Category — 2.9 Children with Mental Illness: Oppositional Defiant Disorder

Children with ODD are very defiant. This means  they say no to everything and everyone. They rebel against  the adults  around them, especially their parents. They can argue a lot and may not respond to requests or instructions. Most children go through a defiant stage at some point in their lives. This is typical. But when a child is defiant almost all the time and goes out of his or her way to annoy the adults around him, he or she may have ODD.

A child may have ODD if:

• He or she is in a bad mood, most of the time;
• He or she does not follow requests most of the time;
• He or she does the opposite of what is asked most of the time;
• He or she argues about everything, from the smallest to the biggest thing (Fig. 1);
• He or she appears to be resentful (see full Glossary) of adults, and especially his or her parents;
• He or she has frequent and intense temper tantrums;
• He or she tries to annoy others on purpose (that is, He or she does things that he or she knows would annoy his or her parents);
• He or she appears angry and spiteful;
• He or she lies and blames others for his or her mistakes;
• He or she has few, if any, friends.

Figure 1. Arguing

Children with ODD may have difficulty in developmental areas:

• Academic: children with ODD do not do well academically. They perform less well than their peers and do not do well on standardized (see full Glossary) and/or regular tests. It is because they are not as smart as their peers. It is because they are not interested in academics. It could also be because they know that not doing well would annoy their parents;
• Social/emotional: children with ODD usually have a low self-esteem. They do not have many friends and seem to annoy their peers just like they annoy adults. They are angry and may be sad. This  makes it difficult for them to make friends;
• Mental health: many children with ODD also have an anxiety disorder and some also suffer from depression. Therapy can help these children with all these symptoms;
• Cognitive: some children who have ODD also have ADHD. These children may have a dual diagnosis of ODD and ADHD. They  may have an Individual Education Plan (IEP) that deals with both disorders (which overlap a lot).

Children with ODD need help in the classroom. Their teacher has to be very creative because most techniques that work with other children may not work with them. Unlike other children with other special needs, children with ODD are not eager to please adults. In fact, they go out of their way to annoy adults and do the exact opposite of what they are supposed to do. The teacher will need to gather a lot of resources, get help from the special educator in school and maybe also a behavior interventionist, to reach and teach a child with ODD. Here are a few suggestions:

• These children need to feel welcome in the classroom. They know they are difficult. Teachers need to make sure these children know that their behaviors and attitudes are not welcome in the classroom, but they are!
• These children are defiant. They will say no just to say no. Teachers will need to be creative in finding ways to encourage these children to want to participate in activities and lessons;
•  Teachers need to know when to ignore behavior that is annoying but not very disruptive and when to step in so everyone feels safe and secure in the classroom;
• The teacher may need to give these children extra time to hand in in-class and homework assignments. This is not because these children need extra time to perform these tasks. It is because they are defiant and may not turn in assignments on time;
• The teacher may need to place the child on a behavioral contract (a written contract between the child and the teacher). The behavioral contract can be developed in consultation with the school’s special educator and the behavior consultant. The contract will include what is expected from the child and what happens when she or he does not respect the class rules. The contract can also include a section where the child lists what he or she expects from his or her teacher.

Children with ODD need help as soon as they can get it. They need individual psychotherapy to work out their anger and frustration with adults, especially their parents. Therapy should be intensive and start as soon as possible after the child is diagnosed with ODD. Also, many children with ODD could use social skills training. They need to learn how to interact properly with others. They need to learn to respect others. Psycho-therapy should be provided by an experienced  clinical psychologist.

But individual psycho-therapy is usually not enough. There seems to be a mismatch between the child with ODD and his or her parents. That is, the child and the parent’s temperaments do not match, and there is no goodness of fit. (Please refer to social/emotional section of the birth to six course, in order to learn more about temperament and goodness of fit.) Most children diagnosed with ODD will receive family therapy, with their parents, and the individual therapy they need. It is also highly recommended that parents enroll in parenting classes to learn more about child development and how to best treat their child. This does not mean that parents are doing something wrong. But they do appear not to be “in-sync” with their children and this is why parenting classes are often a good idea  .

Research suggests that therapy provided by an experienced psychologist can be very helpful for  children with ODD. The vast majority of children with ODD get help can overcome this disorder. Those who do not could end up getting diagnosed with a more serious disorder called Conduct Disorder. It is important that children with ODD get help as early as possible.

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