An ODD Diagnosis Doesn’t Make Your Child “Bad”

In recent years, I’ve encountered a growing number of parents in my therapy practice who come to me fearing that their child has oppositional defiant disorder (ODD). According to the American Psychiatric Association, the primary signs of ODD are angry and irritable mood, argumentative and defiant behavior, and vindictiveness.

Often these parents will share that a teacher or doctor told them their child may have ODD, and that when they looked up the condition online, they recognized some of the symptoms in their child’s behavior. As a parent myself, the worry and confusion on my clients’ faces and, in their voices, simply breaks my heart.

One unintended effect of putting the ODD label on a child, in my experience, is that it makes parents feel like something is intrinsically wrong with their child — and wrong with them as parents. The ODD diagnosis can also cloud the process of figuring out why a child is struggling and how to best address their behavioral issues. And parents aren’t the only ones who feel bad when their child is diagnosed with ODD. Kids feel bad, too. With this in mind, I’ve developed my own approach for helping families overcome their fear of the ODD Boogeyman. 

The first step is taking the sting out of the label. So, someone thinks your kid has ODD. That’s okay. No matter what anyone says, even someone with a certain level of expertise, your kid is not a bad kid. In my 20 years of practice, I have never met a bad kid. The truth is that most kids have moments when they’re aggressive or defiant. Nothing is wrong with you as a parent, either. You’re going to be alright, and so is your child.

The second step is understanding what brought them to my office. What’s happening? At school? At home? Maybe your kid refuses to take direction from adults or has been aggressive toward their classmates. That kind of behavior is certainly upsetting, and you, of course, don’t want to condone it, but there are a lot of things we can do to address it. 

The third — and perhaps most important step — is figuring out the why. Why is your child behaving this way? For the vast majority of kids, there’s a very legitimate reason.

When parents take a moment to reflect on the situations or triggers that may be contributing to their child’s most concerning behavior, they’re usually able to identify something significant. For example, a parent may realize that their child is at their most oppositional after a really hard day at school. Maybe the bully was even meaner than usual. Or the child feels bad about themselves because the other kids read at a higher level. The child manages to keep their cool for the entire school day, but once they get home and are around people with whom they feel safe, all their difficult emotions come out in a way that can be hard to stomach. At the core, this child experiences a deep level of anxiety, and they’ve yet to develop the skills to cope with it. 

Other reasons may have less to do with a child’s internal experience and more to do with what’s happening around them. Maybe Mom and Dad are getting divorced. Or the Grandparent they’re really close with is sick. Or a parent is in the military and was recently deployed overseas. These aren’t easily solvable problems.

If the issue is related to the parent, the parent may feel guilty or defensive. What I always remind people is that we’re all doing the best we can at any given moment. Even if the problem can’t be readily addressed, identifying it means moving past labeling and pathologizing and moving towards a remedy for the child’s behavior. 

The fourth and final step takes you back to the symptoms, which we have the tools to address. We can help a child with aggression by teaching them to understand the emotions that fuel it. Then, we can work on self-regulation by helping a child develop greater mind-body awareness. One way to do this is with a biofeedback video game that encourages children to practice bringing their heart rate up and then back down. Doing this over and over again familiarizes children with what is happening in their bodies when they enter heightened emotional states and creates an automatic calm-down response. Whatever strategy you decide to employ, the key to success is being creative and treating the child from a positive, compassionate, and strengths-based standpoint.

Diagnosing a child with ODD is an overly simplistic way of naming their behavior. What I find most troubling is that the diagnosis can put a child on a tragic life trajectory, particularly when it comes to children of color in low-income communities. First, it’s ODD. Then, it’s conduct disorder. By the time that child reaches adolescence, the people who are supposed to help them are instead afraid of them. These types of kids tend to receive the harshest form of treatment: the criminal justice system. It may sound extreme, but it happens far too often. What I’m proposing is that practitioners strive to look beyond a child’s disruptive behavior and see the context surrounding them. I believe a holistic approach produces better outcomes for children, parents, and society as a whole.

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