Understanding Oppositional Defiance in Children and Adolescents
Parenting is challenging—more so if you are raising a child who is often angry, argumentative, and stubborn. In this case, you may need to know more about Oppositional Defiance in Children and Adolescents. Such children and adolescents have poor relationships not only with their parents but also with other authority figures (e.g., teachers). They may have conflicts with peers too.
While being oppositional is normal in some situations (e.g., when upset or tired) and maybe a normal part of development (e.g., early adolescence),1 being oppositional on a regular basis might indicate the presence of oppositional defiant disorder.
Oppositional defiant disorder
A considerable proportion (prevalence rates vary between 1% and 11%) of young people meet the criteria for an oppositional defiant disorder. The criteria, as described in the latest Diagnostic and Statistical Manual of Mental Disorders, require the presence of four of the symptoms described below, for most days, for at least six months. These symptoms need to be present in the interactions between the individual and another person (not just a sibling):
1. Losing his or her temper
2. Being easily annoyed
3. Getting angry
4. Arguing with authority figures
5. Breaking the rules or defying authority figures
6. Intentionally annoying others
7. Blaming others
8. Being vindictive
Sometimes these behaviors are limited to one setting (e.g., at home). In more severe cases, however, they are seen in multiple settings (e.g., at school, in interactions with peers).
It is important to note that diagnosing a child with this condition does not mean the child is to “blame” or that the child’s family plays no role in the development of the problematic behavior. In reality, a child’s difficult temperament might cause hostility in the parents, and their hostility (e.g., harsh parenting) might make the child’s behavior problems worse, creating a vicious circle.
Indeed, children and adolescents with this condition are more likely to live in families where caregivers are neglectful, inconsistent, or use abusive parenting practices.
Both psychological interventions and pharmacological ones (i.e. medications) are available for the treatment of an oppositional defiant disorder. However, psychological treatments appear to be more effective than medications.2
Psychological treatments include individual therapy, group therapy, and family therapy. Also beneficial is teaching clients new skills like social skills, anger management, perspective-taking, and problem-solving.
Therapy usually includes, especially in the treatment of younger individuals, a parent training component. Parents are taught how to communicate more clearly, reinforce their children’s good behaviors, pick their battles, set appropriate limits, take a break to avoid making conflicts with their children worse, and engage in self-care.
As far as medications, no drug has received approval specifically for treating this condition. In many cases, medications are prescribed only when co-occurring conditions are present.
For instance, oppositional defiance shows considerable overlap with attention-deficit/hyperactivity disorder (ADHD), and medications prescribed for ADHD may improve behavior problems in those with oppositional tendencies too.
Similarly, antidepressants, like the selective serotonin reuptake inhibitors (SSRIs), might reduce anger and other mood problems in patients with the oppositional defiant disorder who also meet the criteria for a mood disorder.
Mood stabilizers and antipsychotic medications are prescribed too, though there is less research support for their use in this population. They are used mainly when the person’s aggressive tendencies have been causing serious problems. In general, these medications should be used in conjunction with therapy, and their benefits must be weighed against their serious side effects (e.g., weight gain).
This article is provided by Dr. Ralph Kueche (Child Psychologist). Dr. Kuechle is a Child and Adolescent Clinical Psychologist who specializes in treating children and their families who may be struggling with mood and behavioral issues. Learn more about Dr. Kuechle.