Faculty Field Notes: Oppositional Defiant Disorder | School of Behavioral Health | Loma Linda University
Child
By dkrueger - January 11, 2019

Disruptive behaviors are a common occurrence in children. While almost all children exhibit some level of rule breaking, defiance, or acting out, only a subset of children may need intervention to curb these behaviors.

Maya Boustani, PhD, clinical child psychologist and Assistant Professor at Loma Linda University’s School of Behavioral Health, Department of Psychology, answers some of the most common questions about Oppositional Defiant Disorder (ODD).

What is ODD?

Disruptive behavior problems in children and adolescents encompass a wide range of behaviors, including tantrums, defiance, ignoring requests from parents or teachers, lying, stealing, substance use, and delinquency. These problems are disruptive to the family and school environments and may cause problems in children's lives. Oppositional Defiant Disorder (ODD) is a disorder typically diagnosed during the elementary school years and includes a variety of symptoms such as anger and irritability, frequent loss of temper, being easily annoyed, arguing with authority figures, refusing to follow rules, deliberately annoying people, blaming others for mistakes, and being vindictive.

What is the difference between ODD and CD?

There are two main types of disruptive behavior problems: Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD). Both disorders cover a wide range of behaviors. However, CD is much more severe and includes antisocial features that ODD does not.

CD is defined as a persistent pattern of behavior that violates societal norms or the rights of others. For example, children with CD may exhibit aggression towards animals or other children, destroy property, use deceitfulness or threats, or engage in serious violations of rules. Children with CD are at high risk of peer rejection, academic failure, and involvement in substance use and delinquency as they get older.

ODD is more mild than CD. Symptoms that are usually present around individuals the child knows well, and may not be obvious in all settings. ODD generally begins in early childhood.

What are the risk factors?

Several risk factors may contribute to the development of ODD:

Biological: Some children may be born with a naturally difficult temperament at birth. These children often have difficulty regulating their emotions as toddlers, are highly reactive to situations, have low frustration tolerance, and are hyperactive from a young age. Children who have a learning disability and children who have experienced a perinatal complication or a traumatic brain injury have a higher likelihood of developing ODD.

Psychological: Children who are frequently sad, jealous, clingy with their parents, or emotionally neglected are more likely to develop ODD.

Social: Children who have social work involvement or violence in the home are more vulnerable to ODD. In addition, children who lack stability (e.g., have moved homes and/or changed schools multiple times) are also at increased risk.

Parenting: Poor parenting practices such as harsh discipline, inconsistent supervision, lack of routine or structure in the home, or abuse and neglect can trigger or exacerbate disruptive disorders such as ODD.

What are the protective factors?

Biological: Children with a happy temperament (often referred to as "easy" babies) are less likely to develop ODD compared to those that are more "difficult".

Psychological: Children who effectively cope with stress and adapt to change easily are less vulnerable to developing ODD.

Social: Children who have good relationships with their grandparents, and children who have two or more hobbies tend to be more protected.

What can parents do?

When it comes to disruptive behavior disorders, including ODD, parents are the medicine! Parenting practices and the parent-child relationship are an essential part of treating ODD, regardless of the cause. Parents may attend a parent-training program to learn effective discipline strategies and approaches to curb their child’s behaviors. In these programs, parents can learn how to set clear rules and expectations, praise children for positive behaviors, and implement effective consequences for negative behaviors. The key to success is consistency and follow-through. Parents often fail to follow through with consequences, forget to praise, or use inconsistent strategies – which can all exacerbate symptoms of ODD.

What are some effective therapies to help with ODD?

Luckily, there are many effective therapies to address disruptive behavior problems, many of which use similar strategies. Effective parent-training programs to address ODD include Parent-Child Interaction Therapy, Helping the Non-Compliant Child, Positive Parenting Program, The Incredible Years, and Parent Management Training.

Where can I get help?

The doctoral psychology students* at Loma Linda University's School of Behavioral Health are trained in parent management techniques and can see children and their parents at the Behavioral Health Institute at a reduced rate. You may call 909-558-9339 and press #2 to make an appointment with a psychology student.

*All students are supervised by a licensed clinical psychologist.

National directories of clinicians who provide evidence-based treatments: 
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