Understanding Oppositional-Defiant Disorder
Updated: Jun 29, 2020
What is it?
In my private practice as a child and family psychologist, I help many, many families with children who have Oppositional-Defiant Disorder (ODD). When asked to explain ODD, I initially think to myself that the title itself is quite descriptive. These children take a contrary, oppositional view to everything and will be openly defiant when asked or told to do something they don’t like. But then again, don’t all children misbehave sometimes? Isn’t defiance just one way children gain independence from their parents? Is ODD really a problem in the child or a problem with the way the parents, well, parent? Obviously, there is more to ODD than meets the eye.
Take for example the following children:
Thomas has for years shown worsening problems at school and home. His parents are literally afraid to give him chores for fear of his routine explosions that can include yelling and cussing, throwing things, crying, and running from the house. In fact, they find it is just easier to pick up things for him rather than risk setting him off. At school, Thomas refuses to do any written work. He pouts, falls out of his chair, and has started to tell the teacher that he hates her.
Andrew seems to always wear a scowl, his mother says. She believes he must be deeply unhappy, but the only feeling he will express is anger. He lashes out whenever he is even mildly criticized. Even things that should be fun can be intensely frustrating to Andrew. He may be enjoying video games one minute and then suddenly erupt in frustration when he suffers failure. He has on several occasions thrown the console across the room.
Monica goes around the playground with a chip on her shoulder. Other kids know they can get a rise out of her easily so she is often the target of teasing. Nevertheless, she insists on being the boss in any game she joins and will not put up with children who question her rules. She either ejects them from the game or she quits herself, stomping off in a huff. Monica holds grudges for a long time and her parents have overheard her using very crude language to describe children who have crossed her.
Let’s examine what makes these three children with ODD different from other children. First of all, the Diagnostic and Statistical Manual, the resource book which describes all psychiatric conditions, specifies that a child must meet at least five (many argue six would be more appropriate) of the following behavioral criteria to qualify for a diagnosis of ODD:
A pattern of negativistic, hostile, and defiant behavior lasting at least six 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 and vindictive
The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.
From the outset we see that ODD children may differ from other children in terms of how long and how often they show this defiant and intentionally irritating behavior. ODD children have behaved this way for at least the last six months, whereas other children may have only recently developed the problem behaviors. Children who have only recently defied authority, broken down into temper tantrums, or annoyed others may be going through a normal developmental phase (e.g., the so-called terrible two’s) or may be reacting to other stressors (e.g., poor peer relationships, academic problems, family conflict).
Also, the diagnostic criteria specifies that the behaviors occur often, which of course begs the question, how often is often? Some researchers have suggested that behaviors such being spiteful or vindictive may be considered to be often occurring even they occur only once every few months, whereas most others are considered to be occurring often only if they occur at least 2-4 times each week. Moreover, the criteria from the DSM gives us one more clue about how often is often by noting that the problem behavior must cause truly serious problems in friendships, school functioning, or home life for the diagnosis of ODD to be considered.
Ross Greene, Ph.D., author of The Explosive Child, has argued that these criteria fall short in two ways. First, they do not explain the underlying process behind the oppositional, defiant behavior. In other words, the criteria say nothing about why the behavior occurs in some children. Second, the DSM criteria imply that oppositional, defiant behavior is intentional in ODD children. While it often appears this way to many parents, teachers and even therapists, Dr. Greene offers a new understanding of children with ODD especially those who are inflexible and explosive.
They show an extreme lack of flexibility and give-and-take in relationships and
they fall apart in the face of frustration. These ODD children cannot handle transitions because they cannot shift gears as easily as most people do.
They are impulsive and tend to react in defiant ways even when they have suffered negative consequences for their actions many times.
They have an extremely low boiling point. Their lightening-fast blowups may
occur over seemingly trivial events. They also have a low tolerance for frustration. ODD children escalate more quickly up to intense rages and are quick to react with aggression.
They think in rigid, black-and-white ways about most events. They are very
focused on justice and fairness. They are stubborn and cannot get injustices or their own wants off their minds.
They are extremely persistent and will continue to provoke or attack others even
when it is clear that the negative behavior is not working and consequences would be much more positive for changing the defiant behavior.
Defiance can come out-of-the-blue. They may be in a good mood one minute,
then having a temper tantrum the next.
Many ODD children have specific issues that lead to conflict. For example, they
may rebel over the texture of clothing, the taste or smell of food, or the sequence in which things must be done. Their inflexibility may be worsened by other associated problems such as moodiness, hyperactivity, impulsivity, anxiety, or social skill deficits. Even though many children are cranky when they are hungry or tired, ODD children may completely melt down under these conditions.
As you can imagine, regardless of which set of descriptive characteristics you use, children with ODD and their families go through very rocky times. Many researchers suggest that ODD and other aggressive disorders may be one of the most stable patterns of behavior. That is, children who are oppositional and defiant early in their childhood are very likely to show the same behavior in later years. Some children even develop worse problems and may be diagnosed in adolescence with a Conduct Disorder. In addition, many children with ODD go on to have serious problems with friendships, intense family conflict, academic failure, and depression.