8/3/2019 Oppositional Defiant Disorder (ODD) in Children
1/26
Oppositional Defiant DisorderOppositional Defiant Disorder((ODD) inODD) in Children andChildren andAdolescents: Diagnosis andAdolescents: Diagnosis and
TreatmentTreatment
by Jim Chandler, MD, FRCPC
8/3/2019 Oppositional Defiant Disorder (ODD) in Children
2/26
W hat is it?W hat is it?y ODD is a psychiatric disorder that is
characterized by two different sets of problems. These are aggressiveness and a
tendency to purposefully bother andirritate others. It is often the reason thatpeople seek treatment. W hen ODD ispresent with ADHD, depression, anxietydisorders, or other neuropsychiatricdisorders, it makes life with that child farmore difficult.
8/3/2019 Oppositional Defiant Disorder (ODD) in Children
3/26
The criteria for ODD are:The criteria for ODD are:A pattern of negativistic, hostile, and defiant
behavior lasting at least six monthsduring which four or more of thefollowing are present:
y 1 . Often loses tempery 2. often argues with adultsy 3. often actively defies or refuses to
comply with adults' requests or rulesy 4. often deliberately annoys people
8/3/2019 Oppositional Defiant Disorder (ODD) in Children
4/26
The criteria for ODD are:The criteria for ODD are:A pattern of negativistic, hostile, and defiant
behavior lasting at least six monthsduring which four or more of the
following are present:y 5 . often blames others for his or her
mistakes or misbehaviory 6. is often touchy or easily annoyed by
othersy 7. is often angry and resentfuly 8. is often spiteful and vindictive
8/3/2019 Oppositional Defiant Disorder (ODD) in Children
5/26
How often is "often"?How often is "often"?
Has occurred at all during the last threemonths -
y 8. is spiteful and vindictivey 5 . blames others for his or her mistakes
or misbehavior
8/3/2019 Oppositional Defiant Disorder (ODD) in Children
6/26
How often is "often"?How often is "often"?
Occurs at least twice a week y
6. is touchy or easily annoyed by othersy 1 . loses tempery 2. argues with adultsy
3. actively defies or refuses to complywith adults' requests or rules
8/3/2019 Oppositional Defiant Disorder (ODD) in Children
7/26
How often is "often"?How often is "often"?
Occurs at least four times per week y
7. is angry and resentfuly 4. deliberately annoys people
8/3/2019 Oppositional Defiant Disorder (ODD) in Children
8/26
W hat causes it?W hat causes it?y No one knows for certain. The usual pattern
is for problems to begin between ages 1 -3. If you think about it, a lot of these behaviors
are normal at age 2, but in this disorder theynever go away. It does run in families. If aparent is alcoholic and has been in troublewith the law, their children are almost threetimes as likely to have ODD. That is, 1 8% of children will have ODD if the parents arealcoholic and the father has been in troublewith the law.
8/3/2019 Oppositional Defiant Disorder (ODD) in Children
9/26
W ho gets it?W ho gets it?
y A lot of children! This is the mostcommon psychiatric problem in children.Over 5 % of children have this. In youngerchildren it is more common in boys thangirls, but as they grow older, the rate is
the same in males and females.
8/3/2019 Oppositional Defiant Disorder (ODD) in Children
10/26
8/3/2019 Oppositional Defiant Disorder (ODD) in Children
11/26
W hat happens to children who haveW hat happens to children who have
this when they grow up?this when they grow up?y Second, ODD may turn into something else.
About 5 -10 % of preschoolers with ODDwill eventually end up with ADHD and nosigns of ODD at all. Other times ODD turnsinto conduct disorder (CD). This usuallyhappens fairly early. That is, after a 3-4 years
of ODD, if it hasn't turned into CD, it won'tever. W hat predicts a child with ODDgetting CD? A history of a biologic parentwho was a career criminal, and very severe
ODD.
8/3/2019 Oppositional Defiant Disorder (ODD) in Children
12/26
W hat happens to children who haveW hat happens to children who have
this when they grow up?this when they grow up?y Second, ODD may turn into something else.
About 5 -10 % of preschoolers with ODDwill eventually end up with ADHD and nosigns of ODD at all. Other times ODD turnsinto conduct disorder (CD). This usuallyhappens fairly early. That is, after a 3-4 years
of ODD, if it hasn't turned into CD, it won'tever. W hat predicts a child with ODDgetting CD? A history of a biologic parentwho was a career criminal, and very severe
ODD.
8/3/2019 Oppositional Defiant Disorder (ODD) in Children
13/26
W hat happens to children who haveW hat happens to children who have
this when they grow up?this when they grow up?y Third, the child may continue to have
ODD without any thing else. However, bythe time preschoolers with ODD are 8years old, only 5 % have ODD and nothingelse.
8/3/2019 Oppositional Defiant Disorder (ODD) in Children
14/26
W hat happens to children who haveW hat happens to children who have
this when they grow up?this when they grow up?y Fourth, They continue to have ODD but add
on comorbid anxiety disorders, comorbidADHD, or comorbid Depressive Disorders.By the time these children are in the end of elementary school, about 2 5 % will have
mood or anxiety problems which aredisabling. That means that it is veryimportant to watch for signs of mooddisorder and anxiety as children with ODD
grow older.
8/3/2019 Oppositional Defiant Disorder (ODD) in Children
15/26
W hat is the difference betweenW hat is the difference between
ODD and ADHD?ODD and ADHD?y ODD is characterized by aggressiveness,
but not impulsiveness. In ODD peopleannoy you purposefully, W hile it is usuallynot so purposeful in ADHD. ODD signsand symptoms are much more difficult to
live with than ADHD. Children with ODDcan sit still.
8/3/2019 Oppositional Defiant Disorder (ODD) in Children
16/26
My child has been diagnosed withMy child has been diagnosed withODD. I don't like to say this, but noODD. I don't like to say this, but noone can stand him. Is this common?one can stand him. Is this common?
8/3/2019 Oppositional Defiant Disorder (ODD) in Children
17/26
y U nfortunately, it is quite common. In comparison toADHD alone, children and adolescents with ODDplus ADHD or just ODD are much more difficult tobe with. The destructiveness and disagreeableness arepurposeful. They like to see you get mad. Everyrequest can end up as a power struggle. Lyingbecomes a way of life, and getting a reaction out of others is the chief hobby. Perhaps hardest of all tobear, they rarely are truly sorry and often believenothing is their fault. After a huge blow up, the child
with ODD is often calm and collected. It is theparents who look as they are going to lose it, not thechild. This is understandable. The parents haveprobably just been tricked, bullied, lied to or havewitnessed temper tantrums which know no limits.
8/3/2019 Oppositional Defiant Disorder (ODD) in Children
18/26
My father in law says the wholeMy father in law says the wholeproblem is my husband and I. Myproblem is my husband and I. My
daughter convinced him that she isdaughter convinced him that she isa victim of uncaring parents. Howa victim of uncaring parents. Howoften does this happen?often does this happen?
8/3/2019 Oppositional Defiant Disorder (ODD) in Children
19/26
Too often! Children and adolescents with ODDproduce strong feelings in people. They are trying toget a reaction out of people, and they are oftensuccessful. Common ones are: inciting spouses tofight with each other and not focus on the child,making outsiders believe that all the fault lies with theparents, making certain susceptible people believethat they can "save" the child by doing everything thechild wants, setting parents against grandparents,setting teachers against parents, and inciting the
parents to abuse the child. I frequently see childrenwith ODD in which teachers and parents andsometimes others are all fighting amongst each otherrather than with the child who is causing all theturmoil in the first place.
8/3/2019 Oppositional Defiant Disorder (ODD) in Children
20/26
W hat can be done?W hat can be done?Containment:y 1 . Come togethery 2. Have a plany 3. Decide what you are going to ignorey 4. Try very hard not to show any emotion
when reacting to the behaviors of children and adolescents with ODD.
8/3/2019 Oppositional Defiant Disorder (ODD) in Children
21/26
W hat can be done?W hat can be done?The Good of Containment:y especially helpful for dealing with less
aggressive behavior.y Supports all who are dealing with childy Can lead to the child abandoning his
efforts at annoying others and choosingto do more reasonable things with histime.
8/3/2019 Oppositional Defiant Disorder (ODD) in Children
22/26
W hat can be done?W hat can be done?
The Bad of containment:y
Time consumingy Must have a lot of patiencey Doesn't work as well with severe
aggressiveness
8/3/2019 Oppositional Defiant Disorder (ODD) in Children
23/26
W hat can be done?W hat can be done?
Additional advices:y
Make sure that you are as healthy andstrong as you can bey Limit Televisiony Eliminate or reduce video and Computer
games
8/3/2019 Oppositional Defiant Disorder (ODD) in Children
24/26
W hat can be done?W hat can be done?
Medical Interventions ODD are usuallyco-morbid with other problems. If yourchild has another co-morbid condition,you should look at the handout forinformation on the medical and non
medical treatment of that disorder
8/3/2019 Oppositional Defiant Disorder (ODD) in Children
25/26
W hat can be done?W hat can be done?More non-Medical Interventions:y Enlist others to help youy W hat you should do is everything you can
to share the parenting.y Discover what your child is truly
interested in.y Hospitalize the child.
8/3/2019 Oppositional Defiant Disorder (ODD) in Children
26/26
In summaryIn summaryy ODD is one bad problem. There is no
one thing that will probably fix it. Makesure you are not prematurely ruling out
any of the possible interventions above. If you are not careful, it can destroy youlong before it ruins the kid. If nothing isdone, the outcome can be dismal. It is
absolutely key to keep working to doeverything you can to keep this problemfrom devastating your life and your child's.