Oppositional Defiant Disorder Symptoms and Management

Does “no” seem to be your child’s favorite word? Do you expect temper tantrums whenever you set a boundary or deny your child something? Do you struggle with their constant arguments and pushback? Or has your child exhibited resentful, spiteful, or vengeful attitudes or behaviors?

The word no may be only two letters long, but in some children the constant message of defiance comes across loud and clear. Children usually start to embrace their ability to say no when they reach around two years old, and it marks an important stage of their development.

However, when your older child or teen is saying no to almost anything you ask, you may be dealing with oppositional defiant disorder (ODD).

SYMPTOMS OF OPPOSITIONAL DEFIANT DISORDER

Many kids and teens demonstrate a rebellious streak or resistance to typical parental requests, like completing their chores or going to bed on time. But oppositional defiant disorder in children means that their responses of no are severe or persistent (lasting 6 months or more). They may even say no to things that most kids would enthusiastically agree to.

ODD, a behavioral disorder, is estimated to affect 2% to 11% of all children. Kids with ODD tend to be uncooperative at both home and school, causing relationship difficulties with parents, teachers, peers, and siblings. They may argue, become easily annoyed, or throw temper tantrums.

How many nos are considered excessive enough to indicate ODD? If you find that asking a question receives a refusal from your child more than 7 out of 10 times—perhaps even reaching 10 of 10—that’s a sign you may be dealing with ODD.

More formally, the National Library of Medicine shares 8 symptoms listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The child should show at least 4 of these on most days for at least 6 months:

1. Loses temper
2. Touchy or easily annoyed
3. Angry and resentful
4. Argues with authority figures or (for children and adolescents) with adults
5. Actively refuses or defies complying with requests or rules
6. Deliberately annoys others
7. Blames others for his or her mistakes or misbehavior
8. The child has been spiteful or vindictive at least twice within the past 6 months

OPPOSITIONAL DEFIANT DISORDER AND THE BRAIN

In brain SPECT scans at Amen Clinics, oppositional defiant disorder in children has been linked with increased activity in the front part of the brain, including in a brain region called the anterior cingulate gyrus (ACG).

Healthy Brain SPECT Scan

ODD SPECT Scan

SPECT is a functional brain-imaging technology that evaluates blood flow and activity in the brain. In simple terms, it shows areas with healthy activity, too little activity, or too much activity.

In the scans shown here, blue represents average activity while red and white represent increased activity levels.

In the healthy brain scan, the highest level of activity is seen in the cerebellum (situated at the back/bottom of the brain). In the ODD brain scan, there is excessive activity in the ACG.

Known as the brain’s gear shifter, the ACG is the region that allows us to switch up our thoughts. Someone with too much activity in the ACG means they’re more likely to get stuck in a thought loop or fixed on a single action.

Not surprisingly, SPECT scans also show this brain pattern in those with obsessive-compulsive disorder (OCD). But in oppositional defiant disorder, the brain gets stuck specifically on negating—which can look like repeatedly saying no or arguing.

Due to the difficulty in shifting thoughts, parents can find themselves unable to dissuade their child from a problematic line of thinking or behavior.

Though many children grow out of this condition, ODD is also possible in adults. Researchers have known for years that oppositional defiant disorder in adults often corresponds not only to ODD in childhood, but to other co-occurring mental health conditions.

For example, one study found that people who had attention-deficit/hyperactivity disorder (ADHD) and a childhood history of ODD displayed increased risk for bipolar disorder, multiple anxiety disorders, and substance use disorders, compared to ADHD patients without ODD.

Researchers concluded that both children with ODD and adults with a childhood history of ODD “have high rates of psychiatric comorbidity and more impaired psychosocial functioning” than those without ODD. 

OPPOSITIONAL DEFIANT DISORDER TREATMENT

Understandably, parents dealing with children who have oppositional defiant disorder symptoms often feel stressed, confused, or even hopeless. But children with ODD can be helped with treatments for oppositional defiant disorder—even without the use of prescribed drugs.

It’s critical to diagnose and treat oppositional defiant disorder, because ODD can point to, or lead to, larger issues. The Cleveland Clinic reports that most children and teens with ODD have at least one additional mental health concern, such as:

• ADD/ADHD
• OCD (or another type of anxiety disorder)
• Differences in learning or learning disabilities
• Clinical depression or other mood disorders
• Impulse-control disorders

In addition, roughly 30% of children with ODD will eventually show signs of conduct disorder, which encompasses both behavioral and emotional problems that may escalate to aggression.

On a positive note, patients at Amen Clinics have found success with natural treatments for ODD, including using nutraceuticals for symptom regulation.

One study in the Journal of Abnormal Child Psychology showed that omega-3 fatty acid supplements, combined with individual and family psychoeducational psychotherapy (a family-focused type of cognitive behavioral therapy), showed promise in treating youth with depression and behavior problems like ODD.

Another study in Frontiers in Psychology noted that diet may have an impact on ODD behavior, as children with both ADD/ADHD and ODD were found to experience a major decrease in symptoms by following a few-foods diet.

In addition to individual and family therapy, a variety of other helpful treatment options for children and parents alike include:

• Parent management training to help families manage the problematic behavior
• Social skills training to help enhance the child’s flexibility in social settings and situations
• Cognitive behavioral therapy to help children reframe their negative thoughts and thus improve their behavior

HOW FAMILIES CAN MANAGE OPPOSITIONAL DEFIANT DISORDER

Families can also benefit from utilizing a variety of coping techniques at home with their children. For example, try offering positive reinforcement for good behavior and setting age-appropriate consequences for unacceptable behavior.

Work with your child’s other authority figures, from teachers to other parents, to exchange management skills.

Here are some additional tips for helping your child with ODD:

1. Set an example.

When you engage in arguments by yelling or acting out, you’re only modeling the behavior that you’d like to eradicate in your child. Conversely, if you always give in to their tantrums, you’ll reinforce that behavior pattern, too.

Instead, stay firm, calm, and kind. And, since ODD or oppositional thinking can run in families, examine your own behavior. Do you struggle with obsessive thoughts, compulsive behaviors, or an inflexible personality? Find ways you can make an effort to think and act in a more flexible manner.

2. Prevent the no.

When you ask a child with ODD a yes or no question, chances are, you will receive a no in response. Instead, offer your child an either-or option—for example, “Would you prefer either X or Y?”

An additional tactic is to include them in the decision-making process by offering possible time frames on completing a task. Allowing them to choose their timing can help remove them from the stuck thought patterns around being defiant.

3. Break patterns.

Another way to interrupt the stuck thought patterns associated with ODD is to suggest a time-out when arguments feel heated. You’ll not only allow yourself and your child to cool down, but you’ll also throw a wrench in the loop of negative thinking.

Distractions and cool-downs can be helpful for both children and parents. Return to the issue later, with a clearer and calmer head.

FINDING HELP FOR OPPOSITIONAL DEFIANT DISORDER

While oppositional defiant disorder symptoms in children can create stressful dynamics at home and in school, there is hope for those who are affected. It’s important to include the entire family in the management and treatment process, while ensuring proper diagnosis of any other mental health conditions that may be present.

Brain SPECT scans can help identify co-occurring conditions. And pairing natural treatments with therapeutic techniques can help minimize the impacts of ODD, allowing your child to grow and develop into a healthy, responsible adult.

Oppositional defiant disorder (ODD) and other mental health issues can’t wait. At Amen Clinics, we’re here for you. We offer in-clinic brain scanning and appointments, as well as mental telehealth, clinical evaluations, and therapy for adults, teens, children, and couples. Find out more by speaking to a specialist today at 877-247-7938 or visit our contact page here.