What causes ODD?
There are two main sources of the two main symptom categories of Oppositional Defiant Disorder (ODD):
- Most ODD symptoms stem from limitations in the ability to regulate emotion. The emotional regulation and impulsive aspects of ADHD can be one of the main underlying causes of ODD.
- The social conflict component of ODD is learned, or habitual, usually resulting from a pattern of parent-child interaction that is highly emotional and inconsistent. The child’s emotional dysregulation can exacerbate the parents’ emotional response to the behavior and vice versa. There is often one parent who experiences more of the ODD reactions from the child at first, then over time the ODD patterns expand to other authority figures such as teachers. Usually this takes time.
How is ODD treated?
When there is a concomitant ADHD, treatment of ADHD often results in reduction in the emotion regulation and impulsivity components of ODD. Starting with treatment of the ADHD is a helpful way to initiate the re-patterning of the social relationships in which conflict has become a default.
For individuals with ODD who do not have ADHD, starting with treatment of the emotion regulation via medication, therapy, or a combination thereof is usually beneficial.
One helpful thing to remember about ODD is that the symptoms of ODD are by nature “ego-dystonic,” meaning that, by definition, the individual with ODD experiences internal distress related to the symptoms, and experiences the symptoms as interfering with her functioning in family and social relationships. This is an important feature of ODD to keep in mind, because the argumentative tendencies and anger/irritability naturally elicit a defensive reaction. This is a natural and expected dynamic and will occur inevitably.
The thing to do when on the receiving end of ODD symptoms is to provide neutral and systematic response to the behavior. This is much easier said than done, and often requires support for parents and/or partners of the individual with ODD. A combination of a systematic parent training program for the parents plus individual psychotherapy for the child/adolescent will be most beneficial.
ODD is a pattern of escape avoidance learning. The oppositional behavior is not a way to seek attention. It is a way to escape the demands of parents.
Ignoring ODD will feed right into the process of escape. It is the inconsistency in the success/failure of the oppositional behavior that breeds its persistence. The thing to do is to add positive attention and implement a consistent reinforcement schedule, all the while decreasing the emotional valence of the reaction to the child’s behaviors.
