Oppositional defiant disorder is a label that is applied to many children now days. The term is used to describe children who for a period of at least 6 months have often to always 1) argued with adults, 2) defied or refused to do what they were told to do, 3) lost their temper, 4) annoyed others, 5) blamed others for their actions or misbehaviors, 6) been touchy or easily annoyed by others, 7) been angry or resentful, and 8 ) been spiteful or vindictive. At least four of these behaviors have to be present for the label.
Children, however, are not born with the label. These behaviors develop over time due to an interaction of three factors. The first is a child’s temperament. Temperament consists of traits of behavioral response that we are all born with. We inherit these traits from our families. The second factor involves any physical, developmental, and learning issues that the child has. The third factor is the actions, interactions, and reactions of the world around the child.
Temperamentally, three traits at levels of easy stress and poor strategy development, make the child vulnerable to a poor interaction with others in his environment. These are adaptability, basic mood, and intensity of response. A child who may be described as ODD, will be slow to adapt to change, handle transitions, and process other people’s opinions, beliefs, or directions. This child will likely be very negative about starting something, going some place, or eating something new. Most of these children are also very immediate and intense in their reactions, being very over reactive to the situation.
While not all of these children have any significant problems, if he does have issues such as language problems or learning problems, he will likely show his frustration more quickly and be more difficult to help. Many times these problems are not recognized, which makes matters worse, since his behaviors will not be seen in context of his frustrations and confusions.
Adults coming in contact with such as child, will likely be reactive to the child’s behavior, becoming argumentative in response. As the child intensifies, the adult then begins threatening the child with removal of privileges. The child becomes more frustrated, feeling that the adult doesn’t understand or doesn’t care about the anxiety, frustration, and confusion he is feeling. Each new encounter reaffirms these feelings, and feeling forced to do things he feels he can’t do, leads to denial of ownership of the outcomes, especially negative outcomes. Eventually, with the introduction of a mental health provider, the label of oppositional defiant disorder is delivered.
Does this scenario have to always end the same way? Not if parents and primary care providers begin to ask “why” a child is finding it so hard to handle day-to-day situations. Begin by looking at temperament, physical, developmental, and learning issues, finding out if even minor problems are present, which with his temperament profile can be more impairing. Address the associated problems in conjunction with a positive behavioral program that provides guidance, counseling, and parent management training. This includes with staying calm, talking quietly and a little bit slower. Make the sentences simpler when he is upset. Ask him what he finds upsetting in what he was told, or was to do. Teach him problem solving and conflict resolution techniques. Put things in a visual format to allow for longer and more effective processing of information.
High risk children don’t have to evolve into the label of oppositional defiant disorder. But it takes the adults, using their adult skills of patience, consistency, and problem solving to help. Let’s do more of this and make O.D.D. an endangered species.