How is oppositional defiant disorder diagnosed?
Parents, teachers, and other authority figures in child and adolescent settings often identify the child or adolescent with ODD. However, a child psychiatrist or a qualified mental health professional usually diagnoses ODD in children and adolescents. A detailed history of the child’s behavior from parents and teachers, clinical observations of the child’s behavior, and, sometimes, psychological testing contribute to the diagnosis. Parents who note symptoms of ODD in their child or teen can help by seeking an evaluation and treatment early. Early treatment can often prevent future problems.

Further, oppositional defiant disorder often coexists with other mental health disorders, including mood disorders, anxiety disorders, conduct disorder, and attention-deficit/hyperactivity disorder, increasing the need for early diagnosis and treatment. Consult your child’s physician for more information.

Treatment for oppositional defiant disorder:
Specific treatment for children with oppositional defiant disorder will be determined by your child’s physician based on:

  * your child’s age, overall health, and medical history
  * extent of your child’s symptoms
  * your child’s tolerance for specific medications, procedures, or therapies
  * expectations for the course of the condition
  * your opinion or preference

Treatment may include:

  * individual psychotherapy
    Individual psychotherapy for ODD often uses cognitive-behavioral approaches to improve problem solving skills, communication skills, impulse control, and anger management skills.
  * family therapy
    Family therapy is often focused on making changes within the family system, such as improving communication skills and family interactions. Parenting children with ODD can be very difficult and trying for parents. Parents need support and understanding as well as developing more effective parenting approaches.
  * peer group therapy
    Peer group therapy is often focused on developing social skills and interpersonal skills.
  * medication
    While not considered effective in treating ODD, medication may be used if other symptoms or disorders are present and responsive to medication.

Prevention of oppositional defiant disorder in childhood:
Some experts believe that a developmental sequence of experiences occurs in the development of oppositional defiant disorder. This sequence may start with ineffective parenting practices, followed by difficulty with other authority figures and poor peer interactions. As these experiences compound and continue, oppositional and defiant behaviors develop into a pattern of behavior. Early detection and intervention into negative family and social experiences may be helpful in disrupting the sequence of experiences leading to more oppositional and defiant behaviors. Early detection and intervention with more effective communication skills, parenting skills, conflict resolution skills, and anger management skills can disrupt the pattern of negative behaviors and decrease the interference of oppositional and defiant behaviors in interpersonal relationships with adults and peers, and school and social adjustment. The goal of early intervention is to enhance the child’s normal growth and developmental process, and improve the quality of life experienced by children or adolescents with oppositional defiant disorder.

Once you have successfully avoided having your buttons pushed and gained some control over your child’s behavior, it is time to go on the offensive to soothe her, and help her get back to an even place.  Oppositional kids do not like being soothed by their caretakers.  This places them back into the role of being a child, and puts you back into the role as the parent.  One of the driving forces behind ODD is that, for whatever reasons, a child is trying to grow up too quickly, and considers herself to be equal to her parents. The ODD child may feel less loved due to the amount of conflict going on, and it is difficult to simultaneously feel loved as a child and try to operate on an adult level.  Your child may know intellectually that she is loved, but not feel loved.  Parents must be able to show love, and soothe and nurture their child. This is not always easy to accomplish, especially when previous negative behavior patterns have become ingrained.

Children look to their parents for a sense of security, belonging and identity.  As our society becomes more complex, the need for our children to develop a clear set of values is critical.  Current research also has indicated that boys with ADHD and increased oppositional behavior are at greater risk for later antisocial behavior.  With this in mind, the need for structure becomes particularly relevant in today’s world.  It is apparent that children affected by a variety of neuropsychiatric disorders are at greater risk for oppositional behavior.  Since this behavior will create additional difficulties for them as they pass through the various developmental stages, it becomes even more important to use the authority vested in us as parents to establish consistent limits and consequences, and to distinguish boundaries within the family.  This will form a family unit characterized by established guidelines, affording children a secure backdrop in which they can grow and thrive.

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Source: Children’s Hospital Boston

References

Steiner H, Remsing L, Work Group on Quality Issues. Practice parameter for the assessment and treatment of children and adolescents with oppositional defiant disorder. J Am Acad Child Adolesc Psychiatry. 2007;46:126-141.

Levy, Ray and O’Hanlon, Bill, Goode, Tyler Norris.  (2000).  Try and make me! Simple Strategies That Turn Off Tantrums and Create Cooperation, Rodale Press

Sells, Scott.  (1998).  Treating the Tough Adolescent, A Family-Based, Step-By-Step Guide, Guilford Press, New York, NY.

Pliszka, Steven and Carlson, Caryn and Swanson, James.  (1999).  ADHD With Comorbid Disorders, Clinical Assessment and Management, Guilford Press, New York, NY