- Parenting Tips for ODD — Oppositional Defiant Disorder
- Page 3
- Typical School Day in the Life of an ODD Child’s Parent
- Who Would Have Thought?!
- Is that YOUR Kid?! The One Who’s Always In the Principal’s Office?
- Opportunity and Responsibility
- Oppositional Defiant Disorder | Diagnosis & Treatments
- How is oppositional defiant disorder treated at Boston Children's?
- Parenting guidance and modification
- Social-emotional skills training
- Psychiatric medication
- Coping and support
- Oppositional defiant disorder (ODD): children 5-12 years
- Diagnosing oppositional defiant disorder (ODD)
- Behaviour management plans for oppositional defiant disorder (ODD)
- Working on oppositional defiant disorder (ODD) at home
- Working with your child’s school on oppositional defiant disorder (ODD)
- Looking after yourself when your child has oppositional defiant disorder (ODD)
- Risk factors for oppositional defiant disorder (ODD)
Parenting Tips for ODD — Oppositional Defiant Disorder
Parents are often left wondering if their child’s argumentative, limit-testing, back-talking, rule-breaking behavior is “typical” teen or pre-teen defiance—or if it’s something else.
What is Oppositional Defiant Disorder (ODD)? Clinically speaking, Oppositional Defiant Disorder (ODD) is “a pattern of angry/irritable mood, argumentative/defiant behavior or vindictiveness lasting at least six months.
” But what does that mean, exactly? Limit-testing behavior crosses… Read more »
This week, read about an oppositional, defiant teen in James Lehman's compelling book, Transform Your Problem Child. Meet the parents and family of Caleb, who have been dealing with their son's behavior since he was a young child, and «raising their tolerance for deviance» with each instance of acting out. When Caleb gets physically abusive,… Read more »
The start of every school year brings all sorts of images to mind: shopping for clothes and school supplies, getting back into a routine of dinner and bedtimes that may have become relaxed during summer, and relief from arguing siblings who have been stuck together 24/7 for the past three months. Many parents are relieved when school starts up again, but for parents of Oppositional Defiant (ODD) kids, this is often a time of anxiety and even dread.
Typical School Day in the Life of an ODD Child’s Parent
As the mother of an ODD child, Kim Abraham remembers a “typical school day” in her family’s life:
As long as you’re doing your job, it’s your child’s responsibility (and ultimate choice) on whether or not to take you up on those opportunities—and to deal with the natural consequences and find a new path if he doesn’t.
We’d start the day fighting to get our son up. Even when he was only seven, he’d make himself a dead weight in the bed. Once we got him up, the next challenge was getting him dressed. He literally struggled, argued and fought against every effort we made to get him ready.
Long after the school bus passed, he was still in his pajamas, kicking and yelling. In the end, we had to pretty much drag him into the car and my husband would dress him as I drove. If there hadn’t been two of us, he never would have gotten into the car.
We’d squeal into the parking lot as the warning bell was ringing and hand him off to the school staff, peeling out before he could scramble back into the car. Then my husband and I would try to pull ourselves together as we faced work and the calls we’d be getting later in the day about our son’s poor behavior.
Mornings with our other child were completely different: there was breakfast, getting the backpack together, brushing teeth. There was a routine.
Was school particularly more traumatic for my ODD child than any other kid? No. He went to the same school as my other child – a school that was free from gangs or serious violence. He was a bright child — gifted in fact — so the work itself wasn’t a struggle. If anything, he was bored.
So why did he refuse to go? He just didn’t want to. That’s it. There were other things he’d rather be doing than sitting in class and because he was ODD, he didn’t have the personality that cared about the expectations of his parents, the school or society. He didn’t care that the law said he must attend.
He didn’t care about consequences for us — or himself.
Who Would Have Thought?!
If you would have asked Kim when her son was born what she expected his school experience to be , this was not the picture she would have described. Parents of ODD kids are usually in for a rude awakening when their child begins attending school.
Transitions are typically difficult, especially between summer break and the new fall year. There’s usually conflict with peers, teachers, the principal and anyone who tries to enforce rules with an ODD child. ODD children fight against rules and being controlled – it’s just their nature.
The school setting is not a place where a child who fights authority will be welcomed. One parent we met remembers getting a phone call from cafeteria staff – her daughter had made a mess and was refusing to throw away her napkins. “What do you want me to do,” thought the mom.
“Come up there and force her to throw the napkins away?!”
The adults in an ODD child’s life have expectations for that child’s behavior and performance. We expect our children to attend school, be on time, respect the rights of others, follow the rules, do their classwork and homework.
The problem is, the expectations of society and parents aren’t usually a priority for ODD kids – their own wants and needs are. Adults continue to hold onto those expectations long after it’s evident a child is refusing to comply.
The result for many parents of ODD kids? Daily power struggles.
Is that YOUR Kid?! The One Who’s Always In the Principal’s Office?
Many parents we’ve known have shared experiences working with their child’s school that have left them feeling ashamed, humiliated, frustrated and at times downright furious. It’s a powerful system to encounter and when your child is the one who insists on doing things his or her way, it can turn into an “us vs. them” situation.
If your child’s school is open to working with you as a team, that’s wonderful. Many teachers and administrators understand that parenting an ODD child is extremely difficult and offer support when it comes to that child’s education. But often the stress parents and educators feel when dealing with a challenging child comes together in the perfect storm.
Everyone starts looking to each other on how to control that child and whose fault his behavior is. Somehow – even though you’re miles away—your daughter’s refusal to participate in an activity or your son’s refusal to do his classwork becomes a reflection on you.
The focus can get way, way off track and instead of holding the child accountable, it turns into a blame game.
If you’re dreading “back to school” time, here are a few tips to keep in mind about your child’s education:
- Communication is Key. Communicating with school staff can often feel an intimidating task. But remember that your child’s teacher and school administrators are often just as frustrated and unsure how to handle his behavior as you are. Try to remember that you’re all working toward the same goal: for your child to become an educated, productive member of society. Keep a notecard handy that reminds you of this goal and pull it out anytime you have phone or in–person contact with the school.
- Keep Your Child Responsible. As adults, we can do everything in our power to offer educational opportunities to our children. Transportation, supplies books and pencils, support in understanding the classwork, clearly communicating rules and expectations are all things we can control as adults. However, in the end, it’s up to your child to take advantage of those opportunities. Short of putting the textbook on his head and hoping the information just seeps into his brain, there’s no way to force a child to learn material when he is refusing. If he does refuse to complete the work he’ll still learn – he’ll just be learning that there are natural consequences to his choices.
- Make Your Child an Educational Partner. Remember: this is your child’s education, not yours. You’ve already gone through school. Perhaps you graduated, perhaps you didn’t. Perhaps yours was a good experience, perhaps it wasn’t. Particularly as she gets older, your child should be an active partner in her educational experience. What does she want? Are there alternative education opportunities that might better meet her needs and still meets society’s legal expectations? Be open to your child’s ideas on what needs to happen for a successful education.
- Try Not to Predict the Future. Most of us get frightened – even terrified – when our kids begin to struggle in school. If my child is struggling in the 2nd or 4th or 6th grade, what will happen down the road? The worst case scenario: he may not graduate. That thought strikes fear and disappointment into the hearts of many parents. But what’s the worst case scenario here? Many people succeed in life even though they decide to take an alternate route. Jobs in the trade and service industries are no less valuable than those that require college or even high school diplomas. Many, many successful people chose not to take their parents and the school system up on the opportunity for a formal education: Ansel Adams (famous photographer), Bryan Adams (singer/songwriter), Nora Roberts (bestselling author), Carl Lindner (self-made American businessman and billionaire), Kevin Bacon and Johnny Depp (actors), Sonny Bono (singer and politician) are some names that come to mind. And remember: just because a child doesn’t take advantage of formal education now doesn’t mean she won’t return to it later in the form of a GED, night school or a college placement test. Having said this, there’s no way to predict that your child won’t successfully graduate, despite struggles in school. But fear can lead us to react, as parents, in a way that contributes to our child’s negative school experience.
Opportunity and Responsibility
In today’s world, parents and educators sometimes put more effort into a child’s education than into the child himself. Education is about more than “book learning.” It should be the time when our children begin to learn about the real world and how they will navigate through that world successfully.
It’s our job as parents, educators and as members of society to offer every child the opportunity to have a formal education. It’s our job to provide a safe environment and ensure that our children have the tools to support them in their learning. If a child is struggling, we need to look at what may be going on.
(Is there a learning disability, is he being bullied, is there something interfering with his ability to do well in school?) As long as you’re doing your job, it’s your child’s responsibility (and ultimate choice) on whether or not to take you up on those opportunities—and to deal with the natural consequences and find a new path if he doesn’t.
Parenting ODD Children and Teens: How to Make Consequences Work
We Got a Diagnosis for Our Child—Now What? ADHD, ODD, LDs and More—What a Diagnosis Means for Your Child
Oppositional Defiant Disorder | Diagnosis & Treatments
At Boston Children’s Hospital, a mental health clinician (typically a child and adolescent psychiatrist, child psychologist or psychiatric social worker) will make the diagnosis following a comprehensive psychiatric assessment with you and your child. During the assessment, you will be asked to talk about your child’s behavioral problems and to give an overview of your child’s family history, medical history, school life and social interactions.
Your child’s mental health clinician will help explain the disorder and answer any questions you or your child may have. The next step is developing a mutually agreed-upon treatment plan that works for you, your child and your family.
How is oppositional defiant disorder treated at Boston Children's?
ODD is typically treated with one or a combination of the following methods:
Parenting guidance and modification
Your involvement as a parent is crucial to the treatment of your child's oppositional defiant disorder.
Here at Boston Children's, we've learned that the best approach to ODD is helping parents learn and use effective parenting strategies; anticipate and prepare for problematic behavior; manage and respond to outbursts and tantrums; and implement structure and consistency in the child's life and daily routine.
Parenting modification strategies taught at Boston Children's focus on:
- developing a warm, loving relationship between parent and child
- providing a predictable, structured household environment
- setting clear and simple household rules
- consistently praising and rewarding positive behaviors (such as getting ready for school and bed on time)
- consistently ignoring annoying behaviors (such as whining or badgering), followed by praise when the annoying behavior ceases
- consistently delivering consequences (such as “time-outs” or loss of privileges) for dangerous or destructive behaviors (such as physical aggression or destroying possessions)
Social-emotional skills training
Strengthening the impact of the parenting modification techniques you are learning, therapy for ODD will also focus on providing social-emotional skills training for your child. Through the course of therapy sessions with the clinician, your child will learn:
- new skills for identifying and managing feelings
- how to get along better with others
- strategies for making good decisions that are thinking rather than feeling
In addition to therapy, your clinician may recommend medication to treat your child's oppositional defiant disorder. There currently are no drugs prescribed specifically for ODD, but certain symptoms of the disorder, when found in conjunction with another disorder, can respond very well to medication in conjunction with psychotherapy (which is also referred to as «talk therapy»).
Drugs that may be prescribed to treat ODD symptoms include:
Stimulants for ADHD
- methylphenidate (Ritalin)
- dextroamphetamine (Dexedrine)
Antidepressants for depression or anxiety
- escitalopram (Lexapro)
- fluoxetine (Prozac)
Other medications that may help decrease disruptive behaviors
- guanfacine (Tenex)
- clonidine (Catapres)
- risperidone (Risperdal)
- aripiprazole (Abilify)
Boston Children's Department of Psychiatry and Behavioral Sciences has a specialized Psychopharmacology Clinic to help determine whether psychiatric medication might be a useful addition to a child's treatment plan, but we never prescribe medication as a standalone treatment. Medication, when prescribed, is always part of a two-step approach in conjunction with talk therapy.
Learn more about psychiatric medications for children and adolescents.
Coping and support
In addition to the condition-specific information provided here, Boston Children's offers the following resources for support:
- Boston Children's Hale Family Center for Families is dedicated to helping families locate the information and resources they need to better understand their child's particular condition and take part in their care. All patients, families and health professionals are welcome to use the center's services at no extra cost. The Center for Families is open Monday through Friday from 8 a.m. to 7 p.m., and on Saturdays from 9 a.m. to 1 p.m. Please call 617-355-6279 for more information.
- The Boston Children's Department of Spiritual Care (chaplaincy) is a source of spiritual support for parents and family members. Our program includes nearly a dozen clergy members — representing Episcopal, Jewish, Lutheran, Muslim, Roman Catholic, Unitarian, and United Church of Christ traditions — who will listen to you, pray with you and help you observe your own faith practices during your child's treatment.
- The Experience Journal was designed by Boston Children's psychiatrist-in-chief, David DeMaso, MD, and members of his team. This online collection features reflections from kids, families and health professionals about dealing with physical illnesses asthma and diabetes, as well as mental health conditions ADHD and depression.
- The Advocating Success for Kids (ASK) Program at Boston Children's provides multidisciplinary evaluation, referral and advocacy services for children under 14 who are experiencing behavioral, emotional, learning or developmental problems, either at home or at school. ASK works with children who receive their primary care either at Boston's Bowdoin Street Community Health Center, Martha Eliot Health Center, Joseph M. Smith Community Health Center, or at Boston Children's Primary Care Center. For more information about ASK, please call 617-355-4690.
Oppositional defiant disorder (ODD): children 5-12 years
Oppositional defiant disorder (ODD) is a childhood behaviour problem.
Children with ODD:
- won’t do what people ask
- think that what they’re being asked to do is unreasonable
- get angry and aggressive about being asked to do things.
All children are disobedient and cranky sometimes, especially if they’re tired, upset or frustrated. But a child with ODD behaves this a lot, and the behaviour is so severe that the child has trouble doing ordinary, everyday things.
Diagnosing oppositional defiant disorder (ODD)
To be diagnosed with oppositional defiant disorder (ODD), a child must have constant angry and cranky moods, along with negative, defiant behaviour that upsets other people. A child must also have at least four symptoms from the following list.
- loses their temper
- argues with adults
- actively refuses to do what adults ask and disobeys rules
- often deliberately annoys people
- often blames others for mistakes or challenging behaviour
- is easily annoyed by others
- is often nasty or unkind.
A child with ODD shows the symptoms:
- very often
- in a way that interferes with daily activities
- for at least six months.
If you think your child might have ODD, start by talking with your GP about a referral to a paediatrician, psychiatrist or psychologist. These health professionals can diagnose oppositional defiant disorder (ODD) and help your child develop the social, emotional, behavioural and thinking skills they need to thrive.
Your GP will probably talk with you about a mental health treatment plan for your child. If you have a plan, you can get Medicare rebates for up to 20 sessions with a psychologist. If your child is referred to a paediatrician or psychiatrist, you can get Medicare rebates for these appointments.
Behaviour management plans for oppositional defiant disorder (ODD)
Managing oppositional defiant disorder (ODD) in children is about first accepting that your child will behave in challenging ways.
The next step is working with health professionals to develop a behaviour management plan, which can make the behaviour easier to handle – for you and your child.
A good plan will help your child:
- learn how to improve their behaviour and understand how it affects other people
- manage strong emotions anger and anxiety
- improve the way they solve problems, communicate and get on with other children.
These things will help your child make and keep friends, say what they think without getting angry, accept no for an answer, and play well with others.
A good behaviour management plan will also help you cope with your child’s challenging behaviour by helping you:
- understand the causes of your child’s behaviour
- work out how you can increase your child’s positive behaviour and manage their challenging behaviour
- support your child in managing strong emotions and improving social skills
- work on strengthening your family relationships.
Children with ODD need professional diagnosis and treatment early on. This will help your child develop skills to make and keep friends, get and keep a job, and build a support network later in life.
Working on oppositional defiant disorder (ODD) at home
Here are some strategies for working on your child’s ODD behaviour at home:
- Use specific praise to encourage positive behaviour – for example, ‘It was really helpful when you put your plate on the bench’.
- Look at using a structured reward system a reward chart. These work especially well for children aged 3-8 years.
- Give short, direct and specific instructions – for example, ‘Please put the dishes in the sink’.
- Give choices about when your child can do tasks, not whether your child will do them – for example, ‘Would you to do your homework now, or after the next TV show?’
- Follow up on negative behaviour straight away. For example, if your child doesn’t do what you ask, ask again and say, ‘This is the last time I am going to tell you’. If your child still doesn’t cooperate, be ready with a consequence loss of privilege.
- Use consequences in the same way and for the same behaviour every time. This means your child knows what to expect. For example, you might always use a time-out for hitting.
- Acknowledge your child’s strong emotions and let them know you’re there to listen and help. For example, ‘I understanding you’re feeling angry. Do you want to talk about it?’
It’s a good idea to ask your child’s psychologist for more specific strategies that you can use at home to support your child’s therapy.
Your child needs to know that they’re important to you. One of the best ways you can send this message is by spending positive time together doing things your child enjoys. This will help to strengthen your relationship with your child.
Working with your child’s school on oppositional defiant disorder (ODD)
It can help to talk to staff at your child’s school about your child’s treatment plan and any other recommendations from your child’s psychologist, psychiatrist or paediatrician. Your child’s school might be able to help with things :
- classroom behaviour management programs – for example, seating your child at the front of the classroom away from distractions
- structured classroom activities – for example, having a daily planner on the wall that lets children know what’s happening and when
- alternative thinking strategies – for example, allowing children to offer their own ideas about ways to solve problems
- emotional regulation programs that teach children how to manage strong emotions anger and frustration
- resilience, wellbeing and bullying intervention programs
- rewards for good behaviour, so that your child doesn’t feel that they’re always being punished for unacceptable behaviour.
Your child will get the most benefit from therapy when you, your child’s mental health professionals and your child’s teachers work together.
Looking after yourself when your child has oppositional defiant disorder (ODD)
Looking after yourself gives you the energy you need to help your child with oppositional defiant disorder (ODD) grow and thrive.
Here are some tips on how you can care for yourself when you have a child with ODD:
- Make some time every day to be on your own to read a book, watch a TV show, go for a walk, or do something you enjoy. Start with five minutes at the end of the day if that’s all you have.
- Ask family, friends or members of your support network to look after your child for a little while so you can have some time to yourself.
- Make time for some physical activity – for example, walking, yoga or swimming. A bit of exercise can give you more energy to work with your child.
- Make some time to do fun activities with your partner, if you have one. Your child’s difficult behaviour can be stressful for your relationship, especially if you and your partner don’t agree about how to handle your child’s behaviour.
- Seek professional help from a GP or counsellor if you feel you can’t cope.
Sharing support, advice and experiences with other parents can be a big help. You could try starting a conversation in an online forum or joining a parent support group.
Risk factors for oppositional defiant disorder (ODD)
It’s hard to say why children develop oppositional defiant disorder (ODD). But it might be a combination of genes and environmental factors. For example, there are some risk factors that are linked to ODD, your child’s temperament and stress in your child’s life that affects their relationship with family or community.
Children with ODD often have other difficulties learning disabilities, attention deficit hyperactivity disorder, anxiety disorders, mood disorders or language impairment.