At some point, every parent finds themselves at the end of their rope, pulling their hair out as a result of a youngster throwing a temper tantrum. We wish we could be miraculously transported to another place and time, far away from our screaming, disobedient preschooler. Aside from giving in to unreasonable demands, nothing we do or say at times like these will appease that child at that moment. And so we may take a deep breath, count to 10 — whatever helps to keep us calm and in control — and we pray for it to pass quickly. Yet some parents may find themselves in these situations way too often. Some kids have more than their share of tantrums and particularly disobedient behavior, and perhaps they are even hostile. How does a parent know when their child is just being a typical preschooler having a bad day, or if there is a serious underlying problem?
According to the American Academy of Child and Adolescent Psychiatry (AACAP), “Openly uncooperative and hostile behavior becomes a serious concern when it is so frequent and consistent that it stands out when compared with other children of the same age and developmental level, and when it affects the child’s social, family and academic life.” Does this describe your child? If so, your child may have ODD.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) defines Oppositional Defiant Disorder (ODD) as a behavioral disorder in which a child displays behavior that follows a pattern of negativism, hostility and defiance, lasting at least 6 months, and four or more of the following must be present:
Your child often:
- loses her temper
- argues with adults
- actively defies or refuses to comply with adults’ requests or rules
- deliberately annoys people
- blames others for his or her mistakes or misbehavior
- is touchy or easily annoyed by others
- is angry or resentful
- is spiteful or vindictive
Dr. Sue Antell, a developmental neuropsychologist who specializes in the diagnosis of behavioral and developmental disorders of young children, points out that kids with ODD know what is expected of them, are capable of appropriately responding, and yet choose not to. A child with ODD is most likely to display such behavior at home, around the people that he or she is most comfortable with, but not necessarily at school or with other adults and acquaintances. Although it may seem difficult to imagine a child as young as preschool age exhibiting behavior to this degree, sadly ODD does indeed affect such young children. Dr. Antell has seen patients this young who have even posed a “risk of physical harm to others in their families.”
Children with ODD often find themselves being disliked by those who associate closely with them, including teachers and peers. These children are also at a higher risk than others of becoming victims of child abuse. “Simply because their behavior can be so incredibly taxing for a parent to manage,” says Atwell. It can be a frightening ordeal for family members and loved ones close to a child with ODD. It is essential that children with symptoms suggesting ODD be seen by a mental health care professional.
Some additional warning signs are children who are, for no apparent reason, angry at everyone and everything; children who use whining and demanding behavior as their foremost method of interaction; those who are aggressive toward adults; and those who attack others with weapons such as sharp objects. Dr. Antell suggests that aside from these indications, if a parent feels that their child’s behavior is consistently out of line and not well controlled, whether the child has ODD or not, it may benefit both child and parent to seek professional assistance. Often there are other disorders present upon close examination of a child’s behavior, and a qualified professional will be looking to see if this is the case. “It may be difficult to improve the symptoms of ODD without treating the coexisting disorder,” according to the AACAP.
The AACAP suggests that if a parents feel something may be wrong with their child’s behavior, they can begin by speaking with friends and family, perhaps the school counselor or the child’s physician in an effort to gain as much information as possible about finding help. Trying to find a good health care professional can be overwhelming, so the AACAP produced a list (#1) of helpful sources of information, including definitions and distinctions between various mental health care professionals.
Although it is difficult to say how a behavioral disorder such as ODD develops — whether there is a biological predisposition for it or whether it is brought into existence through particular social conditions — evidence seems to suggest that such behavior is escalated when dealt with in an over-restrictive way. Discovering the root of such a child’s behavior is of utmost importance.
“Find out what they are defying and opposing,” says Dr. Aaron Kipnis, a professor of clinical psychology and author of Angry Young Men: How Parents, Teachers, and Educators Can Help “Bad Boys” Become Good Men. “Oppositional behavior can be a healthy response to an unhealthy situation, or an unhealthy response to a healthy situation.” Dr. Kipnis says it is often better to assume that something about a child’s oppositional behavior is right instead of wrong, and the key is to help them express themselves in a more positive way in communicating whatever it is that is bothering them.
Treatment for children with ODD is generally behavioral. According to Dr. Antell, Intensive Applied Behavior Management Training for parents is the best approach. This entails a behavioral plan specifically crafted to an individual child and family. Particular factors which result in the defiant behavior will be identified and targeted, and specific reinforces and consequences of a child’s behavior will be appropriated to the age and developmental stage of the child.
Brian* was a very irritable and frustrated baby and toddler. “The slightest thing would set him off,” says his mother, Kay*. “If he didn’t get what he was asking for at that moment, he would throw himself on the floor and have a fit, or even try to hit me.” His behavior became progressively worse and more difficult to manage as time went on, and when he was 5, his parents took him to see a child psychologist. Because they have two older girls who never exhibited behavior similar to that of Brian’s, his parents were afraid that something might be “wrong” with him. Brian displayed some of the symptoms which categorize ODD, although his psychologist prefers to treat the problem rather than dwell on the label. Brian’s mother explains that “it has not been an easy road, and we still have issues to deal with, but I do see improvement with Brian.”
One of the most essential things that Bian’s parents learned from the therapy they have been undergoing is there is no one approach to parenting. “I see now that we have to be more lax with Brian than with the girls and that’s fine, it just takes some getting used to,” says Kay. Through extensive behavioral management training, they are learning to change their style of parenting to one that is comfortable for both Brian and themselves. They have come to understand that Brian is an individual with needs very different from their daughters. Realizing this important difference and learning to readjust has helped them all a great deal. “One of the good things that has come out of our therapy is that I’m a lot less frustrated because I’m trying to understand where Brian’s behavior stems from, and I think that our relationship is improving because of it.”
It can be extremely trying for parents raising a child with ODD, but there are ways that parents can help themselves and their children. The AACAP suggests positive reinforcement and praise for your child when he or she shows flexibility and cooperation. It is a good idea to take time outs if you feel you may make a conflict worse, and support your child if he does the same. Pick your battles, set up reasonable limits for your child, maintain your own interests outside of dealing with your child and try to get as much support as possible from other adults associated with you and your child. It may also help to manage your personal stress with exercise and relaxation, and don’t hesitate to use respite care if you need to.
It is hard to say what the prognosis for treatment of ODD is or will be, but many children do respond well to these positive techniques. Dr. Antell maintains that parents should never give up on their child. Do not lose hope, because, as she says, “your child is a work in progress… a person waiting to unfold.”