and the family for the child's return home.
• Time Out if needed. If the child becomes unable to control himself, he may be separated from the other patients. If he seems violent, he may be placed in a "safety room."
• Restraints may be used for patients who pose a danger to themselves or others. This usually involves leather bands or straps used to hold the child in a bed.

What is a good book about ODD?

The Explosive Child by Ross W. Greene, Ph.D. a good place to start.