Lynda Weppler realized there was something different about her son around the time he began crawling. In preschool, Jesse was often in trouble for fighting. At age four, he threatened to call the police and have Weppler arrested for child abuse when she refused to take him to a restaurant. In kindergarten, he was suspended for throwing a shoe and a chair at his teacher. At home, he hurled a toy box through a window and kicked holes through walls.
"I was constantly screaming and sobbing," Weppler says. "I was a total wreck. I went to counseling to find out how not to hate my son." Finally, following a harrowing third grade year, Weppler arranged to have Jesse tested for behavior disorders. The diagnosis?
Oppositional defiant disorder (ODD).
What Is ODD?
ODD represents the extreme end of the spectrum of noncompliant behavior in children, according to Dr. Russell Barkley, author of
Your Defiant Child: 8 Steps to Better Behavior
When does normal defiant behavior in children become abnormal? "There are degrees of abnormality," he says, "but when the child's behavior begins to impair major life activities, including those in the community, in school, and in peer and family relationships," this impairment points to ODD.
According to the American Psychiatric Association's
Diagnostic and Statistical Manual of Mental Disorders
, ODD is characterized by "a pattern of negativistic, hostile, and defiant behavior lasting at least six months, during which at least four of the following are present:
Often loses temper
Often argues with adults
Often actively defies or refuses to comply with adults' requests or rules
Often deliberately annoys people
Often blames others for his mistakes or misbehavior
Often is touchy or easily annoyed by others
Often angry and resentful
Often spiteful or vindictive
It is important for the doctor to rule out other conditions, like a mood disorder, conduct disorder, or attention deficit hyper activity disorder (ADHD).
Children with ODD often do have learning problems, and many meet criteria for ADHD. Conditions like bipolar disorder may be associated with symptoms similar to ODD, but may have different treatment approaches. Keep in mind that if your child is not responding to treatment, he could have the wrong diagnosis or possibly co-occurring conditions, like ODD and ADHD.
What to Do?
Find a Therapist
If you have concerns about your child's behavior, ask the pediatrician for a referral to a child psychologist or psychiatrist. Dr. Douglas Riley, a child and adolescent psychologist,
recommends that parents thoroughly interview therapists. "Ask what methods they use. How well do they know kids with ODD? How many such children are they seeing currently? If you are not comfortable with a particular therapist, move on."
Learn New Parenting Skills
Parents of children with ODD should avoid getting weighted down in guilt, shame, or
depression, says Riley. It is easy, but misguided, to take the child's behavior personally, he says.
Trying to use reason and logic with children who have ODD only results in anger and frustration. This then leads to arguments with a child who feels no compulsion to play by the rules, and who is at his most natural when he is in conflict with someone. Parents must teach their children that the only way to access the good things in life is by playing by the rules. Children must be given clear pictures of how they are expected to behave and interact within the family. They must understand that failure to comply will result in losing access to those things they value most, which will then have to be earned back.
How can you change your parenting style, though? There are parent training programs that have shown to be effective in treating ODD. In these types of programs, you learn how to use techniques like positive reinforcement and time outs to manage your child's behavior. Other types of treatments that are available for you and your child include: psychotherapy, family therapy, training to learn problem solving skills, and social skills training.
Learn About Medication Options
In some cases, the doctor may recommend medicine to treat severe symptoms of ODD, especially if your child also has ADHD. Examples of medicines that may be prescribed include risperidone (Risperdal), and clonidine (Catapres).
How Is Jesse Doing?
Since Jesse's diagnosis, Weppler has gotten Jesse counseling, arranged for interventions in school, and created a good support system at home. "He is becoming part of the world now, instead of being the center of his universe," says Weppler. "Two years ago, I was afraid I was raising a potential front page horror story. Now my kid is fun and he is going to be fine."
Jesse, now 11, remembers a time when it was hard to find things to do that wouldn't get him in trouble. Today, he is a skateboarder and frequently a role model for others in the classroom. He says, "It feels good that I can be an example to other kids who are having a harder time than me."
Diagnostic and Statistical Manual of Mental Disorders.
4 ed. Washington, DC: American Psychiatric Association; 1994.
Greene RW, Biederman J, Zerwas S, Monuteaux MC, Goring JC, Faraone SV. Psychiatric comorbidity, family dysfunction, and social impairment in referred youth with oppositional defiant disorder.
Am J Psychiatry
Lavigne JV, Cicchetti C, Gibbons RD, Binns HJ, Larsen L, DeVito C. Oppositional defiant disorder with onset in preschool years: longitudinal stability and pathways to other disorders.
J Am Acad Child Adolesc Psychiatry
Loeber R, Burke JD, Lahey BB, Winters A, Zera M. Oppositional defiant and conduct disorder: a review of the past 10 years, part I.
J Am Acad Child Adolesc Psychiatry
Please be aware that this information is provided to supplement the care
provided by your physician. It is neither intended nor implied to be a
substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER
IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the
advice of your physician or other qualified health provider prior to
starting any new treatment or with any questions you may have regarding a