Coping With Oppositional Defiant Disorder

Apr 22, 2014

Social Worker Cynthia Holcomb helps "Mrs. Smith’s" son by teaching him coping skills.
Credit Carla Eckels

Oppositional defiant disorder, ODD is characterized as argumentative, hostile, defiant behavior, and is reported to affect up to 16 percent of young people. Sometimes ODD is one of several behavioral disorders that can cause problems at school and at home. KMUW’s Carla Eckels reports...

Families who must live with ODD face a sensitive and often difficult path. Because of that we are not using actual names for this story.

“Mrs. Smith” lives in Sumner County. Several years ago, she married into a family which included a child who showed signs of having the disorder.

"I thought uhhhh, I don't know if we can do this because he was out of control," she says. "I don’t know any other term to say it but that he would have tantrums if he didn’t get his way you know he was just not a very likable child at the time."

Many children who are tired, hungry or upset certainly can disobey or argue with parents. But in children and teens with ODD, symptoms occur more frequently and can interfere with their relationships and with their ability to adjust to different environments.

"I'll never forget the first time I ever went to a department store with him," Smith says. "He wanted something, he had a melt down that was just terrible and I thought oh, if I get you out of this store... you will never come back to this store."

Mrs. Smith and her husband noticed other issues with their child, so they took him to a center in Wichita that works with children with special needs.

"He might know his ABC’s today, but then tomorrow he might forget, so we knew that there was some problems there," she says. "So we took him to Heartspring in the summer between second grade and third grade year. We had him tested and he went to several sessions, several testings, and the diagnosis was ADHD with ODD."

Psychiatrist Heidi Ogden

 "I think an important thing about Oppositional Defiant Disorder is to also look and make sure that there’s not any other mental health problems going on," says Psychiatrist Heidi Ogden.

"Oppositional Defiant Disorder in itself is a child who defies authority figures, is argumentative, doesn't follow the rules very well," she says. "But there's a lot of things that can cause those symptoms such as Attention Deficit Hyperactivity Disorder (ADHD) which is very treatable. Depression in children comes out as a lot of defiance and that's treatable. Anxiety in children can comes out as not minding and talking back so it's very important to look for....other reasons that a child is acting up, talking back intentionally, annoying others, rather than just giving the diagnosis of ODD."

Dr. Ogden says that Oppositional Defiant Disorder is thought to be caused by a combination of biological, psychological, and social factors. ODD tends to occur in families with a history of ADHD, substance use, or mood disorders such as depression or bipolar disorder. Mr. and Mrs. Smith sought help for their child through counseling sessions at the Mental Health Association in Wichita. Dr. Ogden says that counseling and consistency are two of the keys.

"They can learn positive coping skills, it can help the parents do a better job with their discipline, consistency is absolutely imperative to help a child learn how to react to consequences," she says. "If you aren't consistent on how you discipline a child, they will continue to push the limits because sometimes the parent gives in and goes ahead and says, "Oh go ahead and do it,  it's too much work to keep this limit."

Another parent who is dealing with a child with ODD is "Ms. Jones," who is a single mom living in Wichita with her 13-year old daughter. Ms. Jones’ teenager has been diagnosed with a combination of disorders including ODD, ADHD, and depression. Ms. Jones says her daughter is one IQ point above the level that would be considered mild mental retardation. She says that when her daughter was a toddler, she didn’t act like a typical child.

"She was very defiant," Jones says. "She didn't want to listen. She was very aggressive. She was very violent. Everything that you told her, she didn't want to do. She would throw things. She would hit her head against the wall. She just didn’t listen to anything."

Ms. Jones says her daughter's behavior now is kind of like the weather.

"She's up and she's down," Jones explains. "She'll have a good day you know for maybe a week and then she'll have a bad day for a week and you never know what's going to set her off."

"Violence and severe aggression are not typically part of ODD," Dr. Ogden says. "You can get children with high levels of aggression when ODD is accompanied by other mental health problems such as severe ADHD, depression, Bipolar Disorder, and psychotic symptoms. But ODD on it’s own does not usually include aggression."

Ms. Jones uses coping skills she learned through parenting classes to try and redirect her teenager before a meltdown and also on how to keep her daughter busy with activities. Parenting classes also helped Mrs. Smith deal with negative behavior with her child.

"I now teach that parenting class just to learn what to do with children with ODD. We've learned that we have to stand our ground, there has to be consequences," she says.

Mrs. Smith says her son receives a lot of praise too. He works with the school’s social worker, Cynthia Holcomb.

"He's learned a lot of coping skills that he’s been using, social skills to get along with his peers," Holcomb says. "He's made a lot of improvement over time and is doing very well."

Holcomb says it’s important to be consistent with the rules as well as the rewards. Offering positive praise, such as 7 positive things said for every one negative thing, makes a huge difference. Holcomb also instructs teachers on strategies to use in the classroom.

"Maybe giving them extra breaks," she says. "Having something that they can fit it with their hands, trying to use some of those coping skills that I've worked with the kids individually or in group with, so that when they do start to get escalated, or upset, or frustrated, the teachers can recognize that and help them take that break."

Some children are given medication for disorders, but for Oppositional Defiant Disorder, Dr. Ogden says that medications are not usually recommended.

"I don’t believe that medication is indicated for ODD alone," she says. "But it’s very important to see if there’s another physical or mental health problem that is treatable by medication. ODD alone, the number one treatment for that is family therapy and individual therapy.”

Most everyone agrees it’s the counseling, the consistency, and the healthiest support group you can get that will help families who are working to cope with ODD everyday.

For more information on ODD, click on our links below:

American Academy of Child Adolescent Psychiatry - Oppositional Defiant Disorder Resource Center

Health Research Funding

Mental Health Partners - ODD Tips For Parents.

This story originally aired on Morning Edition on April 22, 2014.