P: We have a nine-year-old son, Jason, who has recently been diagnosed with Oppositional Defiant Disorder (ODD). Since he was three years old, we were told he simply had a „strong character.“ How can a parent or professional differentiate between a „strong-willed child“ and Oppositional Defiant Disorder? Can ODD be diagnosed before the age of nine? What can you tell us to help our son with this condition?
R: I have worked individually in private practice and in group therapy with children who have ODD. The diagnosis is difficult. The diagnosis is based on the criteria from the „Diagnostic and Statistical Manual of Mental Disorders“ (DSM5-TR), published by the American Psychiatric Association. A task force of experts in child and adolescent disorders devised the diagnostic criteria. Obviously, some children under the age of nine have enough behaviors that match the diagnostic criteria and can be diagnosed early, while others have fewer clear symptoms.
The criteria for diagnosing oppositional defiant disorder include a pattern of angry or irritable moods, as well as argumentative/defiant or vindictive behavior that lasts for a minimum of six months, demonstrated by at least four symptoms from any of the three categories (angry/irritable mood, argumentative/defiant behavior, and vindictive attitude). These behaviors must be demonstrated towards at least one person other than a sibling. ODD can be classified as mild, moderate, or severe. It is estimated that between 1% and 11% of children have this disorder (DSM5TR, p.464)
What can parents do to help a child with oppositional defiant disorder? Once diagnosed, a child with ODD needs a combination of parent training, medication, and behavioral therapy. Additionally, here are some suggestions for parents:
- Be patient with your child and learn as much as you can about ODD.
- Read books on raising a child with ODD. For example: „Parenting Children with Oppositional Defiant Behavior“ by Erika Bishop, 2023; „Oppositional Defiant Disorder Activities“ by Laura McLaughlin, 2022. This book contains „100 exercises that parents and children can do together to improve behavior, develop self-esteem, and foster connection.“
- Set boundaries and give clear instructions. In my practice, I have sometimes written expectations/behavior instructions on a card that the child keeps in their pocket. When they need to be reminded of the limits or expected behavior, I ask them to take out their card to review it.
- Avoid getting into power struggles. If you see one about to start, request a break. Set a time to resume the conversation.
- Encourage your child to identify their feelings and practice self-control. Encourage communication rather than acting out.
- Reward the behavior you want to see in your child. Use verbal praise or small rewards.
- Use consequences that you can control and that are appropriate for your child. For example, suspending the privilege of using video games, television, or cell phones.
We hope these suggestions that have worked for other parents and therapists will help guide your child with oppositional defiant disorder.
Betty Richardson, PhD, RN, CS, LPC, LMFT, is an Austin-based psychotherapist.