Is “Oppositional Defiant Disorder” a Diagnosis or a Symptom, and How is it Treated?

Young girl with ODD looks angrily at the viewer.

In my latest book, Managing the 5 Most Challenging Childhood Behavioral Health Conditions of Our Day, I write about behavioral challenges and some of the overlapping conditions. In today’s post, I want to share more about the idiosyncrasies of the condition referred to as “Oppositional Defiant Disorder,” or ODD.

What is Oppositional Defiant Disorder?

Oppositional Defiant Disorder is a disorder that manifests, as the name implies, with significant levels of oppositionality and defiance. Specifically, the child demonstrates an angry and irritable mood, is argumentative and defiant, and prone to being vindictive. In children 5 or younger, these behaviors would need to be observed most days for at least six months; older than 5, at least once per week for six months.

Not due to…

It’s important to note that the symptoms cannot be better explained by a mood disorder such as depression or bipolar disorder.

So, what causes ODD?

That is the 64,000 dollar question and, really, it’s a important point. In that respect, I’ve tended to perceive signs of ODD more as symptoms than as a primary diagnosis.

When is ODD, actually ODD?

There are times when a child is very strong-willed and seems to have been born with a hard-nosed disposition; everything is a fight, argumentative, and moody. In those situations, in the absence of any other identifiable diagnosis, ODD may fit. Interestingly, that situation is often genetic; invariably I hear how the child is similar to an uncle or some other family member, even if they rarely come in contact with that relative. Also, if a child has experienced very difficult situations, such as family turmoil and strife, but there is simply not enough evidence to diagnose with a mood disorder or trauma, then ODD may fit but there will be a caveat explained in the report.

However, I’ve found…

In most cases, when a child is presenting as argumentative, moody, and defiant, there is an underlying reason. In those cases, ODD is more of a symptom than a diagnosis. I often find that children who have been diagnosed with ODD, upon closer look at the situation, actually do meet criteria for some other primary diagnosis, and it’s that primary diagnosis that is causing the argumentativeness, moodiness, and defiance. This may include a mood disorder or that the child is traumatized; keep in mind that children tend to act the way they feel.

Treatment?

If the child does, in fact, have straight-forward ODD, then the treatment is largely based in counseling and behavior management. In that respect, counseling targets coping skills and helping the child to get his or her needs met without causing mayhem, as well as an opportunity to vent frustrations. The counseling is also for the parent to help with communication and to practice reflective-listening, which is a wonderful approach. If interested in learning about reflective listening, check out the first chapter of the book ‘How to talk so kids will listen, and listen so kids will talk”, Adele and Mazlish. Behavior management is simply, ‘how are we going to manage his behavior’? We want to move toward respectful communication, ‘talking things out to problem-solve’, and a reasonable and logical dialogue in that respect. However, that takes time. So, in the meantime, we want to rely on lots of praise and reinforcement for making good choices, a sticker chart, a consistent routine, and firm but fair limits. We want to avoid our biggest enemy when it comes to parenting; pestering and becoming emotional. Also, check out my earlier post, Why Taking Away Privileges and Time-Out Don’t Work (and how to make them work), which soon will be expanded into an eBook and podcast.

If the ODD is due to an underlying condition, then we treat that underlying condition; this too involves counseling (geared directly toward depression, anxiety, trauma, family harmony) and behavioral management.  Hope that helps to explain and clarify the ODD diagnosis. Feel free to send any inquiries my way to jcarosso@cpcwecare.com. May God bless you and your family.