Oppositional Defiance Disorder

Every teacher has experienced that student who just refuses to follow your instructions.  They are defiant, disobedient and, if challenged will escalate the conflict even in the face of extreme consequences.  These kids attract the diagnosis of Oppositional Defiance Disorder (ODD).  The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, lists criteria for diagnosing ODD. These include emotional and behavioural symptoms that last at least six months. Of course, this is not for a teacher to diagnose but it’s helpful to know the obvious symptoms.

Angry and irritable mood:

• Often and easily loses temper
• Is frequently touchy and easily annoyed by others
• Is often angry and resentful

Argumentative and defiant behaviour:

• Often argues with adults or people in authority
• Often actively defies or refuses to comply with adults' requests or rules
• Often deliberately annoys or upsets people
• Often blames others for his or her mistakes or misbehaviour

Vindictiveness:

• Is often spiteful or vindictive
• Has shown spiteful or vindictive behaviour at least twice in the past six months

The severity of the effect of this disability is variable ranging from:

• Mild - Symptoms occur only in one setting, such as only at home, school, work or with peers.
• Moderate - Some symptoms occur in at least two settings.
• Severe - Some symptoms occur in three or more settings.

For some children, symptoms may first be seen only at home, but in time extend to other settings, such as school and with friends.  However, by the age of eight years the disorder is well established being more common in boys than girls.  Girls do become more defiant coinciding with the onset of puberty.  Another factor that may influence the apparent difference between the genders is that boys act out their resentment and are generally more aggressive while girls will internalise and appear to be more compliant.

The causes of ODD are predictable and as with most developmental disorders they come from a chaotic or dysfunctional childhood.  Typically their home-life is hectic and unpredictable resulting in at least an insecure attachment to their parents.  These behaviours may have started as a way of getting attention and this was reinforced by the parent; defiance worked!

It’s hard to say exactly why children develop ODD. It’s probably not because of any one thing. But there are some risk factors that have been identified that are linked to the development of ODD.  These are:

• temperament – some children are born with an easy-going nature and conform to rules however, ODD kids resist from the start of their development
• low academic performance at school – for example, if children have learning difficulties they will resist new lessons
• speech and language problems in everyday life
• poor social skills, poor problem-solving skills and memory problems
• parenting and family factors – for example, inconsistent and harsh discipline, and a lot of family stress
• school environmental factors – for example, schools with severe punishment or unclear rules, expectations and consequences
• community factors – for example, negative influences from peers, neighbourhood violence and a lack of positive things to do with free time.

Children with ODD often have comorbid difficulties most prevalent being attention deficit hyperactivity disorder (ADHD) with 65% of ADHD attracting the ODD diagnosis. There is some suspicion that the defiance is a result of the child’s ADHD leading to them missing instruction and appearing to be defiant.  Other combined disabilities include learning disabilities, autism, anxiety and mood disorders or language impairment.

Never underestimate the power of this disability; when faced with a direct conflict between following the teacher’s instruction or maintaining their defiance the latter will prevail because following the teacher’s instruction would represent a loss of their sense of having power over their ‘self’.  In most cases this can be avoided by giving the child a choice in the way they perceive the consequences you present.  Say they are refusing to start to write in a lesson, you might say ‘do you want to do that with your blue or black pen – it’s your choice’.  The tag, ‘it’s your choice’ is the critical feature of the dialogue you have with ODD students.  Giving them that choice allows them to preserve a sense that they are in control.

I remember one particular child, call him Mark, in a special setting who was directed to get on a train at the end of the school day, just to go home and avoid causing trouble on the station.  He was told that if he didn’t get on he would be expelled.  You have to understand Mark was an extremely dysfunctional student who had passed the school leaving age and had received multiple long-term suspensions.  At our school the students were taught about behaviour and they all knew about ODD.  I said to Mark ‘what if I had told you not to get on the train’ what would you have done.  He knew he would have got on the train but even knowing this he still refused and was expelled.  I have often thought about my behaviour in this situation and if I knew then the lessons in this Newsletter I hope I would have acted differently.

As you can see dealing with these oppositional children is a real challenge. And in such a case as Mark’s it would have been better not to get in such a situation however, there was a lot of other things going on in this case.  But there are some things that will help you deal with these students.  These are: 

• Understand the causes of ODD, the lack of positive attention and identifying ways to increase the opportunities to provide positive feedback

• Modelling emotional control - ODD kids invariably have poor emotional regulation so it is important that you remain calm
• Give short instructions with limited choice (i.e. ‘Would you like to play in the sand or have something to eat?)
• It often works to give two similar choices with a time frame, such as “I’ll give you a minute to choose to write with the blue pencil or the red pencil”  If there is no choice made after your time limit, the teacher makes the choice of something quite different such as, completing a different aspect of the task not using pencils.
• Avoid negative consequences – this is difficult for older kids but for pre-schools emphasis on positive reinforcement on positive behaviours.
• Emphasise the child’s importance by doing things they like with them – pay them real attention.

Finally – look after yourself.  These kids consume a lot of the staff’s energy so make sure the organisation provides opportunities to withdraw from highly charged situations and have access to debriefing.