Changing your view of oppositional defiant disorder (ODD)

During the early years it is difficult to differentiate between age appropriate behaviour and something more concerning.

Need to know

During the early years it is difficult to differentiate between age appropriate behaviour and something more concerning. You’ve probably heard of the terrible twos, threenagers and the fournados, all named after developmental changes that come with children becoming more aware of the world around them and their place in it. By the age of 6 most children have started school and certain behavioural differences become more obvious and difficult to manage using traditional parenting methods.

Oppositional Defiant Disorder (ODD) is characterised by extreme disobedience and hostility towards authority figures. To be diagnosed, it must be present for at least 6 months and severely impact daily life. Children and adolescents with ODD may have trouble controlling their temper, show a pattern of angry or irritable mood, defiant behaviour, or vindictiveness.

Children with untreated ODD can go on to develop Antisocial Personality Disorder and more seriously a Conduct Disorder (CD). Early intervention can effectively treat ODD and prevent severe problems with relationships and career stability later on in life.

Why it’s important

Traditional methods of treating ODD include Parent Management Training that rely heavily on punishments and rewards to curb the behaviour of the child. The focus is on the behaviour (symptom) rather than what is causing it. But research in this space continues to evolve, and now experts in the field are shining a light on how trauma and anxiety can underlie dysregulated and oppositional behaviour.

According to Mona Delahooke – PhD, child psychologist and author of Beyond Behaviours -, the neuroscience of ODD is important in how we go about treating it “We also need to abandon old models treating a child with an ODD diagnosis as needing to work on simply becoming more compliant—essentially, blaming the child. Too often, we assume that what a child or teen needs is better behavioral management, more consistent parenting, or better medication. But current neuroscience shows otherwise: the behaviors we label in ODD are likely ways of responding to stress. They indicate a pattern of underlying emotional dysregulation that regularly sends the child into a fight/flight response.” 1

Having this new understanding of ODD can help you reframe your perspective from thinking “my child is giving me a hard time” to asking “why is my child having a hard time?”. This view is very powerful in shaping how you respond to ODD behaviours. If you see your child as someone who is experiencing severe and often unpredictable stress responses, you will be more empathetic to their needs and receptive to finding the root cause.

Tips and strategies

Keywell can help you to record and identify what is setting in motion behaviours of concern, in the meantime, there are some things you can do at home to help your child manage these intense stress responses.

1. Self pep talk – you are probably worn down from constant friction, so it’s important to engage your inner monologue by reminding yourself that the misbehaviour is not deliberate. Your calmness will help you de-escalate your child more than your anger.

2. Create safety & sooth – if you take the view that your child is stuck in a fight-or-flight response triggered by a sense of danger, the first step is to make them feel safe. Their nervous system is on high alert and you need to first switch that off. Keep in mind that the rational part of the brain goes offline and you cannot reason with your child at this point. Instead, you can establish a sense of safety by.

  • Removing the stimulation/stressors – if possible, take them away from the (noisy/hot/busy) environment or ask the person at the centre of the confrontation to step away.
  • Using reassuring language – your tone of voice can make a huge difference to your child and them feeling safe. The louder they shout the softer your voice should become.
  • Using physical touch – you can put your hand on their shoulder or give them a strong hug, but only if they are receptive to touch. You might need to find a different way to sooth them if they are reactive to being touched. Consider music, a comfort toy or weighted blanket

3. Connect & teach – learning and problem solving can only happen when the fight-or-flight response is switched off and the thinking brain can be reactivated. Your child needs to be calm before they can take in what you say. Wait until you are both calm before attempting to communicate with them.

  • Find the trigger – turn on your empathy and dig deeper into your child’s stressors or difficulties. Give them the opportunity to explain their point of view without accusations or shame. This is your chance to learn more so that you can work together on finding a solution.
  • Help to recognise the signs – talk about the physical sensations that they experience before losing control. By recognising the physical changes in their body, your child can learn to implement regulation techniques or signal to you that they need help regulating.
  • Identify strategies – together with your child, you can find the regulation strategy that works for them.  Breathing, counting, walking away, finding a safe space, and signaling are techniques that, with practice, your child can implement to self regulate or ask for help regulating.
  • Brainstorm solutions – together with your child, you can agree on solutions that will address the problem or trigger that sets off the behaviour. With everyone’s concerns on the table it is easier to find a satisfactory outcome that takes into consideration their feelings and your worries.

4. Consequences not punishments – in many cases punishments can only make things worse. A consequence relates to the event and doesn’t shame the child. For example: 

  • siblings are fighting over a toy, the consequence is that the toy gets put away; 
  • siblings are arguing because they can’t agree on what they watch on TV, the consequence is that the parent chooses something for everyone to watch; 
  • your child smashes the iPad, the consequence is their pocket money is used to fix the damage.

5. Get professional help – find someone who is open to looking into what is causing the behaviour rather than just focusing on behaviour management. Depending on you child’s age, consider Cognitive Problem-Solving Skills Training to teach your child positive ways of responding to stressful situations

6. Self care – if you are the primary caregiver you must make your self-care a priority to avoid burning out. Ask friends or family to help, even if it’s only for a few hours or look into respite services. You will parent better when you feel your best.

Resources

  1. https://monadelahooke.com/deconstructing-oppositional-defiant-disorder/
  2. https://www.aafp.org/afp/2008/1001/p861.html
  3. https://starr.org/2011/oppositional-defiant-disorder-or-trauma/
  4. https://www.besselvanderkolk.com/uploads/docs/dtd_paper_wendy_dandrea_ortho.pdf
  5. https://raisingchildren.net.au/guides/a-z-health-reference/odd
  6. https://www.aacap.org/App_Themes/AACAP/docs/resource_centers/odd/odd_resource_center_odd_guide.pdf
  7. https://static1.squarespace.com/static/5c1d025fb27e390a78569537/t/5ccdff181905f41dbcb689e3/1557004058168/Neuroception.pdf
  8. https://www.coregcommunity.com/_files/ugd/ca2e13_4e82d0f2ef4642c0a7bbf0f586f74e13.pdf
  9. https://www.coregcommunity.com/_files/ugd/ca2e13_b791571d82eb48c79bba38e2dfac6753.pdf

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