More Than Just Naughty: Dealing with ODD in Children
Forty percent of children with ADHD also develop oppositional defiant disorder. Kids with ODD demonstrate consistently angry, violent, and disruptive behaviors toward authority figures. Learn how to regain control as a parent with these ODD strategies.
Every parent of a child with attention deficit (ADHD or ADD) knows what it’s like to deal with behavior problems — your child saying no to requests or blurting out disrespectful retorts. Children with ADHD andoppositional defiant disorder (ODD) take defiant behavior to the extreme. They have a pattern of angry, violent, and disruptive behaviors toward parents, caretakers, and other authority figures. These children require smart, specific oppositional defiant disorder strategies — and more than their fair share of patience.
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ODD and ADHD: Stats and Facts
Forty percent of children with ADHD also develop ODD. Before puberty, ODD is more common in boys; after puberty, it is equally common in both genders. About half of all preschoolers diagnosed with ODD outgrow the problem by age eight. Older kids with ODD are less likely to outgrow it. Oppositional defiant disorder may persist into adulthood.
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ODD and ADHD: The Links
A child’s oppositional behaviors aren’t intentional. Experts think that ODD is linked to intense impulsivity. Not being able to control impulses, combined with the stress and frustration of trying to get on top of ADHD symptoms every day, lead some children to lash out, physically and verbally.
Every child will act out and test his boundaries. It may be hard to know whether a child is normally defiant or has ODD. Consult a therapist trained in childhood behavioral problems. He should also screen for anxiety and mood disorders — each of which may cause oppositional behavior. Left untreated, ODD can evolve into conduct disorder, a more serious behavioral problem.
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Steps to Treating ODD
Treatment strategies for co-existing ODD and ADHD start with controlling ADHD symptoms. When a child’s hyperactivity, impulsiveness, and inattention are reduced, there is usually an improvement in ODD symptoms. Stimulant medications have been shown to decrease ADHD symptoms, as well as those of ODD, by up to 50 percent.
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If a child with ODD doesn’t respond well to stimulants, some doctors prescribe the non-stimulant atomoxetine (brand name: Strattera). In one study, researchers found that the medication significantly reduced ODD and ADHD symptoms. However, higher doses of the medication were needed to control symptoms.
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Change a Child’s Behavior — by Changing Yours
The treatment of choice for ODD is parent-management training. Parents are taught to change their reactions to a child’s behavior — good and bad. Training involves using carrots and sticks — giving well-defined rewards and praise when your child cooperates, and consequences for misbehavior. Therapists will also work with a parent and child together to solve specific challenges.
ODD experts find the following strategy effective for parents: Ask your child with ODD calmly to do something. If he doesn’t respond to you in two minutes, gently tell him, “I’m asking you a second time. Do you know what I’m asking you to do — and the consequences if you don’t? Please make a smart decision.” If you have to ask a third time, he suffers the pre-arranged consequence — no TV or video games for an hour. Whatever it is, the consequence should fit the misbehavior for it to matter to your child.
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Get Everyone on the Same Page
For behavior therapy to work, all of the caring adults in the child's life should use the same discipline strategies that you do. Grandparents, teachers, nannies, and other adults who spend time alone with your child with oppositional defiant disorder must understand which carrots and sticks you use and, above all, use them consistently. If one of them gives into your child’s bad behavior, it can undermine your discipline program.
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Do Not Take ODD Personally
It is difficult for a parent to remain calm when a child with ODD is verbally abusing her, but don’t overreact. Yelling or spanking may worsen a child’s oppositional behaviors. Stay calm and emotionally neutral amid your child’s defiance. Oppositional kids have radar for adult hostility. If they pick up your anger, they’re going to match it. Figure out your coping strategy ahead of time so that you can remain calm when triggered by your child's behaviors.
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Make Room for Praise
Helping parents learn to praise good behavior is one of the toughest challenges therapists face. Many parents are so focused on bad behavior that they stop reinforcing positive ones. A few tips for children with ODD: Specify the praiseworthy behavior, be enthusiastic while not overdoing it, and finish up with a non-verbal gesture — a kiss on the cheek or a hug.
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Be Creative and Be Consistent
The more creatively you tailor your program of rewards and punishments to your child’s specific abilities and needs, the better. Her needs change as she grows. Creativity is important, but consistency is vital to success. Consistency in the way you treat your child — setting rules, conveying expectations — is the key to cleaning up your child’s ADD/ODD act.