Most children go through phases of being difficult, but in some cases, it might be more than an attitude problem that’s plaguing your child. Dr Russell A Barkley, PhD, Clinical Professor of Psychiatry and Paediatrics, Medical University of South Carolina, and author of two parenting books, Your Defiant Child and Your Defiant Teen, talks to us about Oppositional Defiant Disorder (ODD), and what sets it apart from just ‘bad attitude’.
How is Oppositional Defiant Disorder (ODD) different from the occasional, routine defiance that children exhibit?
Defiance simply refers to either a verbal refusal by a child in response to a command or a request, a physical resistance to guidance by the parent or a failure to comply with any requests (passive non-compliance). Yes, all children do this occasionally. It is when the defiance becomes more frequent and severe, thus impairing a child’s activities (affecting family or peer relationships, school performance, conduct in the community or self-care), that it is characterised as a disorder. We refer to that stage as Oppositional Defiant Disorder (ODD).
Typically, ODD manifests itself in two dimensions. First, the emotional dimension, which involves display of excessive emotions such as anger, temper, irritability, impatience, frustration, or low tolerance. Second, the social dimension where a child is often in conflict with others, especially parents. This manifests as refusal, defiance, arguments or tantrums by the child.
What are the causes of ODD?
Current theories and evidence support a four-factor model of ODD.
Child’s characteristics: A child’s temperament, personality and psychological traits (such as ADHD, bipolar disorder, depression) are factors that contribute to the emotional dimension of ODD.
Disrupted parenting: This means that parents are inconsistent while dealing with child-misbehaviour. They express high levels of negative emotion (yelling, screaming, threats, anger), or frequently vacillate between lax and harsh punishment. So, children learn to manipulate parental behaviour to their advantage.
Parent characteristics: A parent’s own psychological or psychiatric disorders, such as ADHD, depression, adult bipolar disorder, antisocial personality disorder, and drug abuse can contribute to a child’s non-compliant behaviour.
Family context: Background stress events, such as marital problems, divorce, poor health, financial distress, unemployment, etc. can lead to disrupted parenting, which in turn leads to defiant behaviour in children.
To understand ODD, you must look at all 4 factors.
What are the characteristics of ODD?
Frequent anger, hostility, irritability, and frustration in response to parental commands along with frequent arguing, refusal, tantrums, and physical resistance to parental direction are the most commonly seen manifestations of the ODD. For example, when asked to pick up toys, or do homework, the child says ‘no’ and continues doing what he wishes.
The parent repeats commands, the child still refuses, and anger starts escalating on both sides. The demands by the parent become more insistent, along with threats of punishment. The child starts screaming and throwing tantrums. The person who escalates to high rates of emotion first, often coerces the other to give in.
What are the long-term effects when defiance is not handled effectively?
Delinquency, conduct disorder, and anti-social behaviour; child-depression, deteriorating peer relationships, declining academic performance and dropping out of school are the commonly seen consequences of ODD when it goes unchecked.
How can parents deal with defiance in their child?
First, the child must be evaluated to determine if he/she may be suffering from another disorder like ADHD, bipolar disorder, or depression, among others. This may be contributing to the child’s emotional dysfunction. Treating the underlying cause can help reduce the child’s defiant behaviour, and sometimes even resolve it.
Second, the parents should be screened for any psychological problems or psychiatric disorders that may be contributing to their disrupted parenting. Any diagnosed problem can then be treated.
Third, the family environment must be evaluated for any high levels of stress. Finally, parents should be trained in child behaviour management (modification) and in methods for reducing the child’s episodes of defiant behaviour.
ODD often requires the support of professionals. A psychiatrist may be needed to diagnose and treat any psychiatric disorders with medication. A psychologist, on the other hand, will help in testing and diagnosing the disorder, and in conducting parent-training classes.
Methods to help reduce excessive defiant behaviour:
Increase the amount of approval, recognition, praise, and rewards when the child complies with requests. Token or point systems are a great way to motivate children to comply.
Implement a mild form of discipline. As an example, if the token system is being used, enforce a loss of tokens or points for defiance. Use time-outs (placement in a chair in a dull corner of the house) for more serious episodes of defiance. The key here is to act quickly, within 10 seconds of the initial defiant behaviour.
Have a transition plan just before starting any new task with the child or before entering into a new situation (like visiting a store):
- Go over the rules the child must follow
- Have the child restate them
- Explain the rewards for complying with these rules
- Explain the consequences of non-compliance
- Start the task and follow your plan.
- Don’t wait till the end to reward the child. Instead, give rewards throughout the performance of the task.