In today’s column, you will learn about a common childhood behavioral disorder called Oppositional Defiant Disorder, or ODD. Let’s start with a basic definition: ODD is a pattern of negative, hostile and defiant behaviors, which is first seen in children around the age of four. Here is a description from parents and teachers of a six-year-old boy who has been diagnosed with ODD.
Parents report these behaviors in their son Michael: “He yells, whines, complains, defies us, screams, throws temper tantrums lasting 20-30 minutes, steals, lies, argues, teases his sisters, swears, refuses to do his chores.”
Michael’s teachers report these behaviors: “He talks back to his teachers, fails to complete homework, fights during recess, disrupts the classroom, humiliates others, annoys and teases his classmates.”
What child would want to be like this? The answer: None.
Lesson A: ODD is a behavioral disorder which the child cannot control. The ODD child, like Michael, needs help — from his parents, his school, and from professionals — to learn behavioral skills so he can take control of his life. What happens if an ODD child does not receive treatment? Research findings, especially the work by Dr. Gerald Patterson, have identified three stages in the progression of untreated ODD.
Stage 1: Early childhood (2- 10 years old). The main cause of ODD in early childhood is severe disruption in the relationship between the parent and the child. Once this bond is damaged or broken, the parent loses their ability to effectively discipline their child. Events which can break the parent/child bond include; hostile divorces where the child is exposed to years of parental anger; medical illness of a parent (especially severe medical problems causing the mother to be hospitalized); psychiatric illness of a parent (depression); trauma to the family (death, domestic violence); parental substance abuse; severe economic stress or job loss. A good way to view ODD is to consider how an automobile works. Your car has both a brake and a gas pedal. If you remove the brake, your car goes out of control. In the same way, a family which has lost its brake (parental authority) becomes a family out of control. ODD children, through no fault of their own, are living in a family where the “braking system” is disabled or removed.
Lesson B: ODD is a Family Diagnosis, not an individual child diagnosis.
Stage 2: Middle childhood (10-15 years old). The ODD grade school child becomes the ODD middle school adolescent. At this time, two huge events occur: the ODD child will be socially rejected by normal peers, and, school report cards start to show D’s and F’s. This deadly brew (social rejection plus school failure or retention) pushes the ODD adolescent into the only group which will accept him/her. That is, the kids at the bottom of the barrel - the” bad kids”-the kids who resort to drugs, alcohol, and destructive, explosive excitement such as violence or crime.
Stage 3: Adolescence (15-19 years old). The ODD adolescent, now associating with peers who are angry, defiant and violent, completes the race of developmental self-destruction by committing crimes which take them into jail or prison.
Lesson C: ODD is best treated at ages 4-10, so the progression towards jail is stopped.
How is ODD treated? First, clear goals for treatment are established: 1: Re-build the parent/child relationship. 2: Stop all ODD behaviors. 3: Prevent school failure. 4: Teach the child social skills to build positive peer relationships. 5: Help the family re-build from the hardships which produced the ODD problem in the first place.
The treatment of ODD is one of the most exciting, rewarding and successful stories in the field of psychiatric care. Treatment is family-based, skill-based, and includes making a direct and continuous link with the child’s school. Parents are taught behavioral skills to motivate their child, increase their child’s ability to follow rules, and ways to re-build their child’s self-esteem. Behavioral treatments of ODD are highly successful if, families commit to a treatment program and if school’s open their arms to the new generation of treatments, where academic success is viewed as a critical part of the child’s recovery.
Dr. Richard Elghammer contributes his column each week to the Journal Review.
