Q We have a nine-year-old son who has just been diagnosed with Oppositional Defiant Disorder (ODD). We were told from the time he was three that he was just “strong-willed.” How can a parent or professional tell the difference between a “strong-willed child” and oppositional defiant disorder? Can ODD be diagnosed earlier than nine years old? What can you tell us to help our son with this condition?
A I’ve worked individually in private practice and in group therapy with kids who have ODD. Diagnosis is difficult. It is based on criteria in the “Diagnostic and Statistical Manual of Mental Disorders” (DSM5-TR), published by the American Psychiatric Association. Obviously, some children younger than nine years old have enough behaviors that match the criteria, and they can be diagnosed early while others have fewer clear symptoms.
The criteria for diagnosis of ODD include: a pattern of angry or irritable moods and argumentative /defiant behavior or vindictiveness which lasts a minimum of six months. These behaviors must be demonstrated toward at least one person who is not a sibling. ODD can be classified as mild, moderate or severe. Somewhere between 1% and 11% of children are estimated to have this disorder (DSM5TR, p.464).
What can parents do to help a child with oppositional defiant disorder? Once diagnosed, a child with ODD needs a combination of parental training, medication and behavioral therapy. In addition, here are some suggestions for parents:
- Be patient with your child and learn as much as you can about ODD.
- Read books on parenting a child with ODD. For example: “Parenting Children with Oppositional Defiant Behavior” by Erika Bishop, 2023; or “Oppositional Defiant Disorder Activities” by Laura McLaughlin, 2022. This book contains “100 exercises parents and kids can do together to improve behavior, build self- esteem and foster connection.”
- Set limits and give clear instructions. In my practice, I’ve sometimes written behavioral expectations/instructions on an index card that the child puts in his pocket. When he needs a reminder of the limits or expected behavior, I ask him to get out his card to review.
- Avoid getting into power struggles. If you find one beginning, call for a break. Set a time to resume the talking.
- Encourage your child to identify his feelings and to practice self-control. Encourage communication instead of acting out.
- Reward behavior you want to see from your child. Use verbal praise or small treats.
- Use consequences that you can control and are appropriate for your child. For example, suspending the privilege of video games, TV or cell phone use.
Hopefully these suggestions that have worked for other parents and therapists will work to help as you guide your child with oppositional defiant disorder.
Betty Richardson, PhD, RN, CS, LPC, LMFT, is an Austin-based psychotherapist.