MENTAL HEALTH Stress & Anxiety • Obsessive-compulsive disorder • Post-traumatic stress disorder (PTSD) • Phobias • Panic attacks • Generalized anxiety disorder • Adjustment disorders • Social anxiety disorder (social phobia) • Oppositional defiant disorder (ODD)

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Even the best-behaved children can be difficult and challenging at times. Teens are often moody and argumentative. But if your child 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). Emotionally draining for the parents and distressing for the child, oppositional defiant disorder can add fuel to what may already be a turbulent and stressful family life.

You may walk on eggshells around your child with oppositional defiant disorder, not knowing what may trigger a tantrum or argument. While this is one of the most difficult of behavioral disorders, setting firm boundaries with consistent consequences plus a commitment to improving your relationship with your child can help your family overcome the dominating grip that oppositional defiant disorder may have on your household.

The foundation of treatment of ODD is behavioral management. Parents don't have to go it alone in trying to manage a child with oppositional defiant disorder. Doctors, counselors and child development experts can help you learn specific parenting strategies and use proven techniques to help build a foundation of trust between you and your child and improve the underlying basis for these disruptive behaviors.

It may be tough at times to recognize the difference between a strong-willed or emotional child and a child who has oppositional defiant disorder. And certainly there is a range between the normal independence-seeking behavior of children and oppositional defiant disorder. It's normal for children to exhibit oppositional behaviors at certain stages of their development. However, if your child's oppositional behaviors are persistent, have lasted at least six months and are clearly disruptive to the family and home or school environment, the issue may be oppositional defiant disorder.

The following are behaviors associated with ODD:

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

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

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

Oppositional defiant disorder often occurs along with other behavioral or mental health problems such as attention-deficit/hyperactivity disorder (ADHD), anxiety or depression. The symptoms of ODD may be hard to distinguish from those of other behavioral or mental health problems.

There's no clear cause underpinning oppositional defiant disorder. Contributing causes may include:

• The child's inherent temperament
• The family's response to the child's style
• A genetic component that when coupled with certain environmental conditions, such as lack of supervision, poor quality daycare or family instability, increases the risk for ODD
• A biochemical or neurological factor
• The child's perception that he or she isn't getting enough of the parent's time and attention

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 alone causes ODD; however, the more risk factors a child has for ODD, the greater the risk for developing the disorder. Possible risk factors include:

• Having a parent with a mood or substance abuse disorder
• Being abused or neglected
• Harsh or inconsistent discipline
• Lack of supervision
• Poor relationship with one or both parents
• Family instability such as multiple moves, changing schools frequently
• Parents with a history of ADHD, oppositional defiant disorder or conduct problems
• Financial problems in the family
• Peer rejection
• Exposure to violence
• Frequent changes in daycare providers
• Parents who have a troubled marriage or are divorced

If you're concerned about your child's behavior or your own ability to parent a challenging child, seek help from your doctor, a child psychologist or child behavioral expert. Your primary care doctor or your child's pediatrician can refer you to someone.

The earlier this disorder can be managed, the better the chances are for reversing its effects on your child and your family. Treatment can help restore your child's self-esteem and rebuild a positive relationship between you and your child.

Doctors usually diagnose oppositional defiant disorder through information supplied by parents and teachers. It can be difficult for doctors to sort and exclude other associated disorders — for example, attention-deficit/hyperactivity disorder versus oppositional defiant disorder.

Behavioral and mental health conditions are difficult to definitively diagnose. There's no blood test or imaging technique that can pinpoint an exact cause of behavioral symptoms, though these tests are sometimes used to rule out certain conditions. Physicians and other health professionals rely on their clinical judgment and experience, information gathered from parents and teachers who may fill out questionnaires, and possibly from interviewing the child.

Many children with oppositional defiant disorder have other treatable conditions such as ADHD, depression and anxiety. If these conditions are left untreated, managing ODD can be very difficult for the parents, and frustrating for the affected child. Kids with oppositional defiant disorder may have trouble in school with teachers and other authority figures and may struggle to make friends.

ODD may be a precursor to other, more severe behavioral disorders such as conduct disorder, but this is controversial.

Oppositional defiant disorder is not something your child can overcome on his or her own, nor can it be solved with medication, herbal supplements, vitamins or a special diet. Successful treatment of oppositional defiant disorder requires commitment and follow-through by you as parents and others involved in your child's care. But most important in treatment is for you to show consistent, unconditional love and acceptance of your child — even during difficult and disruptive situations. Doing so can be tough for even the most patient parents.

Ideally, treatment for oppositional defiant disorder involves your primary care doctor and a qualified mental health or child development professional. These health professionals can screen for and treat other mental health problems that may be interfering with oppositional defiant disorder, such as ADHD, anxiety or depression. Successful treatment of the often co-existing conditions will improve the effectiveness of treatment for ODD. In some cases, the symptoms of ODD disappear entirely.

A mental health professional can help you learn or strengthen specific skills and parenting techniques to help improve your child's behavior and strengthen your relationship with him or her. For example, you can learn how to:

• Give effective time-outs
• Avoid power struggles
• Remain calm and unemotional in the face of opposition
• Recognize and praise your child's good behaviors and positive characteristics
• Offer acceptable choices to your child, giving him or her a certain amount of control

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 may require counseling, parenting classes or other forms of education, and consistent practice and patience. At first, your child is not likely to be cooperative or to appreciate your changed response to his or her behavior. Expect that you'll have set backs and relapses, and be prepared with a plan to manage those times.

Individual counseling for your child may help him or her learn to manage anger. Family counseling may help improve communication and relationships and help family members learn how to work together. Again, it's crucial to identify and treat any other disorders that may be affecting your child along with oppositional defiant disorder.

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

• Recognize and praise your child's positive behaviors
• Model the behavior you want your child to have
• Pick your battles
• Set limits and enforce consistent reasonable consequences
• Develop a consistent daily schedule for your child
• Work with your spouse or others in your household to assure consistent and appropriate discipline procedures
• Assign your child a household chore that is essential and that won't get done unless the child does it

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. A depressed or anxious parent may disengage from his or her child, and that can trigger or worsen oppositional behaviors.

• 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.