Oppositional and Defiant Disorder: How to understand and help a child with challenging behaviors

Dealing with a child/adolescent with Oppositional Defiant Disorder (POD) can sometimes be quite difficult. 👧🧒

📊 Second or American Academy of Child & Adolescent Psychiatry, POD affects close to 1 to 16% of all school-age children/adolescents.

Many may even be seen as “clumsy” or “poorly educated”, but the truth is that this is a much deeper issue in which the blame, contrary to what is thought, is not on the child.

Therefore, today we explain what this condition consists of, what its causes, symptoms and we also share with you some practical strategies that can be useful in the most difficult times.

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What is Opposition and Challenge Disorder?

AOppositional Defiant Disorder (POD)is one of the most common Behavioral Disorders and occurs mainly in the childhood and adolescence phase.

It is characterized by a recurrent pattern of behaviornegativist, defiant, disobedient and hostile to authority figures such as parents, educators or caregivers.

Normally, it affects children in their growth and in the different contexts of their lives - home, school, extracurricular activities, among others.

In this way, when a child/adolescent presents challenging behaviors in a constant and intense way and, according to DSM-5, for a period of more than 6 months, it is important to seek professional help so that it is possible to overcome these adversities in a healthy and progressive way.

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Common symptoms in Oppositional and Defiant Disorder

Each child is unique and the manifestations of Oppositional and Defiant Disorder can vary from individual to individual. However, the symptoms of this disorder are essentially divided into three main areas:

Anger/irritation states

• Presence of “bad mood”
• Frequent and intense beers
• Constant irritation
• Frustration that comes easily
• High sensitivity to impositions, suggestions or criticisms

Argumentative and Challenging Behaviors

• Frequent discussions and opposition with authority figures (father, mother) or other adults
• Active refusal of rules and simple requests
• Intentionally provoking those around you
• Frequent use of phrases such as “I do not want”, “I do not do”, “you do not command me”
• Blaming others for their own behaviors/mistakes

Ranger and Vengeance Behaviors

• Persistent resentment and for long periods of time
• Retaliatory behaviors
• Desire to “do the same” or “settle scores”

The presence of these behaviors for long periods of time indicates the need to resort to the evaluation of a specialized professional. They have the knowledge and tools necessary to confirm diagnoses and carry out the most appropriate follow-up for each child.

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Causes for Opposition and Challenge Disorder

There is no specific reason for the presence of Opposition and Challenge Disorder. It is a multifactorial condition, in other words, there are several factors that can contribute to its development. Such as:

🧬 Genetic/Physiological Factors:includes the existence of neurobiological markers (such as abnormalities in the prefrontal cortex, amygdala, among others). In addition, children who have a greater genetic predisposition to irritability/impulsivity, have higher risks of developing POD.

🏠 Environmental Factors:unpredictable routines, lack of clear rules and growing up in highly rigid, severe or neglected environments increase the likelihood of developing the disorder.

🧠 Temperamental Factors:Children who show greater emotional reactivity, difficulty controlling impulses, and dealing with boundaries/changes are also at greater risk of developing POD.

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Opposition and Challenge Disorder: Strategies that work!

👉Use “positive reinforcement”: Praise desirable behaviors, no matter how small.

👉 Prefer simple and consistent rules:Children and adolescents with POD need clear rules and a predictable routine.

👉 Avoid direct confrontations or clashes: Children and adolescents with POD react negatively when confronted. At these times it is important to try to remain calm.

👉 Provide choices whenever possible: Instead of immediately imposing an action, try giving choices like “Do you prefer to take a bath before or after doing your homework?” “Would you rather wear the green jersey or the blue jersey?”

👉 Anticipate changes:Changes and transitions can be difficult. Prepare and anticipate the child before these events. For example:

• “From here we go though. When you say “last 5 minutes” you can choose the last toy you want to play with”.
• “In 10 minutes we will take a bath, put on our pajamas and choose a book to read together”.
• “When the timer runs out, it's time to put away the toys. If you want, you can choose a music while I help you”.

👉 Teach emotional skills:It is important to explain to the child that feeling frustrated and/or sad is normal. Whenever we are facing emotionsnegative aspects, it is important to take a deep breath and understand what we can do at the moment that can help us.

• Example: “I know you're sad and it's normal. We will understand what we can do now to overcome this situation”.

👉 Collaborate with teachers/educators: A consistent support network is critical for children and adolescents with Oppositional and Defiant Disorder. There needs to be consistency in the rules in all contexts. In this form:

• The child/adolescent realizes that the rules are the same at home and at school.
• Teachers and educators, as they spend a good part of their day with the child/adolescent, can easily identify triggers for opposition/challenge behaviors.
• Keeping teachers and educators aware of student needs can help them create healthier classroom dynamics by anticipating conflict, helping the child to self-regulate and create positive interactions with colleagues.

All these small actions help the child to feel understood and that he is not in a constant struggle “against the world”.

👉 Use of positive language: It is important that each child/adolescent does not feel alone or that “everything is against you”. You should maintain positive language such as “together we will overcome this” or “we will find a solution”.

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Can Oppositional Defiance Disorder coexist with other disorders?

Yes! It is common for children and adolescents with POD to have other diagnoses such as Attention Deficit Hyperactivity Disorder (PHD).

Studies indicate that about 30% to 75%of children with Behavioral Disorders also have PHDA and that 50% of them meet criteria for other pathologies such as: Mood Disorders, Anxiety, Post-Traumatic Stress Disorder, Difficulties Apprenticeshipor Disorders of Thought.

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How to deal with a child with oppositional disorder?

In the face of suspicions of a Behavioral Disorder such as Oppositional Defiant Disorder (POD) - or even PHDA or PC - it is essential to seek the help and support of specialized professionals. They will be able to confirm the diagnosis and indicate what to do next.

💡 At NeuroImprove Clínic we support children and adolescents who live this reality every day. In this way, in conjunction with Neurofeedbacke a Clinical Psychology, we ensure that, individually and individually, each child reaches the balance and capacity for self-regulation that they need so much!

This follow-up in our clinic is very thorough, complete and adapted to each child who reaches us. In addition, we ensure constant family monitoring during the process. 🧠🧡

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Final Considerations

✅ Oppositional Defiant Disorder (POD) mainly affects school-aged children and adolescents.

✅ Children and adolescents with POD can often be seen as “clumsy” or “ill-mannered” when it comes to a more serious and profound condition.

✅ POD consists of a pattern of negativistic, defiant, disobedient and hostile behavior towards authority figures such as parents, educators or caregivers.

✅ This disorder is divided into three main spheres: states of anger/irritation, argumentative/defiant behaviors, rancor/revenge behaviors.

✅ The causes for POD are multifactorial varying between factors: genetic, environmental and temperamental.

✅ There are some practices that can help you face these difficult times and create a consistent support network.

✅ When opposition/challenge behaviors occur over long periods of time, it is important to consult the opinion of a specialized professional and, if necessary, follow the indicated monitoring/treatment options.

✅ At NeuroImprove Clinic, with the dual approach of Neurofeedback and Clinical Psychology, we are able to help children overcome these difficulties and find a greater balance.

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References

American Academy of Child & Adolescent Psychiatry. (2019) Oppositional Defiant Disorder. https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Children-With-Oppositional-Defiant-Disorder-072.aspx 

Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5). Oppositional Defiant Disorder. https://www.cruzvermelha.pt/images/pdf/DSM-5.pdf 

Ogundele, M. (2018). Behavioral and emotional disorders in childhood: A brief overview for paediatricians. World Journal of Clinical Pediatrics, 7, 9 - 26. https://doi.org/10.5409/wjcp.v7.i1.9.