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Oppositional and Defiant Behavior in Children and Teens

Oppositional defiant disorder (ODD) is a condition that occurs in children. It is characterized by defiant, hostile behavior that is not developmentally appropriate.

Understanding ODD

At certain ages, children may be naturally quite rebellious. Adolescence, for example, may be characterized by frequent bouts of anger and misbehavior, and toddlers generally go through a phase in which they exert their individuality by refusing to follow rules and exhibiting contrary behavior. However, both of these types of rebellious behavior are often simply part of the normal individuation process. They are not diagnosable behavioral conditions, although they may be frustrating and will often require some parental skills with boundaries, patience, discipline, and good communication.

 

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Some children, however, may seem incapable of or completely unwilling to follow rules, cooperate with adults, or accept any sort of discipline or structure. They may challenge their parents frequently and resist attempts to manage their behavior, appearing to be triggered by insignificant things or by nothing at all. When this type of vindictive, argumentative, defiant behavior persists, often to the point of disrupting normal functioning, with incidences occurring on most days for at least six months in children under five or at least once a week for six months in children older than five, ODD may be diagnosed, according to the diagnostic criteria in the Diagnostic and Statistical Manual (DSM).

Symptoms of ODD

According to the DSM, for a child to be diagnosed with ODD, the behavior must not be typical of the child's current developmental stage. Recurrent tantrums in a two-year-old, for example, would not indicate a diagnosis of ODD, while they might in an eight-year-old who exhibited the same behavior. Symptoms of the condition include:

  • Anger, hostility, an irritable mood.
  • A refusal to listen to reasonable directions and obey the rules of parents, caregivers, and other authority figures.
  • The deliberate provocation of others, purposeful attempts to irritate others.
  • Frequent tantrums, difficulty with self-control.

Anxiety, posttraumatic stress and depression can cause symptoms in children that are similar to the symptoms of ODD, so a mental health professional will generally rule out other conditions that present similarly.

 

Defiant children may show remorse some of the time: making promises, asking forgiveness, and appearing to try to do better. Some such promises may be manipulative, though some may be sincere, and many children revert to the defiant behavior. Often, oppositional children do not any signs of remorse. Some children with ODD seem to have no regard for the consequences of their behavior, for themselves or for other people, and they may report emotional numbness and unhappiness.

Causes of ODD

No single factor can predict whether a child will develop a pattern of oppositional behavior, as many different factors may contribute to a child's persistent acting out. ODD is considered by some to be a reaction to a chaotic environment.

 

Inconsistent child-rearing or overly harsh forms of discipline are considered to be significant factors in the development of the condition, and research shows that the children of parents who are incarcerated or addicted to drugs or alcohol are more likely to develop the condition. Early trauma and abuse can also contribute to the development of ODD: Children who have a history of abuse, neglect, or trauma may exhibit oppositional behavior as a response to their experiences. Experiencing any kind of traumatic event increases a child's likelihood of acting out, as the child must cope with challenging feelings, thoughts, and memories. If these feelings are not dealt with, ODD may result. 

 

In some children a chemical issue may be present, as women who use drugs or alcohol during pregnancy may increase the odds of oppositional behavior in their children. In others, oppositional behavior may be the symptom of an underlying mental health condition. Oppositional behavior may also develop when parents do not succeed in teaching boundaries or other social skills. At times, it may not be possible to determine the cause of a child's oppositional behavior, and this may make treatment more difficult.

Therapy for ODD

Defiant behavior can be frustrating in the home and potentially devastating in school, as it can lead to suspension and expulsion and at, the very least, may have a negative effect on a child's ability to learn and his or her relationships with peers. If untreated, oppositional behavior can escalate as the child ages. In the teenage years or during adulthood, oppositional or defiant behavior may have significant and lasting consequences socially, legally, occupationally, and psychologically. A correlation between childhood ODD and later development of a conduct disorder has also been seen in research, and early treatment of ODD may help prevent this development.

 

When treating a child who exhibits oppositional behavior, especially one who is diagnosed with ODD, a mental health professional will typically consider and address all of the factors that may be contributing to the child's misbehavior. Most children who exhibit oppositional behavior on an ongoing basis have a difficult time with emotional expression and may benefit from learning about emotions, which may render them more able to understand their emotional response and teach them how to verbally express their feelings instead of relying solely on physical outbursts.

 

Children who struggle with emotional regulation also tend to have trouble controlling their anger, and anger management therapy may be beneficial when this is the case. Some of the strategies that are taught in anger management include relaxation, goal setting, problem solving, trigger identification, and recognition of consequences.

 

Individual therapy is also helpful when children cannot maintain control over their behavior. Therapists may use behavior modification techniques such as rewards and consequences, or they may employ play therapy, family therapy, or other techniques, depending on the needs of the particular child. In therapy, a child can often learn behavior modification and communication skills that may allow them to better interact with peers, family members, and authority figures. With the help of a therapist, a child may also be able to more deeply explore any personal issues that contribute to the child's defiant behavior. 

 

When a child exhibits defiant and oppositional behavior, it can affect the child's entire family, and family therapy may also be helpful. Oppositional behavior can cause stress in relationships between intimate partners, parents, and siblings, and in order to effectively manage oppositional behavior, the entire family can often benefit from exploring ways to address and cope with their own feelings in order to better support the child during treatment. In family therapy, parenting skills may be addressed, as might the alteration of the family environment, should it be chaotic.

 

A therapist may prescribe medication, such as antidepressants or stimulants, to help treat the symptoms of ODD, especially if the condition occurs with attention-deficit hyperactivity.

Case Examples

  • Art and play therapy for an oppositional foster child: Gerald, 12, is brought to therapy by a foster parent. He is sweet and cooperative some of the time, but he frequently talks back to adults rudely, purposefully breaks rules, sneaks out of the house, speaks angrily to those around him, and refuses to take responsibility for his chores. His foster mother reports that Gerald was neglected by his mother and that he has been in several foster homes. His current foster family would like to adopt him, but they worry that they will not be able to manage his behavior, which seems to be getting worse. The therapist begins by engaging in play with Gerald—art projects, games, and toy army battles. As the therapist develops a relationship with Gerald, the foster parents are brought into some of the sessions, where Gerald is encouraged to write, draw, and talk about his experiences in other foster homes and to communicate these experiences through various means of performance--puppet shows, a play involving everyone in the room, a story with the army men. After several therapy sessions, Gerald begins to show real trust for his foster parents, and his anger becomes more manageable. His behavior, while far from perfect, improves enough to make adoption possible.
  • Wild high school senior: Alice, 17, is staying out past her curfew, cutting class, refusing to eat meals with her family, and drinking alcohol on weekends. She shouts and swears at her parents when they try to speak to her about her behavior, which has gone on for all eight months of her senior year of high school. The parents seek a therapist, but Alice will not go. The therapist talks to the parents about their options, and while they do not wish to emancipate her, they are not sure how much longer they can try to help her, if her behavior continues in the same manner. The therapist explores the couple’s relationship, history, and parenting style and continues to work with the parents, helping them to manage their own stress and address some long-standing intimacy issues. After several weeks, Alice's parents report to the therapist that some of Alice's oppositional behavior has improved, and that she has agreed to enter therapy. During conversations in therapy, Alice's parents become aware of the many ways they have sent mixed messages to her, and she becomes aware of the pain she is causing in her family. Her bad behavior subsides soon after.

References:

  1. American Psychological Association. APA concise dictionary of psychology. Washington, DC: American Psychological Association, 2009. Print.
  2. Harwood, R., Miller, S. A., & Vasta, R. (2008). Child psychology: Development in a changing society. Hoboken, NJ: John Wiley & Sons.

 

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Last updated: 05-21-2015

     

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Oppositional and Defiant Behavior in Children and Teens