If your child has been diagnosed with Oppositional Defiant Disorder (ODD), or if you suspect they might be struggling with it, you’re probably feeling a mix of emotions. Parenting is challenging, and when difficult behaviors arise, it can feel like you’re drowning. ODD is often misunderstood, and labels like this don’t always tell the full story. This guide will break down what ODD is, its symptoms, possible causes, and effective ways to support your child.
Listen to our full podcast episode to learn more about this diagnosis.
What is Oppositional Defiant Disorder (ODD)?
ODD is a pattern of persistent defiance, irritability, and argumentative behavior that lasts at least six months and creates significant challenges at home, school, or with peers. It goes beyond typical childhood stubbornness (and beyond squabbles with their siblings). Kids with ODD often struggle with authority figures, frequently lose their temper, and may intentionally push boundaries in ways that feel extreme.
Some common symptoms of Oppositional Defiant Disorder in children include:
- Frequent temper outbursts
- Excessive arguing with adults
- Refusing to follow rules or comply with requests
- Blaming others for their mistakes
- Purposefully annoying or provoking people
- Acting spiteful or vindictive
These behaviors usually show up more with certain people or in specific settings, like with parents, teachers, or at school.
Learn more:
How Is ODD Diagnosed?
ODD is diagnosed in roughly 2 to 11 percent of children and is more commonly identified in boys than girls. Although, this may be just due to differences in how our society interprets certain behaviors. No matter the diagnosis, the goal is to understand what is driving your child’s behavior and how to support them effectively.
A therapist will meet with you and your child to complete different assessments together. They’ll ask you questions about their behavior, how long these issues have been present, if there have been any major changes or adjustments in recent months, how their general health is, school performance, strengths, and goals for the therapeutic work. All of this information helps them to understand the clinical picture and recognize how to best treat the presenting issues. If you would like to get a more in-depth assessment done, you could work with a psychologist for a psychological evaluation, although this isn’t necessary.
A diagnosis of ODD does not mean you are a bad parent, and it does not mean your child is “bad” either. Kids with ODD often have underlying struggles, like ADHD, anxiety, mood disorders, or past trauma that influence their behavior. What looks like defiance is often a sign of deeper frustration, difficulty regulating emotions, or unmet needs.
Is It Really ODD or Something Else?
Behavioral challenges do not happen in isolation. If your child struggles with behaviors associated with ODD, consider other factors that might be at play. Conditions like ADHD, anxiety, autism, and trauma-related responses can all lead to similar patterns of defiance. Sometimes, what looks like oppositional behavior is really a child trying to regain control in a world that feels overwhelming or unpredictable.
How to Manage ODD Behavior in Children
Helping a child with ODD is not about “fixing” them and it definitely does not just mean that they are bad kids. It is about understanding their needs and guiding them toward better coping skills. Here are some evidence-based strategies that can make a difference:
Use Positive Reinforcement
Catch them being good. Instead of focusing only on what is going wrong, reinforce positive behaviors with praise, rewards, and encouragement.
Set Clear Boundaries and Consistency
Kids with ODD thrive on structure, even when they push against it. Be clear about expectations, stay consistent with consequences, and follow through with what you say.
Engage in Collaborative Problem-Solving
Instead of power struggles, involve your child in finding solutions. Ask questions like, “What made that situation hard for you?” or “How can we handle it differently next time?”
Focus on Connection First
Many kids with ODD act out because they feel misunderstood or disconnected. Strengthening your relationship through one-on-one time, validating their feelings, and staying calm in tough moments can reduce defiance over time.
Seek Family Support and Therapy
Parenting a child with ODD can be exhausting. Parent management training (PMT) and family therapy can provide practical tools to navigate difficult behaviors while strengthening your bond.
Some books that I recommend for kids struggling with behavior issues are:
- “The Red Beast: Helping Children Understand and Manage Anger” by K.I. Al-Ghani
- Age Range: 5-9 years
- This book uses the metaphor of a red beast to represent anger, teaching children ways to calm the “beast” when it wakes up.
- “When I Feel Angry” by Cornelia Maude Spelman
- Age Range: 3-6 years
- This book explores what it feels like to be angry and offers young children simple ways to deal with their emotions.
- “Hands Are Not for Hitting” by Martine Agassi
- Age Range: 3-6 years
- This book teaches children alternatives to using their hands when they are angry, promoting positive ways to express their feelings.
- “That Rule Doesn’t Apply to Me” by Julia Cook
- Age Range: 4-7 years
- This book is all about learning rules and following them, and why rules are important.
When to Seek Professional Help
If your child’s behaviors are significantly impacting family life, school, or friendships, it may be time to seek support from a therapist, psychologist, or behavioral specialist. Therapists can help to see what’s happening beneath the surface and problem solve with you. Kids learn emotional regulation skills in therapy, while parents can learn tools to set limits in a way that fosters cooperation rather than conflict.
Frequently Asked Questions (FAQs) about ODD
What are the early signs of Oppositional Defiant Disorder?
Early signs of ODD include frequent temper tantrums, refusal to follow rules, and ongoing defiance toward authority figures.
Can ODD go away on its own?
While some kids or teens outgrow ODD behaviors, early intervention with therapy and consistent parenting strategies can help manage symptoms effectively. Addressing some of the underlying issues can be crucial to resolving symptoms.
What is the best treatment for a child with ODD?
Behavioral therapy, parent management training, and structured routines are named as the most effective treatment options for children with ODD.
Can adults have oppositional defiant disorder?
ODD is primarily diagnosed in kids, but it is often the precursor to Conduct Disorder or other mood disorders or personality disorder in adults.
What causes ODD?
There is no one cause for oppositional defiant disorder. As discussed on the podcast, ODD can often be masking for or coupled with autism, ADHD, trauma, or other mood disorders. For kids, behavior is how they communicate.
Is ODD real?
A diagnosis is a grouping of symptoms, and Oppositional Defiant Disorder is a real diagnosis in the Diagnostic Statistical Manual (DSM).
This diagnosis has stirred up controversy because:
- It is often diagnosed in kids that are strong-willed, rebellious, or defiant, which can be considered developmentally appropriate or somewhat subjective.
- Family discipline and expectations can vary so widely—it can just be pathologizing inconsistent parenting and family stressors.
- There is a lot of overlap of children diagnosed with ODD and children that have experienced trauma, are diagnosed with ADHD, or other mood disorders. For this reason, people argue that therapists are not always looking at the full clinical picture when using this diagnosis.
Final Note for Parents
A diagnosis like ODD feels heavy, but it is only one piece of a much larger puzzle. Kids are so much more than their behaviors, and we don’t want them to see themselves as “bad” or “difficult.”
Biases in how children’s behaviors are perceived can also influence how often ODD is diagnosed, especially across different cultural and racial backgrounds. As a parent or caregiver, you are your child’s best advocate. Make sure they are seen as a whole person, not just a set of symptoms.
If you are feeling like your child’s therapist isn’t looking at the full picture, don’t feel bad about switching providers. It’s crucial for you to feel listened to and that the therapist is on your side and supporting your family. A psychological evaluation might also be a helpful step towards ruling out other diagnoses or seeing what’s could be happening underneath these behaviors. Several years ago, I worked with a kid that had been previously diagnosed with ODD. After building rapport, learning more about him and his family, we realized that this kid was struggling with sensory issues and depression. Getting to the root of the issue and making some key adjustments made a huge difference for this kid’s behaviors.
Parenting a child with ODD can feel like an uphill battle, but you are not alone. With the right strategies, support, and understanding, you can help your child learn new ways to manage frustration and build healthier relationships. It will not happen overnight, but small steps add up over time.
Podcast Transcript:
Miranda: Welcome to the Therapist Thrival Guide. My name is Miranda. I’m a licensed clinical social worker, and I’m here with Letisha and Gina, both are veterans of this podcast. They are like my two go to, hey, I want to talk about this topic. I want you to be on this podcast about it. And today we are talking about Oppositional Defiant Disorder. Gina, do you want to go ahead and introduce yourself before we get started?
Gina: Yeah, absolutely. I’m Gina Young. I’m an LICSW in the state of Minnesota and a director of community based programs in Minnesota.
I have been working with kids for the last 12 years and it has come across, my desk a few times, I’ve also supervised staff that have been working with kiddos that have been diagnosed with it.
Letisha: Letisha, do you want to introduce yourself? Certainly. I’m Letisha Harris, and I am a MA studying to get my license to be LPCC. I have been working with kids for a long time. I definitely am very curious about learning more about ODD. I don’t know a whole lot about it, but it’s always nice to learn something new. As well as, I’ve worked with kids for a long time, so I’ve seen it often and not really known exactly what it is or why,
Miranda: yeah, and this is one of those topics and one of these diagnoses that feels very taboo for a lot of reasons, and we’ll get into that.
But I wanted to talk through what does the DSM say? What are the symptoms of ODD? And then I want us to talk a little bit about the taboo nature of it, like why are so many clinicians like Gina very resistant to putting this diagnosis on someone’s chart? And then even just like maybe peeling back some of the layers, talking about some differential diagnosis and treatment.
So that’s what my hope is for today. Gina, do you want to just get us started by talking about what does the DSM say about What do you need to do to fit this diagnosis?
Gina: Yeah, and it starts off its own chapter of Disruptive Impulse Control and Conduct Disorders. And so the DSM 5 says that ODD is 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 following categories and exhibited during interaction with at least one individual who is not a sibling.
So the categories are angry, irritable, angry slash irritable mood, and there’s often loses temper, is often touchy or easily annoyed. is often angry and resentful. The next category is argumentative slash defiant behavior. Often argues with authority figures or for children and adolescents with adults.
Often actively defies or refuses to comply with requests from authority figures or with rules. Often deliberately annoys others. Often blames others for his or her mistakes or misbehavior. the last category is vindictiveness. has been spiteful. or vindictive at least twice within the past six months.
Unless otherwise noted for individuals five years or older, the behavior should occur at least once per week for at least six months, category B, the disturbance and behaviors associated with distress in the individual or others in his or her immediate social context. So family peer group work colleagues.
Or it impacts negatively on social, educational, occupational, or other important areas of functioning. category C, the behaviors do not occur exclusively during the course of a psychotic, substance use, depressive, or bipolar disorder. the criteria are not met for disruptive mood dysregulation disorder.
there are three levels of severity. Mild symptoms are confined to only one setting. Moderate symptoms are in at least two settings. And severe symptoms are present in three or more settings.
Miranda: Gosh it’s interesting because when you’re talking about different settings that raises some red flags around this diagnosis if you have a kid who is only being oppositional at school, or if you have a kid who is only being oppositional at home, it just gives me more questions than answers,
And I forget, and maybe you said this already, but is there an age range that has to meet ODD? No. Okay. I remember there being one for conduct disorder though, like you have to meet. Yeah, that one’s over 18. Okay. oftentimes, for conduct disorder, Part of the diagnosis is that they had ODD or it talks about the precursor.
So when we’re talking about oppositional defiance disorder, what’s your issue with this diagnosis?
Gina: So my main issue is throughout my career of working with children and I started off in an agency that was very much focused on the community and working with kiddos with trauma.
ODD is often given by hospitals and in acute settings because you’re getting a parent report and reports from other adults and the kiddo, but there’s usually a focus on the defiance behaviors. So that can happen. And then I think you see it more often in juvenile justice settings as wella kid that won’t listen, a kid that won’t follow the rules.
And in my time working with kiddos, I have never seen an ODD kid that doesn’t have something else going on. I’ve always found an underlying issue underneath the defiance, whether it be a mood disorder like anxiety or depression, or. In most cases, PTSD there’s always been another piece to it, right?
Children do not exist in a vacuum. They exist in environments and within systems that are heavily influencing their behaviors and their presentations. And ODD is saying. Often loses temper, touchy, angry, resentful, challenges authority, deliberately annoys others. That’s like a lot of children I know. It’s just so wide of a scope.
Miranda: And that’s even something with kids that have depression or kids that have anxiety or kids that have trauma. to me, it feels like ODD is almost a symptom instead of a diagnosis.
Do you know what I mean? It feels more like. This is a grouping of symptoms that leads to, of course, that’s what a diagnosis is, it’s a grouping of symptoms, but, to me, it feels like more of a symptom instead.
Gina: The defiance part of it was always Communicating that there was a greater need that we were addressingwhether it would be a family.
And when I was doing crisis work and going in the home, it was always a structural family issue. the kid had gotten an ODD diagnosis when they were. Six, seven, eight, and that had become the kid’s whole identity in the eyes of the parents, right? it was this grumpy, bad child and their parenting Changed once that diagnosis came through so their relationships changed with the child.
So I just have never met a kid that truly meets ODD criteria across a lot of settings without there being additional trauma and or mood issues. it’s the precursor to conduct disorder and then the precursor to juvenile justice and going to jail and prison, right?
To me, it’s more a lack of resources and a lack of skills and us meeting the needs of the kiddos in our community. And then we put them in jail, so that’s not great, and anybody who gives an ODD diagnosis for any child under the age of five, we will talk I’m not a fan of that.
Gina: And I’m going to name that I believe ODD is more often given to black boys. 100%. Yeah. I think we see that in the data that we know from kids that are getting suspended from school, like from kindergarten onward, is that It’s BIPOC kiddos that are getting sent home. And that are not being looked at with as much support and curiosity as we would give other cultures.
Letisha: Yeah. And that’s good reason because when you think about it, coming from my own perspective, just hearing you say that I’m thinking about my two year old, defiant, antagonizing his brother, like things that a two year old would normally do.
And as he gets older, that probably will continue. It might change and vary in different ways, but is that something that he would then be labeled as? more likely to be labeled as ODD as opposed to a normal two year old who has, obviously there are family structures that are different, right?
Obviously, He may have experienced some PTSD or some other things I’m a firm believer that everybody has experienced some PTSD at some time in their life. some people it affects more drastically than others, how will that impact him as he gets older?
And will this become something that would be more looked at when he’s in school as, more of a defiant behavior as. He resists to do something that maybe he’s not comfortable doing, or maybe doesn’t understand, or maybe doesn’t have a proper communication about what does that look like for him when he gets older, and speaking to it as a person of color, it’s more likely to be looked at as that as opposed to a child trying to figure out where his boundaries lie.
Miranda: Oh, yeah. I had a case a couple years ago where there was a kid who came to me with an ODD diagnosis. This was a kid who had gone through so many therapists, and either he fired them or they fired him.
I think he was only like 12. It was a really hard case because he met criteria for ODD. He met every single thing. And as a new therapist, I remember reading this and being like, he meets criteria, but I’m just really struggling with this diagnosis because I don’t want to put this on him.
I am just skeptical of this diagnosis and I think in that particular case, he ended up having psyche vows too because he, it was a long road coming to me up till that point, he had seen a lot of providers and he also met criteria for major depressive disorder.
And kid didn’t have any trauma that we were aware of in his background, but it was one of those cases where you’re like, I just feel like I’m missing something like you. Yes, we have these symptoms. Yes, he’s on his sixth school in the last two years. But I just feel like I’m missing something.
And I think that for some clinicians, ODD can just feel like a lazy diagnosis where you’re not wanting to go that much deeper.
Gina: It feels to me like sometimes when people give adjustment disorder, I’m like, What are you doing?
Miranda: Adjustment disorder for three years,
Gina: Yeah, exactly. I’d be like, did they adjust to anything? Or what’s going on? And I think this aligns, with people who get diagnosed with borderline personality disorder.
Therapists are like, no, thank you. I don’t want to work with ODD. I don’t know how to work with ODD. And then it becomes, they just cycle through people, which just further ingrains the problem and the lack of connection.
Miranda: Yeah. I don’t remember who it was.
It was probably you, Gina. Someone who told me in my early years of being a therapist, when I was first doing that big wave of diagnostic assessments. I remember thinking about how A diagnostic assessment is really meant to be a snapshot of what is happening and a roadmap of where to go from here.
Yeah. It doesn’t have to be a detailed history on everything that this kid has been through or everything that he, that’s happened. It doesn’t have to be a super detailed it doesn’t have to go through every single diagnose, like there’s just there, there are kids in your life that you’ll work with that will meet multiple diagnoses
I had a chart in grad school that talks about the overlapping characteristics of trauma ODD is one of those overlapping diagnoses And I could have given that kid ODD. I could have given him, major depressive disorder.
I’ve seen plenty of kids that meet both of those and anxiety and you can tack on a million diagnoses onto a person’s assessment But I think the question that you have to ask yourself is this giving me the best clinical picture and the best roadmap forward?
Yeah, so I think you just like rather than just Seeing oh this kid has ODD. Oh this kid has You know, they’ve been diagnosed with X, Y, and Z in the past. it’s up to you as the clinician to say, does this still fit this picture even or, maybe we’re doing like a adjustment disorder for the first diagnosis or something while you’re getting to know them.
And while you’re trying to figure out what is contributing to this clinical picture because I feel like I’m missing something.
Gina: When I think also coming to it with a fresh set of eyes, right? I think we have some providers who read that stuff and some who don’t, and I stopped reading it because I was like, I don’t know what’s been tried, what’s worked, what hasn’t worked, we don’t want to reinvent the wheel.
And we want to get some information about that, but every time you meet a kid, you’ve got to be open to giving them a fresh set of eyes and a fair start some providers read that stuff and some who don’t, and I stopped reading it because I was like, This has so much of its own bias from all of the providers that came before I want to come in clear eyed to this situation so that I can make my own decision,
Letisha: Yeah. And to that point, the child if they’ve gone through multiple providers, they’re expecting for you to have that same perspective of them, right? They’re expecting that label is who they are. And you coming in with a fresh set of eyes allows for them to not be seen under that label, but to be seen as who they are, and then you can make a proper diagnosis because you’re looking at them from a fresh set of eyes.
And it can be very intimidating to see certain diagnoses as a clinician, and be like, oh, what kind of crap am I going to get myself into? What kind of person are they going to be, right? But if you allow yourself to have fresh eyes on it, then you can say that may be what somebody’s perspective of, as Gina was saying, that may be their perspective of this person.
But I do have to do my due diligence and allow myself to really see who this person is and see who this child is or this adult, right? See who they are under. That lens as opposed to under the lens of somebody else’s previous experience with them. One ODD child may not be the same as the last ODD child, right?
And one ADHD child may not be the same as the last ADHD child. Being able to See each child differently each day, right? Each week that you come in to see them, you have to have a different set of eyes. That was one thing I learned when I was working in child care, is that I cannot say, you did all of these things to me yesterday, right?
First of all, that’s a two year old or a four year old. They don’t really care or remember what they did to you yesterday, I can’t come in with that bias because then I’m not going to be able to truly educate them help them get to the treatment plan and help them move along in their journey.
Miranda: I think that’s especially key with diagnoses like oppositional defiant disorder where you come in and you’re just like, going to look at this. In a new way I think there’s also a lot of diagnoses, even for adults I was working with a client who came in as an adult and had borderline, I’m not afraid of borderline.
I love my borderline clients. my very first question is usually do you agree with this diagnosis? Do you think that this is, Yeah. Let’s just talk about this. I think that talking about it is going to decrease some of the stigma and the scariness about it.
But You can also take the same principles and think about it when you’re working with kids, about how parents might approach a kid, or if a parent is exhausted and they’re like, this is why my kid’s in therapy, or this is what the issue is, and then you sit down and you talk to the kid and you’re like what do you think the issue is?
Or what’s behind it for you? Or what do you want to be working on? your buy in is going to be so much greater, but then also, you’re going to get so much more insight, again, into the issues below the behaviors, because the parents are sometimes only looking parents, teachers, insert.
But a lot of times they’re only looking at “Oh, he got expelled again” or “Oh, he’s suspended.” And so I think that it’s important to be able to take those cases and try to be as unbiased as you can, because those kids probably have a lot of grownups in their life that don’t believe in them that just only take their behaviors at face value and say he’s a bad kid or he’s this way.
And I think that as therapists, it’s our role to hold on to the hope for our clients, but also be able to look deeper.
Letisha: Eliminate some of those expectations. Because it can be that they don’t. See much value in them, and it can also be that they see way too much value in them,
they think, oh he would never do that, They think so highly of them, right? And the pressure that puts on a child Is overwhelming. Or the enabling that can happen. You have to be this way. You have to do these things. when I was in high school, I had a friend who was overwhelmed with having requirements to be getting A’s all the time.
Miranda: And so that pressure that was on her was overwhelming. I can’t imagine that a child that is considered to be labeled, a certain way or a certain behavior, how much that behavior and the expectation for them to be different is put on them and how much pressure that is for them and they’ll start to that diagnosis, We talked around this a little bit, but let’s talk about differential diagnosis and what are some diagnoses or things that if you have a kid that’s labeled as ODD or maybe you’re considering this diagnosis yourself as a clinician, what are some kind of alternatives or even just what could we be looking at?
Yeah. A DHD. That is a big one. I work with a lot of kids with ADHD and I adore them and they can be really annoying. And there’s nothing wrong with that, right? They have big feelings. They have a hard time expressing them and they want them to get met and they feel like they’re the most important.
Gina: So I absolutely think they can lose their temper. They can be very touchy sometimes. They can have trouble following rules.
Miranda: I think they check a lot of these boxes as well. so it’s important to either make that referral for testing, if appropriate for ADHD.
Gina: Like Miranda said about a snapshot in time, this is a Polaroid of just this moment and we really need to get a view of the child’s functioning across their lifetime and in the various settings that they’re in too. I think there’s quite a bit of crossover with ADHD, I think there’s quite a bit of crossover with trauma.
Miranda: I think the difference with ADHD and ODD is it’s coming from a place of hyperactivity ODD. would look more like deliberate defiance, where an ADHD kid would maybe believe me, it’s they’re not looking at you in the face, in your face and being like, I’m not doing that.
It’s more of it might look different where they’re constantly forgetting they’re supposed to be doing something you were saying it also looks like trauma.
Gina: Trauma and autism. Those are the two things. Especially with trauma. And I think a lot of times from my past experience with kiddos with trauma that end up with an ODD diagnosis, it’s because they can’t trust adults because of things that have happened.
Yeah. We’re talking about complex trauma over a lifetime, a child’s lifetime. We’re not talking about a car accident or one moment. We’re talking about repeated losses and repeated letdowns by systems and by adults. And so by the time you get to them, when they’re 15, they’re over it, like they’re not going to trust another adult.
They’re not going to talk to another therapist that hasn’t been helpful. And so instead the systems have judged and tried to control versus tried to understand and be curious. trauma looks like a lot of different things for different kiddos. a lot of the situations that I’ve come across underneath ODB has been a lot of experiences of trauma.
But other people maybe have not identified it as trauma.
Miranda: And think about it too, it is not a coincidence that when I worked in the foster care system, every kid, I, Worked with as a case manager had been diagnosed with ODD at some point whether it be attachment loss, real traumatic events, like whatever it is, there are things underneath it that are leading to exactly what you’re talking about, Gina.
And this is especially key when we’re thinking about kids who had pre verbal trauma who Can’t say what is bothering them. they feel it differently. They’re experiencing their trauma in their bodies rather than being able to like,
Gina: Nobody named that for them, right? It wasn’t okay to be scared. They had to just not cry and keep moving on with whatever they needed to do. So I agree. So many foster care kids end up with that diagnosis and that is, I think, really harmful to them.
Miranda: Oh, absolutely. when I worked as a home study worker, I would write home studies for families we thought they might be a good family for, then they would go through a period of what was called full disclosure, documentation on this kid so that they could get a full picture of who they might be adopting for so many of those families they would see ODD and they’d be like “ooh, I don’t know if I can do that. I don’t know if I can deal with being a super defiant kid all the time.”
And then, naturally my next thought would be like, “why are you doing this?” but also, I think that diagnosis was very harmful when it came to whether or not a child was quote unquote adoptable.
Gina: And so that was absolutely harmful for a lot of those kids.
Letisha: It’s very harmful when you think about the aspect of the child being accepted, right? If like you were just talking about with adoption, with foster care as well That child, my perception of defiance is different than another person’s perception,
I’m only going off of what I perceive to be defiant. if I’m saying defiant, I’m thinking like, this kid’s gonna be running away, this kid’s gonna be Cursing me out, this kid is going to be doing all of these things, right? Whereas this kid may just be a kid that says no, and it’s very deliberate about their no, if they don’t feel that safe space, they’re more likely to be like, I’m not doing that.
I’m not going there. that defiance is different than it. varies in that expectation of who that child is. you set the child up for failure when the person doesn’t really know the child except for on paper and what somebody else is perceiving to be their behavior.
Gina: What about mood disorders? how might this, what’s the Venn diagram of ODD? Irritability, especially in any kiddo under the age of 18 is definitely one of the criteria for MDD, right? And if we’ve met any teenagers, they’re challenging authority often. like everything’s on a continuum, like we’re talking about, right?
you are absolutely dipping into the mood disorder. Pop when you’re looking at ODD and the other one I was thinking about was autism too. Because let me tell you, they want it a certain way and it’s the only way their brain will accept it to be.
Letisha: Yeah.
Gina: And so here comes a grown up who wants it to be their way for whatever reason they have, especially in a school setting or anything like that.
Especially if they have sensory sensitivities or kids who have trouble communicating, like that are on the autism spectrum, kids use behavior as language.
Miranda: if they don’t want to do something and you’re trying to get them to, but they can’t verbalize that, it can look differently.
Gina: I’ve been learning more about persistent demand avoidance. And how big of an impact that can have on kids with autism and kids with ADHD with a nervous system that’s so dysregulated that it’s always going to look like defiance to other people when in reality it’s them needing it to be offered a different way or at a different time when they’re calmer and when their body is feeling safer.
It’s like your fight, flight, freeze response where if you are sensing that, you’re under attack or something, if your nervous system is sensing that something is wrong,
Miranda: Your amygdala is going to be like, okay, These are your options. for a lot of kids, that’s fight, for me, it’s fight. I’m not going to punch you, but I’m going to fight back, and so defiant.
I think this is just a key part of the conversation there are so many things that can look like this but the part that I think is very unique with ODD that you don’t see in these other diagnoses is the idea of vindictiveness.
Gina: it’s that idea of revenge. Yes.
Needing to get back at the person. when we started working together, you had a kiddo with ODD who could not let go of like, When they had been slighted, they kept a track in their brain of this person has, bumped me in the hallway, they took my lunch, they slid my locker, all of these little things that could be let go.
But for this kiddo, we’re so magnified that you don’t see necessarily in autism or in a mood disorder, but it’s very specific to ODD.
Miranda: it is like an obsession, though.
Gina: Agreed. To me, when we’re talking about a kid who cannot let go of something and it’s like they’re fixated on being slighted it doesn’t necessarily veer into OCD, but it reminds me of the obsessions, like I’m fixated on this and I feel like I have to do something about this, which again falls under anxiety, It’s this idea of injustice which is if the adults are not going to take care of it, then I’m going to get revenge for what I think was a very serious injustice to me, even if it was small And it gets not just obsessive, but magnified in their mind and becomes a much, much bigger deal than what is really going on.
Miranda: But everybody does that on some small level, too, though. I could have an argument with my partner, and then I’m gonna think about it, and it’s gonna get so much bigger in my mind. By the time I see him, we’re gonna have an argument about it.
Letisha: Your part gets smaller. But that’s what I’m saying, is it’s like, there are some parts of this that are common to all people.
Gina: there are shades of it, that are normalized to some extent.
Letisha: I get bitter and mad at some people sometimes and I can’t let it go.
But with a kid with maybe an overwhelmed nervous system and trauma and a lot of adults and systems that are like, you’re the problem. I can imagine. It’s no wonder this gets so big for him. And kids have so little control over so many aspects of their life.
And then you put this diagnosis on top of them. I can only imagine how invalidating that is.
Miranda: To piggyback off of that for a second though, like, how often are kids being told their diagnoses or are they seeing them on a piece of paper and being like, what does that mean?
I think that they’re adults alike where, you might be diagnosed with something and then it’s, I remember I wrote a home study for a family years ago when you’re going through the adoption process, you have to have a letter from a therapist if you are seeing a therapist, you have to have a letter from them that says this is the diagnosis and we approve them or whatever, which is, don’t get me started on that.
As an adoptive parent, it kept me from going to see a therapist during the adoption process because it was another cumbersome step. there’s a letter you need from a therapist if you’re seeing one.
I was writing a home study for this guy and he got a letter from his therapist or he, it like got sent to us and then we included it in the home study. then he was reviewing the home study and he was like, What? I’m diagnosed with Borderline Personality Disorder?
But it was a major diagnosis where he had no idea that he had been diagnosed with this. And I think that happens with kids too. I don’t know how I feel about it’s not like every kid needs to know exactly what their diagnosis is either, but it is just a weird thing.
we are labeling you and then Not talking to you about what this means
Gina: I could do a whole episode about the need to keep them informed at a developmentally appropriate space. I’m not going to be using the words that we’re finding in the DSM, but they’re going to know that they have worries that are affecting a lot of areas of their life.
Yes. as a kid who was in therapy themselves, like I didn’t know what I had into later on. And I was like, Oh, I should have known like that would have been really helpful. Like my parents maybe would have known somebody should talk to me. That would have been really helpful.
And therapy is so scary for kids anyway, because it’s parents making them go. Unless you’re over, like 10 and up and you’re requesting to go, it’s really parents are bringing their littles in and are like, fix these kids. And so I’m not participating in that. it’s going to be a way more inclusive environment.
they’re going to know when I list and I ask all these questions, I want them to know what we’re going to be working on. And I want them to. De stigmatize whatever disorder we’re giving, right? And by not talking about it, we’re keeping it in secret.
Letisha: Aeah, I’m not a fan of that . I was just gonna say, also not weaponizing it against the child, because sometimes you have that parent who’s overwhelmed or frustrated, and it’s a weapon against that child, as opposed to You have this disorder, that is affecting and impacting your everyday life.
And these are the steps that we’re taking to help you manage that. That’s a different conversation than screaming at them because you’re overwhelmed about their diagnoses. And now they’re looking at that as a negative thing on top of all the other negative things that they may be experiencing.
So not using it as a weapon, but allowing them to understand what this does, how this impacts you, what things we’re doing to help manage that, and how we’re helping you to treat that diagnosis so that it helps them to better understand it and be able to work with it and process through it as opposed to it becoming something negative.
So how do you treat ODD?
Miranda: Gina.
Gina: I was doing a little bit of research before and I was looking at the prevalence rate and it’s 2 to 11%, which is really small. it is definitely seen more often in boys than it is girls. I honestly have never met a girl with ODD.
I don’t think I’ve ever encountered a kiddo. With ODD. in my encounters with it, it’s been family interventions that have worked with parents on how to support the kiddo and help them build the skills that they need, at home and then at school as well. And I want to get back to Leticia’s did something really great about weaponizing. ODD can be very much weaponized in schools. And so if you get a kiddo in special education that has an ODD diagnosis, I’ve never seen them in the mainstream setting.
I see them in level three and level four. Because it’s the teachers who are like, I’m not taking an ODD kid. They get shuffled along, and is this helping them having this diagnosis, or is it hurting them?
In fact, are the adults changing their behavior based on the diagnosis that this kid is coming in with? And they spend six hours a day in school, sometimes eight. That’s half their day. And if their teachers are feeling ill equipped and stigmatizing the child, it’s just going to make it worse.
Letisha: That’s true.
Miranda: Yeah. the kids that I’ve had that have been diagnosed with ODD, I have found the most success. With working with them when we come up with goals together When we are heavy with partnership and figuring out, like what are you getting out of this?
Can we come up with different reward systems? Can we do different things that will? Like I had one kid who I had a ticket system where he got a ticket every time he came to session and another ticket if he did something I wanted to do,
And so usually it’s going to be like, do you want to, read a book about it? What do you want to read a book about? and then he got two tickets if he brought something to talk to me about. this kid was obsessed with Pokemon cards, and so I went through a lot of Pokemon cards with this kid, but I want to be clear that when I started seeing this kid in therapy, I had a hard time at first because I was like, I don’t know what to do.
I don’t know if I’m making any progress. It feels like we’re taking forever to build rapport. And it feels as one of those clients where I’m like, oh, I don’t dread seeing you, but I’m also just I don’t know thrilled to see them either. But I think it’s because I was feeling ineffective. It was more about how I was feeling when I was with him. And then I realized that. I think I worked with him for a year or something like that.
By the end of the time that we worked together I’d love to be able to say he made some progress, which was great. but it was just a super hard case where I still think back on that case. I still think that I was missing something in there, whether it be some trauma or something. I was probably still missing something that, he wasn’t communicating to me, and I wasn’t getting from parents. there’s a lot of beauty in the hard cases and a lot of room for improvement. if you are a therapist listening to this being like I have an ODD case that I’ve, that I just am having so much hard, such a hard time with.
It’s I just want to say that, yeah, like they can be hard cases any diagnosis can be a hard case. not just ODD kids, there’s a lot of improvement that can happen. I would encourage you to look at the. individual symptoms and the things leading to this diagnosis,
Gina: You’re going to treat the different things causing distress around autism. I looked up some evidence based practice and one of them was parent management training, which involves teaching parents effective strategies to manage their child’s behavior through consistent positive reinforcement. It’s considered the gold standard of treatment.
Miranda: Makes sense that it’s positive reinforcement that works and not just like I’m taking away everything from you.
Gina: Which is, I think when I was working at Holmes, Parents were removing doors off the hinges and taking everything from the room.
And I was like, they look like a prisoner. This isn’t going to work. it’s not going to work. You can’t take everything from somebody and then still expect them to behave. You know what I mean?
Miranda: Especially if they’re a kid that has been in foster care or has had trauma because they’ll be like, I’ve had everything taken away from me before.
Gina: it just fine.
Miranda: Okay. That’s so interesting. And that kind of tracks with what you were just saying, where it’s so much of, involving the parents.
Letisha: They also listed cognitive behavioral therapy. It can help children with ODD learn to identify and manage their emotions, develop problem solving skills, and challenge negative thoughts, contributing to defiant behavior.
I try to talk about with the people that I supervise is I need you to get an idea of how the child views the world, right? If we can get a snapshot into their brain and understand what negative cognitions they might have that have shaped their identity and their behaviors.
That’s the thing that we can work on to change. And once you change the negative thoughts, you can then change the behaviors. and I think you can do that at a young age too, but somewhere along the line with kids with ODD, it was instead of do what everyone else is doing, I’m going to defy and act out.
And what messages did you get around that, right? And so exploring that more, I think CBT is a cornerstone for a lot of the therapy that we do. And so I’m happy to hear that it’s in here too, as a tool for kids with ODD.
Miranda: This has been awesome. Thank you so much to both of you for joining. This has been a really good discussion and hopefully this has been helpful for people listening just to hear some clinicians talk through how they’ve struggled with this diagnosis and where to go from here because it’s something that’s being diagnosed we need to know how to navigate it and also just how to See what’s underlying too.
I think it’s important. I agree. I don’t think kids are inherently bad. And I think that’s maybe why I struggle with this one. Thank you both so much.
Letisha: Thanks, Miranda
