Oppositional Defiance Disorder: A Breakdown

Written By: Alex Basche, ACS Clinical Intern, Adolescent Substance Abuse Treatment & Community Counseling Programs  

Through my work in ACS’ Substance Abuse Treatment program, it is not uncommon to see co-occurring behavioral disorders in youth struggling with substance abuse. Anxiety, mood and behavioral disorders top the list of the most common adolescent mental health diagnoses, so it is no surprise to see these coincide with substance abuse issues in teens. Oppositional Defiant Disorder (ODD) is prevalent in youth I work with at ACS, so I’ve broken down the facts.

What is ODD
Oppositional Defiant Disorder (ODD) is defined by the DSM-V (The Diagnostic and Statistical Manual used by mental health professionals to diagnose individuals) as “a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least six months as evidenced by at least four symptoms from any of the [defined] categories and exhibited during interaction with at least one individual who is not a sibling.”

Now I know what you may be thinking: “But Alex, you literally just described the majority of teenagers!”  Yes, reader, that I did.

With ODD however, these behavior patterns and mood changes are pervasive and are typically seen with any authority figure regardless of the person’s relationship with them. Such behaviors are typically more severe than what would be expected for someone of the person’s age. So a 15-year-old who is defiant, argumentative and prone to slamming doors might not necessarily have ODD. A 7-year-old with these same behaviors, however, would stand a better chance of qualifying. The behaviors we might see for this 15-year-old with ODD would look more like a deliberate throwing of his father’s car keys in the garbage as revenge for being grounded, rather than an age-appropriate disobedience or outburst.

What Causes ODD?

There are a number of factors that research has shown to contribute to the development of ODD. These include:

Biological

• A brain-chemical imbalance.
• A mother who smoked during pregnancy.
• Poor nutrition in infancy.
• A slow development in the part of the brain responsible for impulse control and judgment.

Family/Psychological

• Absent parent(s).
• Poor relationship with parent(s).
• Neglect or abuse.
• Inconsistent discipline.
• Instability in the home.

The Concern for You and Your Child

If the above symptoms describe your child, you may feel like you’re struggling to stay above water. Simple tasks may result in huge blowups, which might cause instability in your home, hamper your ability to work, or impede your own self-care.

While your child may indeed already be experiencing the negative consequences of their behavior, it is important to understand that, if left untreated, ODD may proceed into Conduct Disorder. Conduct Disorder is marked by intense aggression and defiance including bullying, property destruction, violence towards animals and people as well as deceitful behavior. Those with Conduct Disorder are also at a much higher risk than others to develop a substance abuse disorder.

Treatment Options

Therapeutic intervention is often used in conjunction with medication.  These interventions typically focus on coaching the parent and strengthening their own “toolkit” for working with their child.  Interventions such as Parent-Child Interaction Therapy (PCIT) as well as behavioral coaching from Cognitive Behavioral Therapy (CBT) have been shown to be helpful.  The goal will be to help you create clear, firm, consistent boundaries in your home while also teaching your child healthy coping techniques, assertive manners of communicating their needs/emotions as well as how they can attain an appropriate level of control in your home.
To fully understand the impact medication can have on a child with ODD, it is important to note that the most common diagnosis that also occurs with ODD is Attention-Deficit-Hyperactivity-Disorder (ADHD).  Many children with ODD also have ADHD and it is thus important for your child to also be evaluated for this as well.
Medication may include:

• Psychostimulants such as Ritalin or Adderall (when ADHD is present)
• Blood-pressure medication such as Catapres and Tenex.
• Antidepressants such as Prozac, Lexapro, Celexa.
• In severe cases, antipsychotics such as Abilify, Geodon, Risperdal.

While ACS therapists do not provide medication for mental health issues, we partner with a youth’s primary care physician to ensure that all facets of treatment are provided. Supporting youth mental health is an important part of our community, and ACS professionals are trusted partners for this vital service.

For more information on ODD:

An Overview by The Mayo Clinic

The American Academy of of Child and Adolescent Psychiatry: ODD Fact Sheet and Conduct Disorder Fact sheet