ODD: More than just 'bad behaviour'

If there’s one thing parents can agree on it’s that their child has had a tantrum, or a major meltdown while refusing to do something that you’ve asked of them. The internet is filled with cringe-worthy videos of children having meltdowns over seemingly small issues (whether these should be shared is best kept for another discussion).

But how are parents supposed to know whether their child is simply struggling with a big emotion or whether there is something more serious and long lasting to deal with?

Dr Jade Sheen, Associate Professor School of Psychology at Deakin University says when psychologists are asked to see a child who is being consistently difficult, they look at how long the child’s behaviour has been causing issues. They also look at the impact their behaviour has on the rest of their family and friends, as well as the impact on peers at daycare or school.

“It’s when we see that the child’s behaviour is consistently rebellious or they are consistently angry and that their behaviour is having a negative impact at home as well as in a daycare or school environment, that’s when we’d consider a diagnosis of oppositional defiant disorder,” Dr Sheen says.

“It’s a very challenging area because every child has difficult and temperamental times. But, when it comes to looking at ODD, children with ODD exist in a more extreme end of the challenging spectrum.”

What exactly is ODD and how serious is it?

Put simply, ODD is more than just “bad behaviour”. It means the child cannot cooperate with anything – whether it’s putting on their shoes, sharing a toy or eating their lunch.

No matter what the parent asks them to do, a child with ODD thinks the request is unreasonable and they will refuse to comply – many will become angry or aggressive.

According to Dr Sheen, children with ODD rebel, are stubborn, argue with adults, and refuse to obey. They have anger outbursts and have a hard time controlling their temper, and they’ll exhibit oppositional defiant behaviour in more than one setting.

“A typical child with ODD will be defiant in the home and in other areas such as daycare or school, and they will show this behaviour to more than one person, for example, a parent, as well as a teacher. A sign that your child has ODD is that their behaviour is occurring every day across the board,” Dr Sheen says.

“And a child with ODD will even be defiant when they’re asked to do something that is in the child’s best interest, yet they’re still being oppositional.

“So when their behaviour is starting to interfere with relationships and their day to day life, that’s when the parents need to look seriously at whether their child has ODD.”

Dr Sheen says ODD is seen in one to sixteen per cent of the population, depending on the criteria and assessment methods used, with rates higher in boys than in girls.

However, some researchers believe the criteria used to diagnose ODD contain bias which may lead to a more likely diagnosis for  boys.

The causes and strategies

And while ODD doesn’t seem to have a single cause, Dr Sheen says some factors make a child more vulnerable to developing ODD, including family history of behavioural difficulties, poverty, inconsistent parenting and community violence.

“Some strategies we’d suggest is to offer limited choices wherever possible, and also give the child an opportunity to back down from an argument without losing face.

“Children with ODD will very rarely acknowledge that they’re wrong or that they’re going to follow instructions, but if you say, for example, ‘It seems to me you’ve got two choices, which one would you want?’, then they’re more likely to comply.”

Dr Sheen says an example of this could be a situation where a child is refusing to get out of a swimming pool and come inside for dinner. The child repeatedly refuses to get out of the pool – so what is the parent to do?

“You can get in the pool and chase after them, but it could be dangerous for one or both of you. You could ignore the defiance; but then the child learns that defiance works,” Dr Sheen says.

“You could offer limited choices. For example, you might say, ‘I can see you're having a good time. I imagine you don't want it to end but dinner is on the table. It seems to me you have two choices. You can get out of the pool, have some dinner, and we will make it in time for netball tonight. Or you can stay in the pool and miss out. It's up to you.

“Option two, (our consequence) is something that you can directly manage whether or not you take them to netball.”

Dr Sheen says parents must realise that all behaviour is a form of communication and parents sometimes get so lost in trying to respond to defiant behaviour that they forget to look for triggers.

“Some triggers are directly related to the incident of concern. Others, such as fatigue or problems with friends, occur in the background but challenge the child's coping resources and lead to a later escalation. Once you have identified triggers you can make a plan to address them together,” Dr Sheen says.

“It’s also important to avoid situations where you find yourself in a standoff with the child. It’s not a good idea to create a situation where both parent and child are both digging their heels in and both insisting it has to be their way.

“While you may not agree with their point of view, hearing them out lets them know you are genuinely interested in their ideas and that, where possible, you will work together towards a resolution.”

Most importantly parents, extended family and school staff need to work collaboratively. This means talking regularly, being clear on the best approaches for supporting your child, and communicating the plan back to your child as openly as possible.

“Parents need to seek help when they recognise that their child’s defiant behaviour has continued for longer than two weeks and is impacting them across a couple of environments or is impacting their relationships or their overall functioning.  If that is happening, then it’s definitely worth seeking help of a psychologist or a counsellor.”