Dealing with Oppositional Children in the Classroom

One of the scariest issues for educators is dealing with oppositional children in the classroom. While confrontations do not occur every day in every classroom, most if not all secondary school educators will have to deal with a child who is acting belligerent and speaking in out in their classroom. Following are some ideas and tips to help diffuse the situation instead of allowing it to escalate even further.

Call the Office if You Require Help or an Office Escort—

While it is always best to try and diffuse the situation yourself, you should call the office and request additional adult assistance if things are escalating out of hand. If a child is cussing uncontrollably at you and/or other children, throwing things, hitting others, or threatening violence, you need to get assistance from the office.

Contact the Child's Mom and/or Dad—

Try to get the parent involved as soon as possible. Let them know what happened in class and what you would like them to do to help with the situation. Realize, however, that some moms and dads will not be as receptive as others in your efforts. Nonetheless, parental involvement can make a huge difference in many cases.

Create a Behavior Management Plan for Ongoing Issues—

If you have a child who is often oppositional, you need to call together a parent-teacher conference to deal with the situation. Include administration and guidance if you feel it is necessary. Together, you can create a plan for dealing with the child and possibly helping them with any possible anger management issues.

Do Not Get Other Children Involved—

It is counterproductive to get other children involved in the confrontation. For example, if the child is making an accusation about something you did or did not say, do not turn to the rest of the class to ask them what you said right at that moment. The oppositional child might feel backed into a corner and lash out even further. A better response would be that you will be happy to speak with them about the situation once they calm down.

Do Not Provoke a Child—

While this might seem obvious, it is a sad fact that some educators enjoy provoking their children. Do not be one of those educators. Spend your time focusing on what's best for each child and move beyond any petty feelings you might have about past classroom confrontations and situations. While you might privately dislike a child, you should never allow this to show in any way.

Do Not Lose Your Temper—

This can be harder than it sounds. However, it is imperative that you remain calm. You have a classroom full of children watching you. If you lose your temper and start shouting at an oppositional child, you have given up your position of authority and lowered yourself to the child's level. Instead, take a deep breath and remember that you are the authority figure in the situation.

Do Not Raise Your Voice—

This goes hand in hand with not losing your temper. Raising your voice will simply escalate the situation. Instead, a better tack is to talk quieter as the child gets louder. This will help you keep control and appear less oppositional to the child, thereby helping to calm the situation.

Privately Speak to the Child—

You might consider calling a hall conference with the child. Ask them to step outside to speak with you. By removing the audience, you can talk with the child about their issues and try to come to some sort of resolution before the situation gets out of hand. Make sure that during this time, you recognize that you understand they are upset and then talk with them calmly to determine the best resolution to the problem. Use active listening techniques as you talk with the child. If you are able to get the child to calm down and return to class, then make sure that you integrate the child back into the classroom environment. Other children will be watching how you deal with the situation and how you treat the returning child.

Talk With the Child at a Later Time—

A day or two after the situation has been resolved, pull the child involved aside and discuss the situation with them calmly. Use this to try and determine what the trigger was that caused the problem in the first place. This is also a great time to try and give the child ideas of other ways to deal with the situation that they might be able to use in the future. For example, you might have them ask to speak with you quietly instead of shouting in the middle of class. Please see my best teaching experience where I was able to turn an oppositional child into one who was productive and happy in my classroom.

Treat Each Child as an Individual—

Realize that what works with one child might not work with another. For example, you might find that one child responds particularly well to humor while another might get angry when you try to make light of the situation.

Use Referrals if Necessary—

An office referral is one tool in your behavior management plan. This should be used as a last resort for children who cannot be managed within the classroom environment. If you write referrals all the time, you will find that they lose their value both for your children and also for the administration as well. In other words, you want your referrals to mean something and to be acted on as necessary by the administrator in charge of the case.

==> My Out-of-Control Child: Parenting/Teaching Children with ODD


*ODD Support Group for Parents and Teachers

Behavioral Problems in Students with Oppositional Defiant Disorder [ODD]

Behavioral disorders also known as conduct disorders are one of the most common forms of psycho pathology among kids and young adults and is the most frequently cited reason for referral to mental health services. The appearance of behavioral disorders is increasing dramatically in our K-12 classrooms. As a result their presence severely constrains the ability of the school systems to educate children effectively. The prevalence of behavioral problems among kids and young adults is substantial. Many surveys indicate that behavioral disorders vary among young adults, ranging from 2 and 6% in K-12 children. This percentage translates into 1.3 to 3.8 million cases of behavioral disorders among the school and pre-college population.

Behavioral disorders become apparent when the ODD student displays a repetitive and impact persistent pattern of behavior that results in the significant disruption in other children. Such disturbances may cause significant impairments in academic, social, and or occupational functioning. Such a behavior pattern is consistent throughout the individual’s life. Among the characteristics of a behavioral disorder among kids and adolescents are:

• A display of bullying, threatening, or intimidating behavior.
• Being physically abusive of others.
• Deliberate destruction of other's property.
• Initiation of aggressive behavior and reacting aggressively towards others.
• Showing callous behavior towards others and lack of feelings of guilt or remorse.
• Showing little empathy and concern for the feelings, wishes, and well being of others.
• They may readily inform on their companions and tend to blame others for their own misdeeds.

General Strategies—

• Administer consequences immediately, then monitor proper behavior frequently.
• As a teacher, you should be patient, sensitive, a good listener, fair and consistent in your treatment of children with behavioral disorders.
• Ask previous educators about interactive techniques that have previously been effective with the ODD student in the past.
• Bring to the ODD student's attention science role models with disabilities with a similar disability to that of the student. Point out that this individual got ahead by a combination of effort and by asking for help when needed.
• Change rewards if they are not effective for motivating behavioral change.
• Determine whether the ODD student is on medication, what the schedule is, and what the medication effects may be on his or her in class demeanor with and without medication. Then adjust teaching strategies accordingly.
• Develop a schedule for applying positive reinforcement in all educational environments.
• Devise a contingency plan with the ODD student in which inappropriate forms of response are replaced by appropriate ones.
• Direct instruction or target behaviors is often required to help children master them.
• Do not expect children with behavioral disorders to have immediate success; work for improvement on a overall basis.
• Encourage others to be friendly with children who have emotional disorders.
• Enforce classroom rules consistently.
• Expose children with behavioral disorders to other children who demonstrate the appropriate behaviors.
• Have pre-established consequences for misbehavior.
• In group activities, acknowledge the contributions of the ODD student with a behavioral disorder.
• Make sure the discipline fits the "crime," without harshness.
• Monitor the ODD student's self-esteem. Assist in modification, as needed.
• Praise immediately at all good behavior and performance.
• Present a sense of high degree of possessiveness in the classroom environment.
• Provide encouragement.
• Reward more than you punish, in order to build self-esteem.
• Self-esteem and interpersonal skills are especially essential for all children with emotional disorders.
• Treat the ODD student with the behavioral disorder as an individual who is deserving of respect and consideration.
• Use time-out sessions to cool off disruptive behavior and as a break if the ODD student needs one for a disability-related reason.
• When appropriate, seek input from the ODD student about their strengths, weaknesses and goals.

Teacher Presentation—

• Administer consequences immediately, then monitor proper behavior frequently.
• After a week, or so, of observation, try to anticipate classroom situations where the student's emotional state will be vulnerable and be prepared to apply the appropriate mitigative strategies.
• As an educator you serve a model for the children who are behaviorally disturbed. Your actions therefore, must be consistent, mature, and controlled. Behavioral outbursts and/or angry shouting at children inhibit rather than enhance a classroom.
• Be fair and consistent, but temper your consistency with flexibility.
• Be positive and supportive.
• By using examples, encourage children to learn science so they can emulate adult behaviors.
• Change rewards if they are not effective for motivating behavioral change.
• Check on the ODD student's basic capacity to communicate and adjust your communications efforts accordingly.
• Consultation with other specialists, including the special education teacher, school psychologist, and others may prove helpful in devising effective strategies.
• Develop a schedule for applying positive reinforcement in all educational environments.
• Devise a structured behavioral management program.
• Direct instruction or target behaviors is often required to help children master them.
• Do not expect children with behavioral disorders to have immediate success; work for improvement on a overall basis.
• Encourage others to be friendly with children who have emotional disorders.
• Enforce classroom rules consistently.
• Expose children with behavioral disorders to other children who demonstrate the appropriate behaviors.
• Find ways to encourage the ODD student.
• Group participation in activities is highly desirable because it makes social contacts possible.
• Have pre-established consequences for misbehavior.
• Have the individual with the behavioral disorder be in charge of an activity which can often reduce the aggressiveness.
• If unstructured activities must occur, you must clearly distinguish them from structured activities in terms of time, place, and expectations.
• Instructions should be simple and very structured.
• Keep an organized classroom learning environment.
• Let your children know the expectations you have, the objectives that have been established for the activity, and the help you will give them in achieving objectives.
• Make sure the discipline fits the "crime," without harshness.
• Monitor the ODD student carefully to ensure that children without disabilities do not dominate the activity or detract in any way from the successful performance of the ODD student with the behavioral disorder.
• Monitor the ODD student's self-esteem. Assist in modification, as needed.
• Plan for successful participation in the activities by the children. Success is extremely important to them.
• Praise immediately and all good behavior and performance.
• Present a sense of positiveness in the learning environment.
• Provide a carefully structured learning environment with regard to physical features of the room, scheduling, routines, and rules of conduct.
• Provide encouragement.
• Remain calm, state the infraction of the rule, and avoid debating or arguing with the ODD student with a behavioral disorder.
• Reward more than you punish, in order to build self-esteem.
• Self-esteem and interpersonal skills are especially essential for all children with emotional disorders.
• Show confidence in the children ability and set goals that realistically can be achieved.
• Some aggressive children act as they do because of a subconscious desire for attention, and it is possible to modify their behavior by giving them recognition.
• Special efforts should be made to encourage and easily facilitate children with behavioral disorders to interact.
• Educators should reward children for good behavior and withhold reinforcement for inappropriate behavior.
• The environment must be structured but sensitive to the needs of these youth with behavioral disorders.
• Use a wide variety of instructional equipment which can be displayed for the children to look at and handle.
• When an interest in a particular piece has been kindled, the instructor can talk to the ODD student about it and show him or her how to use it.
• When appropriate, seek input from the children about their strengths, weaknesses and goals.
• You should refer the children to visual aids and reading materials that may be used to learn more about the techniques of skill performance.

Laboratory—

1. Activity instructions should be simple but structured.
2. Be sensitive when making team pairings for activities so that the ODD student with an emotional disorder is supported.
3. Consider alternate activities/exercises that can be utilized with less difficulty for the ODD student, but has the same or similar learning objectives.
4. Every effort should be made to arouse the interest of such children in laboratory activities, so they will learn to perform the activities with success and pleasure.
5. If a ODD student must be denied permission to use the equipment, this should be done on an impersonal basis so the student will not feel hurt or discriminated against.
6. If unstructured activities must occur, you must clearly distinguish them from structured activated in terms of time, place, and expectations.
7. If unstructured activities must occur, you must clearly distinguish them from structured activated in terms of time, place, and expectations.
8. Monitor carefully to ensure that the children without disabilities do not dominate the activity or detract in any way from the successful performance of the ODD student with the behavioral disorder.
9. Plan for successful participation in the laboratory activities by the children with behavioral disorder. Success is extremely important to them.
10. Some children with behavioral disorders may go to great lengths to avoid class participation. To feign their disorder is the method most frequently used, in hope of being excused from participation.
11. Special efforts should be made to get children with behavioral disorders to interact in laboratory activities.
12. To ensure success consider the special needs and interests of each person; give friendly, patient instruction in the laboratory skills; and continually encourage a wider interest in activities.
13. Use a wide variety of instructional equipment which can be displayed for the children to look at and handle.
14. When a ODD student displays a reaction of dislike to the activities this dislike usually stems from fear or lack of experience for the activity or factors inherent within the situation itself.
15. When an interest in a particular piece has been kindled, the instructor can talk to the ODD student about it and show him or her how to use it.

Group Interaction and Discussion—

• Acknowledge the contributions of the ODD student with an emotional disorder.
• Along with the student, devise a contingency plan in which inappropriate forms of response are replaced by appropriate ones.
• As the ODD student's comfort level rises and when a safe topic is available, encourage the student to be a group spokesperson.
• Call for responses and participation commensurate with the ODD student's socialization skills.
• Gradually increase the challenges in the student's participation in group exercises while providing increased positive reinforcement.
• Help the ODD student to feel as though he or she has something worthwhile to contribute to the discussion.
• Should monitor carefully to ensure that the nondisabled children do not dominate the discussion or detract in any way from the successful performance of the student with the behavioral disorder.
• Some children may experience considerable strain in social adjustment in a group context. It may be necessary to work gradually toward group activities. One can devise a strategy of progressing from spectatorship to one-to-one instruction and eventually to small group discussion.

Reading—

• It is necessary to target specific prosocial behaviors for appropriate instruction and assessment to occur such as:

1. Demonstrating appropriate reading.
2. Increasing positive relationships by means of awards when they read appropriately.
3. Reading in group or with others.
4. Taking turns, working with partner, following directions.

• Instructional strategies involving self-control, self-reinforcement, self-monitoring, self-management, problem solving, cognitive behavior modification, and meta-cognitive skills should be focused on teaching children reading skills

Research—

• Depending on the site of the research check the previous two sections.
• Review and discuss with the ODD student the steps involved in a research activity. Think about which step(s) may be difficult for the specific functional limitations of the student and jointly devise accommodations for that ODD student.
• Show clear examples of what the children should expect as an outcome of their research.
• Use appropriate laboratory and field strategies.

Field Experiences—

• Consider alternate activities/exercises that can be utilized with less difficulty for the ODD student, but has the same or similar learning objectives.
• Every effort should be made to arouse the interest of such children in activities, so they will learn to perform the activities with success and pleasure with appropriate behaviors.
• Gradually increase the challenges in the ODD student's participation in field exercises while providing increased positive reinforcement.
• Group participation in field activities is highly desirable because it enhances social contacts.
• Help the student to feel as though he or she has something worthwhile to contribute to the field trip.
• In field activities acknowledge the contributions and assistance of the student with an emotional disorder.
• Make the ODD student with the behavioral disorder become one of the field trip leader of an activity which can often reduce their disorder.
• Special efforts should be made to get children with behavioral disorders to interact with other children.
• Use a buddy system.
• Use appropriate general strategies.
• You should encourage children to practice field skills during their free hours.

Testing—

• Be sensitive to the ODD student's reactions to the various aspects of assessment.
• For each student, accumulate in his or her portfolio several examples of work (quizzes, assignments, projects) that demonstrate knowledge of the subject matter or the unit of study.
• Make special arrangements for the ODD student with an emotional disorder according to what their special needs are and that they do not compromise the integrity of the testing situation.
• Provide private room/smaller group setting/alternative test site (with proctor present); alternatively screens to block out distractions.
• Stay on top of ODD student progress through informal assessment, don't wait until it's too late to discover that there is a problem.

Improve Behavior Problems with the Right Curriculum—

Improve Behavior Problems - Inappropriate curriculum and instruction can lead to many types of problem behaviors among children with learning disabilities. Children may:

• Be embarrassed if material is not appropriate for their age levels.
• Become frustrated if material is too difficult.
• Feel bored with curriculum that is beneath their ability, or involving material that is not interesting to them.
• Feel defensive and disrupt the classroom to protect their egos, attempt to restore their "image" before the class.
• Feel like giving up if instructional delivery is too rapid.

When children with learning disabilities' learning needs are not met, they may show a range of behavior problems. Children's problem behaviors may:

• An attempt to have some control in a situation where they feel powerless;
• An attempt to shift attention away from their learning disabilities;
• Part of their disability, especially if ADHD is involved;
• The natural result of their frustration;
• The result of delayed social skill development or underdeveloped adaptive behavior skills.

Educators and moms and dads can reduce or prevent many behavior problems by:

• Adapt and modify materials to reduce the effect of the disability on classroom performance.
• Choosing materials that are of high interest to the ODD student. Have him select his own materials when possible.
• Ensure that materials are appropriate for your youngster's age level.
• Ensuring that instruction is delivered at or slightly above the youngster's current skill levels. Individual achievement assessment can provide information on a ODD student's skill levels that can be used to identify skills a ODD student needs to learn and provide guidance for selecting materials.

==> My Out-of-Control Child: Parenting & Teaching Children with ODD

* ODD Support Group for Parents and Teachers 

Parenting & Teaching Children with Oppositional Defiant Disorder [ODD]

Even the best-behaved kids can be difficult and challenging at times. Teens are often moody and argumentative. But if your youngster or teen has a persistent pattern of tantrums, arguing, and angry or disruptive behaviors toward you and other authority figures, he or she may have oppositional defiant disorder (ODD).

As a parent, you don't have to go it alone in trying to manage a youngster with oppositional defiant disorder. Doctors, counselors and youngster development experts can help.

Treatment of ODD involves therapy, special types of training to help build positive family interactions, and possibly medications to treat related mental health conditions.

It's not unusual for kids -- especially those in their "terrible twos" and early teens -- to defy authority every now and then. They may express their defiance by arguing, disobeying, or talking back to their moms and dads, teachers, or other adults. When this behavior lasts longer than six months and is excessive compared to what is usual for the youngster's age, it may mean that the youngster has a type of behavior disorder called oppositional defiant disorder (ODD).

ODD is a condition in which a youngster displays an ongoing pattern of uncooperative, defiant, hostile, and annoying behavior toward people in authority. The youngster's behavior often disrupts the youngster's normal daily activities, including activities within the family and at school.

Many kids and teens with ODD also have other behavioral problems, such as attention-deficit/hyperactivity disorder, learning disabilities, mood disorders (such as depression), and anxiety disorders. Some kids with ODD go on to develop a more serious behavior disorder called conduct disorder.

Symptoms—

It may be tough at times to recognize the difference between a strong-willed or emotional youngster and one with oppositional defiant disorder. Certainly there's a range between the usual independence-seeking behavior of kids and oppositional defiant disorder. It's normal to exhibit oppositional behaviors at certain stages of a youngster's development.

However, your youngster's issue may be ODD if your youngster's oppositional behaviors:

• Are clearly disruptive to the family and home or school environment
• Are persistent
• Have lasted at least six months

The following are behaviors associated with ODD:

• Defiance
• Disobedience
• Hostility directed toward authority figures
• Negativity

These behaviors might cause your youngster to regularly and consistently show these signs and symptoms:

• Academic problems
• Acting touchy and easily annoyed
• Aggressiveness toward peers
• Anger and resentment
• Argumentativeness with adults
• Blaming others for mistakes or misbehavior
• Deliberate annoyance of other people
• Difficulty maintaining friendships
• Refusal to comply with adult requests or rules
• Spiteful or vindictive behavior
• Temper tantrums

Related mental health issues—

Oppositional defiant disorder often occurs along with other behavioral or mental health problems such as:

• Anxiety

• Attention-deficit/hyperactivity disorder (ADHD)

• Depression

The symptoms of ODD may be difficult to distinguish from those of other behavioral or mental health problems.

It's important to diagnose and treat any co-occurring illnesses because they can create or worsen irritability and defiance if left untreated. Additionally, it's important to identify and treat any related substance abuse and dependence. Substance abuse and dependence in kids or adolescents is often associated with irritability and changes in the youngster's usual personality.

Causes—

There's no clear cause underpinning oppositional defiant disorder. Contributing causes are likely a combination of inherited and environmental factors, including:

• A youngster's natural disposition
• Abuse or neglect
• An imbalance of certain brain chemicals, such as serotonin
• Inconsistent or harsh discipline
• Lack of supervision
• Limitations or developmental delays in a youngster's ability to process thoughts and feelings

The exact cause of ODD is not known, but it is believed that a combination of biological, genetic, and environmental factors may contribute to the condition.

• Biological: Some studies suggest that defects in or injuries to certain areas of the brain can lead to serious behavioral problems in kids. In addition, ODD has been linked to abnormal amounts of special chemicals in the brain called neurotransmitters. Neurotransmitters help nerve cells in the brain communicate with each other. If these chemicals are out of balance or not working properly, messages may not make it through the brain correctly, leading to symptoms of ODD, and other mental illnesses. Further, many kids and teenagers with ODD also have other mental illnesses, such as ADHD, learning disorders, depression, or an anxiety disorder, which may contribute to their behavior problems.

• Environmental: Factors such as a dysfunctional family life, a family history of mental illnesses and/or substance abuse, and inconsistent discipline by parents may contribute to the development of behavior disorders.

• Genetics: Many kids and teenagers with ODD have close family members with mental illnesses, including mood disorders, anxiety disorders, and personality disorders. This suggests that a vulnerability to develop ODD may be inherited.

Risk factors—

A number of factors play a role in the development of oppositional defiant disorder. ODD is a complex problem involving a variety of influences, circumstances and genetic components. No single factor causes ODD.

Possible risk factors include:

• Being abused or neglected
• Exposure to violence
• Family instability such as occurs with divorce, multiple moves, or changing schools or youngster care providers frequently
• Financial problems in the family
• Harsh or inconsistent discipline
• Having a parent with a mood or substance abuse disorder
• Having moms and dads with a severely troubled marriage
• Lack of positive parental involvement
• Lack of supervision
• Moms and dads with a history of ADHD, oppositional defiant disorder or conduct problems

Stressful changes that disrupt a youngster's sense of consistency — such as divorce or moving — increase the risk of disruptive behavior. However, though these changes may help explain disrespectful or oppositional behavior, they don't excuse it. If you're concerned about your youngster's behavior or trouble adjusting to life changes, talk with your doctor.

Complications—

Many kids with oppositional defiant disorder have other treatable conditions, such as:

• Anxiety

• Attention-deficit/hyperactivity disorder (ADHD)

• Depression

• Learning and communication disorders

If these conditions are left untreated, managing ODD can be very difficult for the parents, and frustrating for the affected youngster. Kids with oppositional defiant disorder may have trouble in school with teachers and other authority figures and may struggle to make and keep friends.

ODD may be a precursor to other, more severe problems such as conduct disorder, substance abuse and severe delinquency.

Preparing for a Dr. appointment—

If your kid has signs and symptoms common to oppositional defiant disorder, make an appointment with your kid's doctor. After an initial evaluation, your doctor may refer you to a mental health professional, who can help make a diagnosis and create the right treatment plan for your kid.

Here's some information to help you prepare for your appointment, and what to expect from your doctor.

What you can do:

• Make a list of your kid's key medical information, including other physical or mental health conditions with which your kid has been diagnosed. Also write down the names of any medications, including over-the-counter medications, your kid is taking.

• Take a trusted family member or friend along, if possible. Sometimes it can be difficult to soak up all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.

• Write down questions to ask your doctor in advance so that you can make the most of your appointment.

• Write down the signs and symptoms your kid has been experiencing, and for how long.

• Write down your family's key personal information, including factors that you suspect may have contributed to changes in your kid's behavior. Make a list of stressors that your kid or close family members have recently experienced and share it with the doctor.

Questions to ask the doctor at your kid's initial appointment include:

• Are there any other possible causes?

• How will you determine the diagnosis?

• Should my kid see a mental health provider?

• What do you believe is causing my kid's symptoms?

Questions to ask if your kid is referred to a mental health provider include:

• Do you recommend any changes at home or school to encourage my kid's recovery?
• Do you recommend family therapy?
• Does my kid have oppositional defiant disorder?
• Is my kid at increased risk of any long-term complications from this condition?
• Is this condition likely temporary or chronic?
• Should I tell my kid's teachers about this diagnosis?
• Should my kid be screened for any other mental health problems?
• What else can I and my family do to help my kid?
• What factors do you think might be contributing to my kid's problem?
• What treatment approach do you recommend?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

What to expect from your doctor—

Being ready to answer your doctor's questions may reserve time to go over any points you want to talk about in-depth. You should be prepared to answer the following questions from your doctor:

• Do any particular situations seem to trigger negative or defiant behavior in your kid?

• Has your kid been diagnosed with any other medical conditions, including mental health conditions?

• Have your kid's teachers or other caregivers reported similar symptoms in your kid?

• How do you typically discipline your kid?

• How have you been handling your kid's disruptive behavior?

• How often over the last six months has your kid argued with adults or defied or refused adults' requests?

• How often over the last six months has your kid been angry or lost his or her temper?

• How often over the last six months has your kid been spiteful or vindictive, or blamed others for his or her own mistakes?

• How often over the last six months has your kid been touchy, easily annoyed or deliberately annoying to others?

• How would you describe your kid's home and family life?

• What are your kid's symptoms?

• When did you first notice these symptoms?

Tests and diagnosis—

To be diagnosed with oppositional defiant disorder, a youngster must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.

Criteria for oppositional defiant disorder to be diagnosed include a pattern of behavior that lasts at least six months and includes at least four of the following:

• Is often angry and resentful
• Is often spiteful or vindictive
• Is often touchy or easily annoyed by others
• Often actively defies or refuses to comply with adults' requests or rules
• Often argues with adults
• Often blames others for his or her mistakes or misbehavior
• Often deliberately annoys people
• Often loses temper

These behaviors must be displayed more often than is typical for your youngster's peers.

In addition, to be diagnosed with oppositional defiant disorder, a youngster's disruptive behavior:

• Must cause significant problems at work, school or home

• Must not meet the diagnostic criteria for conduct disorder or, if the affected person is older than age 18, antisocial personality disorder

• Must occur on its own, rather than as part of the course of another mental health problem, such as depression or bipolar disorder

It can be difficult for doctors to sort and exclude other associated disorders — for example, attention-deficit/hyperactivity disorder versus oppositional defiant disorder. These two disorders are commonly diagnosed together.

As with adults, mental illnesses in kids are diagnosed based on signs and symptoms that suggest a particular illness like ODD. If symptoms are present, the doctor will begin an evaluation by performing a complete medical history and physical exam. Although there are no lab tests to specifically diagnose ODD, the doctor may use various tests -- such as X-rays and blood tests -- to rule out physical illness or medication side effects as the cause of the symptoms. The doctor also will look for signs of other conditions that often occur along with ODD, such as ADHD and depression.

If the doctor cannot find a physical cause for the symptoms, he or she may refer the youngster to a youngster and adolescent psychiatrist or psychologist, mental health professionals who are specially trained to diagnose and treat mental illnesses in kids and teens. Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate a youngster for a mental illness. The doctor bases his or her diagnosis on reports of the youngster's symptoms and his or her observation of the youngster's attitude and behavior. The doctor often must rely on reports from the youngster's moms and dads, teachers, and other adults because kids often have trouble explaining their problems or understanding their symptoms.

Treatments and drugs—

Treating oppositional defiant disorder generally involves several types of psychotherapy and training for your youngster — as well as for you and your co-parent. If your youngster has co-existing conditions, particularly ADHD, medications may help significantly improve symptoms.

The cornerstones of treatment for ODD usually include:

• Cognitive problem solving training. This type of therapy is aimed at helping your youngster identify and change through patterns that are leading to behavior problems. Research shows that an approach called collaborative problem solving — in which you and your youngster work together to come up with solutions that work for both of you — is highly effective at improving ODD-related problems.

• Individual and family therapy. Individual counseling for your youngster may help him or her learn to manage anger and express his or her feelings more healthfully. Family counseling may help improve your communication and relationships, and help members of your family learn how to work together.

• Medication. While there is no medication formally approved to treat ODD, various drugs may be used to treat some of its distressing symptoms, as well as any other mental illnesses that may be present, such as ADHD or depression.

• Parent training. A mental health provider with experience treating ODD may help you develop skills that will allow you to parent in a way that's more positive and less frustrating for you and your youngster. In some cases, your youngster may participate in this type of training with you, so that everyone in your family develops shared goals for how to handle problems.

• Parent-child interaction therapy (PCIT). During PCIT, therapists coach moms and dads while they interact with their kids. In one approach, the therapist sits behind a one-way mirror and, using an "ear bug" audio device, guides moms and dads through strategies that reinforce their kid's positive behavior. Research has shown that as a result of PCIT, moms and dads learn more-effective parenting techniques, the behavior problems of kids decrease, and the quality of the parent-youngster relationship improves.

• Psychotherapy. Psychotherapy (a type of counseling) is aimed at helping the youngster develop more effective ways to express and control anger. A type of therapy called cognitive-behavioral therapy aims to reshape the youngster's thinking (cognition) to improve behavior. Family therapy may be used to help improve family interactions and communication among family members. A specialized therapy technique called parent management training (PMT) teaches moms and dads ways to positively alter their youngster's behavior.

• Social skills training. Your youngster also might benefit from therapy that will help him or her learn how to interact more positively and effectively with peers.

As part of parent training, you may learn how to:

• Avoid power struggles

• Establish a schedule for the family that includes specific meals that will be eaten at home together, and specific activities one or both moms and dads will do with the youngster

• Give effective timeouts

• Limit consequences to those that can be consistently reinforced and if possible, last for a limited amount of time

• Offer acceptable choices to your youngster, giving him or her a certain amount of control

• Recognize and praise your youngster's good behaviors and positive characteristics

• Remain calm and unemotional in the face of opposition

Although some parent management techniques may seem like common sense, learning to use them in the face of opposition isn't easy, especially if there are other stressors at home. Learning these skills will require consistent practice and patience.

Most important in treatment is for you to show consistent, unconditional love and acceptance of your youngster — even during difficult and disruptive situations. Don't be too hard on yourself. This process can be tough for even the most patient moms and dads.

Treatment for ODD is determined based on many factors, including the youngster's age, the severity of symptoms, and the youngster's ability to participate in and tolerate specific therapies.

Lifestyle and home remedies—

At home, you can begin chipping away at problem behaviors by practicing the following:

• Assign your youngster a household chore that's essential and that won't get done unless the youngster does it. Initially, it's important to set your youngster up for success with tasks that are relatively easy to achieve and gradually blend in more important and challenging expectations.

• Build in time together. Develop a consistent weekly schedule that involves moms and dads and youngster being together.

• Model the behavior you want your youngster to have.

• Pick your battles. Avoid power struggles. Almost everything can turn into a power struggle — if you let it.

• Recognize and praise your youngster's positive behaviors. Be as specific as possible, such as, "I really liked the way you helped pick up your toys tonight."

• Set limits and enforce consistent reasonable consequences.

• Set up a routine. Develop a consistent daily schedule for your youngster. Asking your youngster to help develop that routine may be beneficial.

• Work with your partner or others in your household to ensure consistent and appropriate discipline procedures.

At first, your youngster is not likely to be cooperative or to appreciate your changed response to his or her behavior. Expect that you'll have setbacks and relapses, and be prepared with a plan to manage those times. In fact, behavior often temporarily worsens when new limits and expectations are set. However, with perseverance and consistency, the initial hard work often pays off with improved behavior and relationships.

Teaching Students with ODD—

Getting a reaction out of others is the chief hobby of kids with ODD. They like to see you get mad. They try to provoke reactions in people and are often successful in creating power struggles. Therefore it is important to have a plan and try not to show any emotion when reacting to them. If you react too emotionally, you may make big mistakes in dealing with this youngster. Plan in advance what to do when this child engages in certain behaviors and be prepared to follow through calmly.

• Address concerns privately. This will help to avoid power struggles as well as an audience for a potential power struggle.

• Always listen to this child. Let him/her talk. Don't interrupt until he/she finishes.

• Ask moms and dads what works at home.

• Avoid all power struggles with this child. They will get you nowhere. Thus, try to avoid verbal exchanges. State your position clearly and concisely and choose your battles wisely.

• Avoid making comments or bringing up situations that may be a source of argument for them.

• Decide which behaviors you are going to ignore. Most kids with ODD are doing too many things you dislike to include all of them in a behavior management plan. Thus, target only a few important behaviors, rather than trying to fix everything.

• Do not take the defiance personally. Remember, you are the outlet and not the cause for the defiance- unless you are shouting, arguing or attempting to handle the child with sarcasm.

• Establish a rapport with the ODD youngster. If this youngster perceives you as reasonable and fair, you'll be able to work more effectively with him or her.

• Give the ODD child some classroom responsibilities. This will help him/her to feel apart of the class and some sense of controlled power. If he/she abuses the situation, the classroom responsibilities can be earned privileges.

• In the private conference be caring but honest. Tell the child calmly what it is that is causing problems as far as you are concerned. Be sure you listen as well. In this process, insist upon one rule- that you both be respectful.

• Make this child a part of any plan to change behavior. If you don't, you'll become the enemy.

• Never raise your voice or argue with this child. Regardless of the situation do not get into a "yes you will" contest. Silence is a better response.

• Praise childs when they respond positively.

• Provide consistency, structure, and clear consequences for the child’s behavior.

• When decisions are needed, give two choices or options. State them briefly and clearly. Childs with ODD are more likely to complete or perform tasks that they have chosen. This also empowers them to make other decisions.

• When you see an ODD youngster getting frustrated or angry, ask if a calming down period would help. But don't force it on him/her. Rather than sending the child down to the office for this cooling down period, it may be better to establish an isolated “calming down” place in the classroom so he/she can more readily re-engaged in classroom activity following the cooling down period.

Instructional Strategies and Classroom Accommodations for the ODD Child—

• Establish clear classroom rules. Be clear about what is nonnegotiable.

• Post the daily schedule so the child will know what to expect.

• Make sure academic work is at the appropriate level. When work is too hard, childs become frustrated. When it is too easy, they become bored. Both reactions lead to problems in the classroom.

• Pace instruction. When the child with ODD completes a designated amount of a non-preferred activity, reinforce his/her cooperation by allowing him/her to do something they prefer or find more enjoyable or less difficult.

• Systematically teach social skills, including anger management, conflict resolution and how to be assertive in an appropriate manner. Discuss strategies that the child may use to calm him/ or herself down when they feel their anger escalating. Do this when the child is calm.

• Select materials that encourage child interaction. Childs with ODD need to learn to talk to their peers and to adults in an appropriate manner. All cooperative learning activities must be carefully structured, however.

• Minimize downtime and plan transitions carefully. Childs with ODD do best when kept busy.

• Allow the ODD child to redo assignments to improve their score or final grade.

Coping and support—

For yourself, counseling can provide an outlet for your own mental health concerns that could interfere with the successful treatment of your child's symptoms. If you're depressed or anxious, that could lead to disengagement from your child — and that can trigger or worsen oppositional behaviors.

Here are some tips:

• Learn ways to calm yourself. Keeping your own cool models the behavior you want from your child.

• Take time for yourself. Develop outside interests, get some exercise and spend some time away from your child to restore your energy.

• Be forgiving. Let go of things that you or your child did in the past. Start each day with a fresh outlook and a clean slate.

What Is the Outlook for Children With Oppositional Defiant Disorder?

If your child is showing signs of ODD, it is very important that you seek care from a qualified doctor immediately. Without treatment, children with ODD may experience rejection by classmates and other peers because of their poor social skills and aggressive and annoying behavior. In addition, a child with ODD has a greater chance of developing a more serious behavioral disorder called conduct disorder. When started early, treatment is usually very effective.

Can Oppositional Defiant Disorder Be Prevented?

Although it may not be possible to prevent ODD, recognizing and acting on symptoms when they first appear can minimize distress to the child and family, and prevent many of the problems associated with the illness. Family members also can learn steps to take if signs of relapse (return of symptoms) appear. In addition, providing a nurturing, supportive, and consistent home environment with a balance of love and discipline may help reduce symptoms and prevent episodes of defiant behavior.

Many children with ODD will respond to the positive parenting techniques. Parents may ask their pediatrician or family physician to refer them to a child and adolescent psychiatrist or qualified mental health professional who can diagnose and treat ODD and any coexisting psychiatric condition.

==> My Out-of-Control Child: Parenting/Teaching Children with ODD

ODD Leading to Personality Disorder: Case Studies

Jayne-

When Jayne was four or five, she pretty much controlled the house. Somehow she had figured out exactly what she could get away with. She also was able to figure out where her parent's weak points were. More amazingly, she figured out where the weak points in their marriage were. This got so bad that her parents went to marriage counseling and finally adopted a policy of "united we stand, divided we fall" in regards to Jayne. This certainly helped keep Jayne in line in her elementary school years. Jayne also had ADHD, but it was never too severe. She only had to take medication for a few years at the end of elementary school. As she became a teenager, she began to have problems. The loss of a boyfriend led to cutting her wrists.

She always was in some sort of turmoil with her friends or the youth group. People were always trying to "save" her. The school counselor and the youth group leader both "knew in their hearts" that Jayne needed a lot of attention and special care and encouraged her parents to be more understanding on her sensitive nature. Jayne's grandfather said that he "knew in his heart" that Jayne needed a swift kick in the rear. As the teenage years went on, these problems just continued. She got involved in some minor crimes like shoplifting, tried vomiting to lose weight, and smoked pot. Each time she made such a big deal about the whole thing that her parents could hardly stand it. When she was 18, she moved in with an older guy who she thought "really understood her". They have been separated about six times so far. Her life continues in turmoil.

This points out the fact that sometimes, even with great parenting, things don't turn out so well. However, many times with aggressive intervention things go more like this:

Ricky-

Ricky was always hyper and always quite the con artist. The neighborhood mother's never really trusted him. He got referred after he hit the teacher hard enough to knock her down in second grade. We did everything. He took medications for his ADHD. The parents followed through with every type of intervention for ODD. He was very involved in cadets as a teenager. When he was about 19, I met his mother in a store. She wanted to tell me how well he turned out. He was still a bit of a hot head and was still on meds for ADHD, but he was working and had a steady girlfriend. He was hoping to join the militia. Ricky had turned out just fine.

==> My Out-of-Control Child: Parenting/Teaching Children with ODD

* ODD Support Group for Parents and Teachers

Conduct Disorder & Comorbid Conditions: Case Studies

Conduct Disorder (CD) plus Substance Abuse—

Sadly, this is very common. In my clinic, every youngster with CD is assumed to be abusing substances until proven otherwise. Compared with kids who do not have CD, kids who have CD are three times more likely to smoke cigarettes, 2.5 times more likely to drink, and five times more likely to smoke pot. As far as having a problem from drug use, kids with CD a 5.5 times more likely to be addicted to cigarettes, six times more likely to be alcoholics, 7 times more likely to be addicted to pot. This is certainly the most common comorbidity and often goes along with the ones below.

John-

When John was 9, he told his mom that he wanted to buy lunch instead of bring it. His mom at that point still believed that some of what John said was innocent of any other purpose, and so she let him. She did notice that he was very hungry when he came home from school. He said the lunches were small and for an extra 75 cents he could get seconds. She believed this. Two weeks later the principal called to report that John was caught with cigarettes on the playground. John's mom was amazed, as she did not smoke and neither did her husband. Not only that, but he had a whole pack. Well, it took a lot of "interrogation" to get the story out. The lunch money went to buy cigarettes from a boy in Jr. High. John then smoked a few of those and then sold the rest at a big profit. His parents remembered that two years later when he was found drunk in the locker room at Jr. High. Now his parents are lots wiser. John still thinks his parents are totally unreasonable. The rule is you get your allowance and phone privileges as long as those random urine drug screens are normal. If he doesn’t cooperate, then they are assumed to be positive. So he ended up poor and lonely for a few weeks, but now that is under control. As far as cigarettes go, if he can buy them, he can smoke them outside. If he is caught drinking or around people who are drinking, good-bye allowance and phone. John hates it and can't wait until he moves out so he can finally do what he wants.

Conduct Disorder (CD) plus ADHD—

When these two disorders are present, usually the ADHD symptoms are much more severe than when ADHD is present without CD.

Michael-

Michael is now 14. When his mother thinks back to his infancy, she could actually see it coming at age 18 months. At that age he got up in the middle of the night, put a chair up to the door, opened it and went walking outside. The cops found him a while later and brought him home. If only that had been his only contact with them!

Michael's mother hated school almost as much as Michael did. Almost every day there were calls from the school about Michael. In grade primary he tried to stab a youngster with scissors. He was swearing at his teachers by grade one. On Grade two it was stealing lunch money. Every time they seemed to get one problem under control, he was into something else. Everyone seemed at a loss about what to do except her brother. It didn't matter what the weather was like, Michael was out there. His uncle said that by the time he was ten, he could do the work of a grown man. There was no fear in Michael. Cold weather, big swells, nothing bothered him. He refused to do any homework from fourth grade on. Up until that grade, his teachers let him go out for a walk around the building every hour or so, but when a set of keys went missing and were "discovered" by Michael a few days later, the walks ended. Still, compared to the last few years, this was easy.

Michael was suspended from 7th grade after two weeks when he threw a match into a boy's locker. Why? The boy called him stupid. He was out for a week, then after only two more days, he was thrown out for making death threats against the teacher. His parents tried home school and they thought they were getting somewhere - until they got a call from the bank. They were overdrawn. When it all came out Michael had stolen the cash card and figured out the password and had taken out $500 dollars. They still don't know how he did it. Before they could even sort that out, Michael was arrested for vandalizing the school. He would have only received probation, but after giving the judge the finger, he was sent to the MCYC Youth Center. It was the staff there that finally figured it out. This guy could not sit still for anything, he said the first thing that came to his mouth, and was constantly getting in bigger trouble for it. He saw the doctor, ADHD was diagnosed, and he was given medication for this in the Youth Centre. But what will happen in two months when he gets out? His mother spends a lot of sleepless nights thinking about that.

Conduct Disorder (CD) and Depression—

Kara-

Kara is 14, too. Her life didn't start out quite so difficult. In fact, her mom swears that until she was almost 10, there were no problems. That is hard for everyone to believe now. Her mom remembers thinking that Kara was certainly starting the teen years early. At age 11 she was having a tantrum about not being able to go out with her boyfriend who was 15. You could hardly blame her. By the time Kara was 11, she looked like she was 15 or 16. Unfortunately, she did not have the maturity of a 16 year old. She ran away from home at age 12 for a week before they could find her. She brought a bottle of rum to school and got drunk. But more than this, she was absolutely unbearable to live with. She had become super defiant, and would fight her parents or anyone else for no reason at all. She never seemed happy, just angry. Unless she was with her friends, which by age 13 or 14 were 18 or so. Her parents kept asking themselves, "what had happened to their old daughter?” She was failing in school mostly because she was never there. She was never where she told her parents she said she was. The first clue came when she came home high on something and told her parents she was going up stairs to bed. They heard a crash and came in the bathroom to find her trying to cut herself with a broken mirror. Kara wanted to die. Her boyfriend of two months had left her. For a few weeks she just hung around the house and lay on her bed and listened to music. Her parents let her out one night to go to her girlfriend's house. They got a call later that night that Kara had admitted to taking a half a bottle of Tylenol.

It is not uncommon that a mood disorder along with CD gets missed. There are usually so many pressing problems to sort out and so many different stressors, that it isn't until suicide is tried or talked of that many families, physicians, and other health professionals consider comorbid depression. Recent studies of teenagers who have committed suicide have found that these kids are about three times more likely to have CD and 15 times more likely to abuse substance. Suicide is worth worrying about in CD.

Conduct Disorder (CD) plus Tourettes, OCD, and ADHD—

Jake-

Jake is now 12. He has seen more doctors, nurses, and psychologists than most people will see in a lifetime. His father worried that maybe his son could have Tourette's like him, but he never dreamed it could get like this. When he was 4 he was thrown out of pre-school for fighting. Because of his reputation, he was the first youngster where the school approached the parents about getting a teacher's aide in grade primary rather than the parents approaching the school. Lucky for Jake, he never seemed to have all of these problems at once. Usually he would have a tic, especially blinking, which would last a few weeks or so. Then he would have to touch things, and then that might go away, too. The tics and OCD were nothing compared to his behavior. His temper was incredible. The usual pattern was that the excitement of being around other kids would get him so wound up that he was literally bouncing around. This usually led to pushing, fighting, and punishment. He resisted this and usually ended up being sent home as they could not deal with him. He attacked him sister. He attacked his mother and broke her arm. That led to living with different relatives and now a foster home. No one seemed to be able to manage him. The new foster parents were actually being bothered the most by his poor sleep and a nearly constant vocal grunting tic. They brought him to yet another doctor to see if they could do anything about this. He was placed on some medicine for the tic and amazingly, he behavior improved quite a bit. For the first time his parents are hopeful that maybe he can come home again.

==> My Out-of-Control Child: Parenting/Teaching Children with ODD

* ODD Support Group for Parents and Teachers

ODD plus Depression/Anxiety: Case Studies

This is the other common combination with ODD. If you look at kids with ODD, probably 15-20% will have problems with their mood and even more are anxious. Here are some examples of how this can present:

Preschool Katherine—

Katherine is 4. She has not been an easy youngster. Her mom does not like to compare kids, but it is hard not to! Her brother is easy to get along with, excited, and energetic. She expected to have arguments with Katherine about doing a chore or task, but she ends up having an argument with Katherine about doing something fun! Katherine's first response to almost any activity is "No, I don't want to". Her mother has learned that if she can get Katherine out the door and to pre-school, for example, she does quite well once she is there. That is, as long as everything is going her way. It does not take much of a problem for Katherine to lose her temper. Two days ago she was called to preschool when another boy bumped Katherine and she dropped her cheese and cracker on the carpet. Katherine belted the youngster and screamed "I hate you, I hate this place, I hate it!" until her mother came. Of course the next day she was back again and things were going alright. Katherine's mother has some unusual memories, or at least she thinks so. She remembers last fall when they took Katherine horseback riding for the first time. Katherine's face showed true joy for a whole hour. Her mother did not know whether to cry or not, as she could not remember such an expression on her youngster's face before for more than a few moments. That memory makes her hopeful that somehow she can bring that joy back to Katherine.

It is not an easy task. The combination of being irritable and oppositional tests everyone's patience. She did not realize how stressful it was until she started bringing Katherine to a babysitter so she could go out and visit her friends. Finally she did not have to be thinking about how to keep Katherine from losing it every minute. She is finally coming to the decision that try as she might, she cannot make Katherine's life as smooth as Katherine wants it.

Elementary School Tommy—

Tommy is 11 years old. Tommy spends a lot of time in his room doing legos and making models. Then, all of a sudden there is a scream and stuff gets thrown around. If his parents are so unwise as to go up there, they will get to hear Tommy say that he hates this world, hates legos, and hates this stupid model. Then he will usually look up and say something awful to his parents. That is why they just leave him up there. He comes home from school crabby and throws his homework down and goes up plays in his room. His parents realize that he needs to get out and do something, but the only thing they can ever get him to do is go lift weights at the YMCA. Tommy's father has absolutely no interest in lifting weights, but he has done a pretty good job of convincing Tommy that he likes to go. That gets him out of the house about three times a week. As far as playing with other kids, unless his cousins come over, he won't play with anyone. His parents used to ask why and the answer was because no one likes me. Sad to say, it is not hard to figure out why Tommy would have that idea. When a friend comes over, he is so demanding and insists that the youngster do things just the way Tommy wants. Usually Tommy ends up sulking part of the time when he doesn't get his way. So now, his mom invites friends over for Tommy, but she plays right along side of the friend and Tommy. At least they aren't scared off that way.

At school, it is even worse. Everyone seems to know how easy it is to get Tommy to lose his temper. It happens almost every day. He bangs the desk, takes a swing at someone, swears, or kicks them. He is usually caught, and since he is so irritable anyway, the teachers hear a fair amount of defiance. Amazingly, he does pretty well in school once he gets going on something. This year he has changed classes. His old teacher was humble enough to admit that Tommy had pushed her too far and she could not take it any longer. She said she just could not remain professional. Tommy's mom knows how that could happen. Sometimes she just takes off for a walk when Tommy is driving her nuts. She knows she shouldn't leave him alone at home, but she figures if she doesn't go out in the woods for a walk there would be far greater dangers awaiting Tommy at home than if he was there alone. Tommy mostly wishes people would just stop bugging him. Once in awhile, right before bed, Tommy will ask him mom if it hurts to die or what it is like to be dead. She can't tell if he means it or is just saying that to bug her. She is afraid to even think about it.

High School Jeremy—

Jeremy is now 18. Things are going great for Jeremy this year. He is back in school, off drugs, and actually is getting along with his parents. In fact, he actually missed them when they went away. He has been helping his Dad put up dry wall after school. Both he and his parents are grateful for his recovery, but they wished they could have picked it up earlier, like when he was 12 or 13. That's when things really started to get worse. Jeremy had always had a hot temper and still does, but then it was unreal. At age 12 his parents would not let him go to a dance. He broke all the windows in their car. He lasted two months in 8th grade before he was suspended for fighting. Jeremy lost the few friends he had by getting kicked off the hockey team. He swore at a judge during a probation hearing and got two months in the Youth Center which was extended to six months after he tried to attack a guard. All the while he was so irritable and never happy. When he came home from the Youth centre he wanted to be able to drive. They said no, and he decided that was it and went out to hang himself in the barn. His parents still remember those words, "You'll all be f-ing better off without me and if you come after me I'll f-ing kill you, too". That horrible day was the turning point. It took five cops to get him to go to the hospital. It took a careful evaluation to figure out that he wasn't just oppositional, stubborn, and hot headed. He was very depressed, too. Now after 6 months of medical and non-medical interventions, he is 100% better. Jeremy admits that if he had to go back to living the way he was, he'd start thinking of suicide.

These examples show how very difficult the combination of ODD and depression can be for the family and the youngster. Often the depression gets mixed in the midst of dealing with the aggression and defiance. I commonly run across kids like Jeremy who have been oppositional and depressed but no one ever notices the depression until they make a suicide attempt. Looking for depression in ODD children is very important.

==> My Out-of-Control Child: Parenting/Teaching Children with ODD

* ODD Support Group for Parents and Teachers

ODD plus ADHD: Case Studies

If a child comes to a clinic and is diagnosed with ADHD, about 30-40% of the time the child will also have ODD. Here are some examples of how this looks across ages:

Pre-school Kaylee—

Kaylee is now 4 years old. Her parents were very excited when she turned four that perhaps that would mean that the terrible twos were finally over. They were not. Her parents are very grateful that the Grandparents are nearby. The grandparents are grateful that Kaylee's aunts and uncles live nearby. Kaylee's Aunt is grateful that this is her niece, not her daughter. Why? Kaylee requires an incredible combination of strength, patience, and endurance.

Kaylee begins her day by getting up early and making noise. Her father unfortunately has mentioned how much this bothers him. So she turns on the TV, or if that has been mysteriously disconnected, bangs things around until her parents come out. Breakfast is the first battleground of the day. Kaylee does not like what is being served once it is placed in front of her. She seems to be able to sense how hurried her parents are. When they are very rushed, she is more stubborn and might refuse it altogether. It would be a safe bet that she would tell her Mom that the toast tastes like poop. This gets her the first “time out” of the day.

In the mornings she goes to pre-school or goes off with her grandmother or over to her aunts. Otherwise Kaylee's mother is unable to do anything. Kaylee cannot entertain herself for more than a few moments. She likes to spend her time purposefully annoying her mom, at least so it seems. Kaylee will demand over and over that she wants something (e.g., play dough). She knows it must be made first. So her mom finally gives in and makes it. Kaylee plays with it about one minute and says, "Let’s do something" . Her mother reminds her that they are doing something, the very thing that Kaylee has been demanding for the last hour. "No, let’s do something else"

So after Kaylee's mother screamed so hard she was hoarse when her husband came home, Kaylee gets to go out almost every morning. At preschool she is almost perfect, but will not ever do exactly what the teacher wants. Only once has she had a tantrum there. Kaylee gets along with the other children as long as she can tell them what to do.

Her grandmother and Aunt all follow the same “time out” plan. This means she goes to a certain room until she calms down. The room is empty now at Kaylee's grandmother. Kaylee broke the toys, and they were removed. She banged the furniture around and it was removed. What sets Kaylee off is not getting to do what Kaylee wants. She screams, tells people she hates them, and swings pretty hard for a four old. After a half hour it is usually over, but not always. Kaylee will usually tell her mom or Grandmother about these tantrums. The story is always twisted a little. For example, Kaylee will tell her Grandmother that her mom locked her in her room because she was watching TV. Her grandmother used to believe these stories, and Kaylee could tell the whole story of how she was watching this show, and her mom just came in and dragged her to her room.

Now it turns out that Grandma doesn't think much of TV anyways, and so this made a certain amount of sense to her. This led to more than one heated argument between the Grandma and her mom. Of course there was almost no truth to this at all. It took the tables being turned for the Grandma to really believe that her Granddaughter could set up an argument like this. Kaylee came home and told her mom that Grandma let her eat four cookies and an ice cream cone for a treat and that she was very full. Kaylee's mom doesn't think much of treats, and could see how this might happen and thought she would have to talk to her mom. Finally they both realized what Kaylee was doing.

Most of the afternoon with Kaylee is spent chasing her around trying to wear her out. It doesn't seem to work, but it is worth a try. When she is at her aunts, she tries to wreck her cousin’s stuff. When is she good? When there are no other cousins around and she has the complete attention of her Aunt or Grandpa.

Kaylee loves the bedtime battle. She also loves to go to the Mall. But she never gets to go there or hardly anywhere else. She acts up so badly that her family is very embarrassed. Her mother shops and visits only when Kaylee goes to preschool. It is hard to know who is more excited about Kaylee going to school next year, her mother or Kaylee!

Elementary School Toby—

Toby is 10. Toby's day usually starts out with arguing about what he can and can not bring to school. His mother and his teacher have now made out a written list of what these things are. Toby was bringing a calculator to school and telling his teacher that his mother said it was alright. At first his teacher wondered about this, but Toby seemed so believable. Then Toby brought a little (Toby's words) knife. That led to a real understanding between the teacher and Toby's mother.

Toby does not go to school on the bus. He gets teased and then retaliates immediately. Since it is impossible to supervise bus rides adequately, his parents and the school gave up and they drive him to school. It is still hard to get him there on time. As the time to leave approaches, he gets slower and slower. Now it is not quite as bad because for every minute he is late he loses a dime from his daily allowance.

Once at school, he usually gets into a little pushing with the other kids in those few minutes between his mother's eyes and the teacher's. The class work does not go that badly now. Between the daily allowance which is geared to behavior and his medicine, he manages alright. This is good for everyone. At the beginning of the school year he would flip desks, swear at the teacher, tear up his work and refuse to do most things. Looking back, the reasons seem so trivial. He was not allowed to go to the bathroom, so he flipped his desk. He was told to stop tapping his pencil, so he swore at the teacher.

Recess is still the hardest time. Toby tells everyone that he has lots of friends, but if you watch what goes on in the lunch room or on the playground, it is hard to figure out who they are. Some kids avoid him, but most would give him a chance if he wasn't so bossy. The playground supervisor tries to get him involved in a field hockey game every day. He isn't bad at it, but he will not pass the ball, so no one really wants him on his team.

After school was the time that made his mom seriously considered foster care. The home work battle was horrible. He would refuse to do work for an hour, then complain, break pencils and irritate her. This dragged 30 minutes of work out to two hours. So, now she hires a tutor. He doesn't try all of this on the tutor, at least so far. With no home work, he is easier to take. But he still wants to do something with her every minute. Each day he asks her to help him with a model or play a game at about 4:30.

Each day she tells him she cannot right now as she is making supper. Each day he screams out that she doesn't ever do anything with him, slams the door, and goes in the other room and usually turns the TV on very loud. She comes up, tells him to turn it down three times. He doesn't and is sent to his room. She calculated that she has made about 1500 suppers since he was five years old. Could it be that they have gone through this 1500 times? She decides this is not a good thought to follow through. After supper Toby's dad takes over and they play some games together and usually it goes fine for about an hour. Then it usually ended in screaming. So Toby's grandmother had the bright idea of inviting them over for desert at about 8:00 pm most nights. But what about days when there is no school? Toby's parents try very hard not to think about that.

High School Courtney—

Courtney is 15. She is in ninth grade, and from her grades, you would say there is no big problem. She is passing everything, but her teachers always comment that she is capable of much more if she tried. If they gave marks for getting along with others, it would be a different story. Courtney's best friend is currently doing a 6 month sentence for vandalism and shoplifting. Courtney and Robin have been friends since fall, if you can call it that. Since Courtney has almost no other friends, she will do anything to be Robin’s friend. At least that is what her parents think. Courtney thinks it is "cool" that Robin is at the MCYC Youth Center. One sign of this friendship was that Courtney almost always gave her lunch money to Robin. Why? Because Robin wanted it. Courtney thought that Robin was her friend, but everyone could see that Robin was just using her.

What seemed saddest to Courtney's parents is that Courtney could not see this at all. But this was nothing new. She would make a friend, smother them with attention, and that would be the end of it. Or, the friend would not do exactly what Courtney wanted and there would be a big fight, and it would be over. But mostly Courtney complained that everyone bugged her. What seemed to save Courtney was the nursing home. Somewhere along the way Courtney got involved working there. To hear the staff there talk about her, you would never guess it was the same girl. Helpful, kind, thoughtful - they couldn't say enough good about her. In fact her parents joked that maybe if they all moved to the nursing home, it would stop the fighting at home.

They figured it out when another teenager volunteered to help one of the same afternoons as Courtney. Unfortunately the "other" Courtney came out. She was tattling, annoying, disrespectful and hard to get along with. Courtney could get along with any one, as long as they weren't her age, a teacher, or a relative!

These examples stress some of the common features of this comorbid combination. Extremely major social problems with relatively little academic problems are common. Recent research suggests that all things being equal, females with ODD plus ADHD have significantly worse social problems than males with ODD plus ADHD. Courtney in the example above illustrates this.

==> My Out-of-Control Child: Parenting/Teaching Children with ODD

* ODD Support Group for Parents and Teachers