How to recognize and manage children and youth with Oppositional Defiant Disorder

1. Training created and presented by Brenda McCreight Ph.D.

2. DSM-IV Criteria
• A pattern of negativistic, hostile, and defiant behavior lasting at least six
months during which four or more of the following are present:
• 1. Often loses temper
• 2. Often argues with adults
• 3. Often actively defies or refuses to comply with adults'
• requests or rules
• 4. Often deliberately annoys people
• 5. Often blames others for his or her mistakes or misbehavior
• 6. Is often touchy or easily annoyed by others
• 7. Is often angry and resentful
• 8. Is often spiteful and vindictive
• Brenda McCreight Ph.D. workshops 2014

3. Symptoms of ODD
• Repeated temper tantrums, can look like Temper Dysregulation
Disorder
• Constant arguing with adults/authority figures
• Chronic non-compliance with reasonable requests & basic rules
• Deliberately annoys others
• Easily upset by others
• Blames others for her own mistakes, can’t take responsibility
• Brenda McCreight Ph.D. workshops 2014

4. And more…
• Frequent outbursts of anger
• Resentment and jealousy
• Spiteful and will seek revenge on perceived slights
• Swearing
• Says mean and hateful things when confronted or when he believes
he is wronged
• Doesn’t respond well to therapy or medications
• Doesn’t learn or change behavior from consequences or from positive
re-inforcement
• Brenda McCreight Ph.D. workshops 2014

5. What causes ODD?
• Three possible causes:
• 1. Environment - dysfuncational/chaotic family life,
mother smoking during pregnancy, exposure to
toxins
2. Genetics – other family members may have a
mental health diagnosis
• 3. Biological/Neurodevelopmental problems –
the brain is miswired or underdeveloped
• There is no universal agreement on the causes or the *cure*
•
Brenda McCreight Ph.D. workshops 2014

6. ODD doesn’t like to be alone…
• Many children with ODD have other conditions as well, such as:
• 50-65% have ADHD
• 35% will eventually develop some form of affective
disorder such as Bipolar disorder, depression or anxiety
• 15% develop some form of personality disorder
• Many have co-existing learning disorders
• Brenda McCreight Ph.D. workshops 2014

7. Who gets ODD?
• Approximately 10.2% of all children will develop ODD
• It was once thought that the condition affects mainly boys, but it is now being
recognized that girls also develop ODD
• There is no agreement on whether ODD exists into adulthood.
• For those who believe it can exist in adults, it is also
believed the adult often have co-existing mental health
conditions, such as antisocial or borderline personality
disorder and depression.
•
Brenda McCreight Ph.D. workshops 2014

8. What’s the prognosis of childhood ODD?
•
•
•
•
Most children grow out of it.
Approximately 70% will have no behavioural problems by the age of 18.
About 10% of all children with ODD will go on to develop conduct disorder.
The earlier a child develops ODD behaviour, the more likely it is that the
condition will develop into the more dangerous conduct disorder.
• Children who develop ODD before the age of 10 are at highest risk of
developing conduct disorder.
• The children who develop conduct disorder are at high risk of developing
lifelong mental illnesses, including anti-social personality disorder.
• Children with ODD are also at a much higher risk of developing other
mental illnesses, including depression and anxiety.

9. How to treat and manage children with
ODD?
• First and most importantly – recognize and accept that the child did
not choose to have this condition and cannot simply choose to
behave in a more acceptable manner. S/he is doing the best possible.
• As the parent or caregiver – learn to deal with your own anger and
frustration about the behaviours – find support, learn all you can
about ODD, develop self care strategies for yourself ie breathing,
meditation, exercise, help your other children cope with the
behaviors of the ODD child or youth.
• Brenda McCreight Ph.D. workshops 2014

10. For the child or youth…
• Teach and role play social skills training to increase the capacity to read
body language and social cues- much like social skills training for children
with autism
• Teach anger management skills
• Teach stress management
• Teach basic problem solving
• Provide academic support
• Give minimal choices
• Provide stability and predictability in the environment
• Teach listening skills

11. More…
• Help the child get enough sleep
• The child may be rejected from sports and other activities with peers
so try to help him or her find sports activities that can be solo events
ie swimming, skating, biking.
• The child may fixate on video games for companionship and for
stimulation and because the games don’t want him or her to behave
– watch for gaming addiction
• Children and youth with ODD require a high level
of parent or caregiver involvement

12. Important points to remember….
• Don’t focus on changing the child’s behaviors – instead – focus on changing
the child’s emotional state! The positive behaviors will follow.
• Notice the good moments and praise them
• Offer encouragement more than correction
• The child or youth will often have an emotional age that is years behind his
or her chronological or cognitive age
• ODD causes a child to be isolated and alienated from family and peers –
focus on creating or maintaining a relationship
• Don’t try to *fix* all of the negative behaviors at once- focus on two or
three at a time
•
Brenda McCreight Ph.D. workshop 2014

13. Medications?
• There is no universal agreement about whether medications help
ODD
• Many children who have ODD require mediations to treat their
co-existing conditions such as ADHD

14. Final words…
• Children and youth with ODD will have the condition for years, so be
prepared to be a highly involved parent or caregiver for a long time
• Plan for self care over the years
• Plan for transitions
• Have a behavior plan or strategy in place for triggering events
• Love the child – you may be all s/he has…

15. Thank you for sharing this time with me!
• You can check out my other services and products at these sites…
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• I provide counselling and consulting in my office or worldwide by
skype or phone. You can contact me at 250-716-9101 or email
brenda@lifespanmediation.org