Running head: OPPOSITIONAL DEFIANT DISORDER

Oppositional Defiant Disorder

Sarah Mahan, Audrey Cammack
Tarleton State University

OPPOSITONAL DEFIANT DISORDER

Abstract
Oppositional Defiant Disorder (ODD) is a childhood disorder primarily characterized by
defiant, disobedient, negative, and even hostile behaviors toward adults and authority
figures. In order for a child to be diagnosed with ODD, these certain behaviors must
occur for at least 6 months. It often appears in the preschool years, but it is difficult to
distinguish from troublesome behavior. Children with ODD have high rates of coexisting
conditions such as attention-deficit/hyperactivity disorder and mood disorders. These
children are at great risk of developing conduct disorder and antisocial personality
disorder during adulthood. Treatment of ODD involves therapy, training to help build
positive family interactions to manage behaviors, and possibly medications to treat
mental health conditions.

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Oppositional Defiant Disorder

Oppositional Defiant Disorder is characterized by the frequent occurrence of at
least four of the following behaviors: losing temper, arguing with adults, actively defying
or refusing to comply with the requests or rules of adults, deliberately doing things that
will annoy other people, blaming others for his or her own mistakes or misbehavior,
being touchy or easily annoyed by others, being angry and resentful, or being spiteful or
vindictive. It is an ongoing behavioral pattern that disrupts the childs daily normal daily
activities, both within the family and at school. The exact cause of this behavior is not
known, but it is believed that a combination of factors may contribute to this condition.
It has been estimated that 2%-16% of children and teens have been diagnosed
with ODD. In younger children this disorder is more common in boys, and in older
children it occurs equally in boy and girls. It typically begins by age 8, but symptoms can
occur much earlier.
Contributing Factors to ODD
First is a biological factor, in which some studies suggest that defects in the brain
or injuries to certain areas can lead t serious behavioral problems in children. The
disorder has been linking to abnormal functioning of certain types of neurotransmitters in
the brain. A neurotransmitters job is to help nerve cells in the brain communicate with
each other. In the event of these chemical not working properly, the messages being sent
may not make it through the brain correctly, which in turn leads to symptoms of ODD, or
other mental illnesses. Many children and teens with ODD also have other mental
illnesses, such as ADHD, learning disorders, depression, or an anxiety disorder. All of
these disorders may contribute to their behavior problems.

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Genetics is another major factor that contributes to the condition of ODD. Many
children and teens with it also have close family members that have been diagnosed with
other mental illnesses, including mood disorders, anxiety disorders, and personality
disorders. It has been shown if the mother is smoking during her pregnancy, the child is 2
to 3 times more likely to end up with ODD when he or she is older. The vulnerability to
develop ODD may be inherited when in this genetic situation. This also suggests that the
environment of a child may play a role in this disorder. Factors like a dysfunctional
family life, inconsistent discipline by parents, or a history of family mental illness, and/or
substance abuse may contribute to behavior disorders developing over the course of their
childhood.
Diagnosis and Clinical Course of ODD
Diagnosis has changed a little over the years, for example it first appeared in the
third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III).
OD symptoms included violations of minor rules, temper tantrums, argumentativeness,
defiance, provocativeness, and stubbornness. Two of the five symptoms were required
for diagnosis, and had to occur more frequently than in other children of the same mental
age. Onset had to be after age 3 and the symptoms had to occur for 6 months or longer
(Luby, 2009). A clarification was added noting that oppositional and defiant behaviors
are common among typically developing preschoolers and that diagnosis requires
symptoms that are more frequent or intense than usual, or symptoms that endure longer
than expected. Debate about the utility of the diagnosis ensued (Loeber, Lahey, &
Thomas, 1991; Rey, 1995), and ODD received more rigorous study during the DSM-IV
field trials (Lahey et al., 1994).

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Todays Diagnosis of ODD

As in adults, most mental illnesses in children are diagnosed based on signs and
symptoms that point to particular illnesses such as ODD. If symptoms are present, an
evaluation by a doctor will begin by performing a complete medical history and physical
examination. There are no lab tests that can specifically diagnose ODD, but the use of test
such as neuroimaging studies or blood tests can be helpful if they suspect there may be a
medical explanation for the behavior problems that occur. The doctor will also look for
certain signs and other conditions that could occur with ODD, like ADD and depression.
If a physical cause cannot be found for the symptoms, they will most likely refer
the child to a adolescent psychiatrist or psychologist. These are people that are specially
trained to diagnose and treat mental illnesses in both children and teens. In the sessions,
specially designed interviews are conducted and assessment tools are used to evaluate the
child for certain mental illnesses. The final diagnosis from the doctor is based on his or
her reports on the childs symptoms and the observation of their attitude and behavior.
Often, the doctor will rely on reports from the parents, teachers, and other adults because
children can have difficulty in explaining their problems and understanding their
symptoms.
Risk Factors and Complications
Possible risk factors of ODD include temperament, parenting issues, and other
family issues (Mayo Clinic Staff, 2015). Children who have a temperament could be
defined has having difficulty regulating emotions, like being highly emotional to
situations or they may have trouble tolerating frustration. A child who experiences abuse
and neglect at home, harsh or inconsistent behavior, and lack of parental supervision are

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at a higher risk for ODD. A child diagnosed with ODD may have trouble at home with
parents and siblings, in school with teachers and peers, and even at work with supervisors
and authority figures. Keeping friends and relationships can also be a problem they may
encounter. ODD may also lead to problems such as; poor school and worm performance,
antisocial behavior, impulse control problems, substance use disorder, and even suicide.
Like noted earlier other mental health conditions may accompany ODD like ADHD,
depression, anxiety, conduct disorder, and learning and communication disorders.
Treatment
Treatment for ODD is determined based on many different factors including the
age of the child, severity of symptoms, and the childs ability to participate in and tolerate
specific therapies. Treatment usually includes a combination of medication and
counseling. It can often last several months or longer. The use of medication alone
generally is not used for ODD unless another disorder, such as ADHD, co-exists. In the
event of this medications may help significantly improve symptoms.
Psychotherapy
One type of treatment is Psychotherapy, which is a type of counseling aimed at
helping the child develop more effective coping and problem-solving skills, as well as
ways to control and express anger. There is a therapy called cognitive-behavioral therapy
that is aimed to reshape the childs cognitions to better their behavior. Family therapy
may also be used to help improve interactions at home and build communication among
family members. Parent Management Training (PMT) is a specialized therapy technique
that teaches parents ways to positively alter their childs behavior. The use of behavior

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management plans involves developing contracts between the parent and child that
identify rewards for positive behaviors and consequences for negative behaviors.

ODD in the Public School System

The disturbance in behavior causes clinically significant impairment in social,
academic, or occupational functioning. ODD can be a significant problem for a child in
the public school system because if they are constantly wanting to defy authority and
have a mental illness that makes it harder for them to behave. This oppositional and
noncompliant behavior may be best understood as the result of incompatibility between
the child and the environment. Prevention in these oppositional behaviors is the key to
having a healthy classroom, and this can be done in numerous ways. Creating a
psychologically supportive classroom is the most important aspect of preventing which
includes; having caring relationships with adults, outlining clear expectations, creating
opportunities for meaningful participation in learning, and emphasizing positive
interactions with peers.
Strategies of Prevention
Creating positive behavior in the classroom can help support to the child
diagnosed with ODD. Alter the physical environment by changing the room arrangement,
location of materials, and observe behaviors linked to environmental triggers like noise,
distractions, or preferential seating. Maintain predictability by having a schedule known
to all by utilizing tools such as planners/agendas and daily classroom posters. Prepare
students for unplanned changes, and make transitions as smooth as possible with the use
of visual, auditory, or tactile cues. Increasing choices for students can help make the

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students think it was their idea in the first place. This can decrease opposition because the
student does not see the authority telling them directly what to do.
Setting goals in working with students diagnosed with ODD is a good step to take
to keep both the student and instructor in check. These goals might include, avoiding
power struggles, understanding the purpose of challenging behaviors and the
developmental level of students, increasing positive interactions between students and
adults, and having students meet the expectations of adults. Think of defiance as an
opportunity to teach students something new (Kohn, 1996).
Conclusion
Overall, ODD is noted as frequent and persistent patterns of irritable or angry
moods, arguing with authority figures, and outright defiant behavior. The course it takes
can start early in preschool years and can lead to the development of other disorders and
usually accompanies things such as ADD, anxiety, or depression. Though this disorder
can cause frequent conflict with parents, teachers, and peers, it can be managed through
the use of medications and therapies. There are many strategies noted in this paper that
can help both a parent and teacher when having a child with ODD. Though the risks and
complications are numerous, treatment and prevention can compromise these difficulties
and help the overall well being of the diagnosed student.

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Grohol, John M., Psy.D., (2013). Oppositional Defiant Disorder Treatment. Retrieved
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Hamilton SS, Armando J, (2008). Oppositional Defiant Disorder [Abstract]. Europe
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Kohn, Alfie, (1996). Beyond Discipline. Retrieved from http://www.alfiekohn
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Luby, Joan L., (2009). Handbook of Preschool Mental Health: Development, Disorders,
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Mayo Clinic Staff, (2015). Oppositional Defiant Disorder (ODD). Retrieved from
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