Overcoming Oppositional Defiant Disorder in children

Children's Health

by Baylor Scott & White Health

Apr 12, 2016

What starts out as harmless playing with the dog, can end in a complete meltdown for one child with oppositional defiant disorder.

Young Jezzy was told to leave the dog alone, but she persists. The dog nips at her, and she yells back. From nearby, her mother Bonita tells her not to act like that, but the screaming continues. Bonita warns Jezzy about losing TV privileges, but the confrontation escalates. Jezzy is sent to her room, and from down the hall you can hear the door slam, kicking and screaming for close to an hour.

For children with oppositional defiant disorder (ODD) there are emotional and behavioral issues that lead to an angry and irritable mood, argumentative and defiant behavior and spiteful actions. This condition is outside the occasional tantrum and manifests much more often.

You might think it is typical of all children to defy, and to an extent that is true. However, there is a difference with children with ODD as their defiance is frequent, intense, continuous and sometimes hostile.

“Part of growing up is defying authority figures, but this level is far beyond normal development,”

“Part of growing up is defying authority figures, but this level is far beyond normal development,” said Nhung Tran, MD, FAAP, a developmental-behavioral pediatrician on the medical staff at McLane Children’s Scott & White Clinic – Temple. “A lot of kids will test limits that involve something important to them, but those with ODD will defy the very smallest of requests. It’s a continuous pattern of being openly uncooperative.”

Bonita and 7-year-old Jezzy have had an exhaustive journey trying to manage this difficult behavior. Bonita described it as “living in hell,” and in the past, she avoided taking her daughter anywhere at all.

“It became impossible to handle, and so we just couldn’t go out in public,” Bonita said. “It didn’t matter where we were, being told no was not an option.”

Bonita stayed home with Jezzy, a single mom since her daughter was two years old. She knew she was being consistent and trying hard to implement discipline and effective parenting.

“At a young age, she would throw her sippy cup on the ground in a fit when I asked her to use her manners. I knew something just wasn’t right,” Bonita said. “It only progressed and got worse as she got verbal.”

Bonita knew other children were not acting this way, and she searched for answers. At first she suspected that Jezzy might suffer from high-functioning autism. She was very repetitive and had sensory issues with lights, clothing and foods. However, as she grew, Jezzy started interacting on a very personal level with her peers. This level of interaction knocked her off the spectrum of autism, yet Bonita was still looking for answers.

Jezzy still had difficulty interacting with others to some degree. There were times when she would react impulsively, sometimes hitting someone who did something she didn’t like. Adjusting to school was sometimes difficult. If Jezzy didn’t like the way her shoe fit, her mother dropped her off at school, giving her over to her teacher, with the shoes in hand.

Bonita worked hard to team up with teachers and physicians to get answers for Jezzy. However difficult times got, Jezzy would always ask for her mom to tuck her in and sing her a special lullaby. Their time cuddling and reading together is what helps them stay close.

“When I met Dr. Tran I was at my wit’s end,” Roesler said. “I immediately had respect for her, because she cared and she listened. When she explained things, she explained them to the T. She broke everything down in great detail for me.”

Dr. Tran explained that Bonita was not a horrible mom, and helped ease her concerns with medication. She explained that if her daughter had an issue with her heart, they might give her medication for it. Likewise, if there was something wrong with her daughter’s brain, medications could help.

Jezzy was five at the time and had started kindergarten. She had support from her teachers at school, but sometimes they didn’t have the staff on hand to take care of her needs. Jezzy would often be found running out of the classroom or hiding under a desk. Despite her classroom behavior, Jezzy is very smart and was reading above grade level.

Her mother thinks some of her issues with ODD are also related to her diagnosis with Attention Deficit Hyperactivity Disorder (ADHD).

“She gets very focused in doing what she wants to do,” said Bonita. “She doesn’t want to be interrupted or taken off track. That’s when she acts out and lashes out, if something takes her off track. They very much feed off of each other.”

Dr. Tran says it is not common for ODD to exist alone, most commonly alongside ADHD or mood disorders.

“Children with ADHD have difficulty controlling impulses and the need to move, touch or talk,” Dr. Tran said. “What happens is ADHD becomes a trigger, because you’re constantly trying to redirect typical ADHD behaviors. So if a child is repetitively asked not to touch the sugar at the restaurant table, for example, it may trigger a hostile response.”

Although in the beginning Jezzy was defiant when it was time to go to the doctor, she is now very involved. She has an open relationship with Dr. Tran, and they continue to visit every three months for ongoing treatment. They discuss behavior, attitude, school issues, eating and growth to make sure Jezzy is on the right track.

Life for the Roeslers is very structured with everything from getting ready for bed to the time they eat ice cream together. This helps Jezzy know what to expect and adapt to her environment. She has done much better, and her mother is pleased with her progress.

“Jezzy has been responsive to the counseling in the context of the medication management appointments,” Dr. Tran said. “Typically for such a severe case, we would stress family and individual psychotherapy along with medication management for whatever condition is co-occurring with ODD.”

In their free time, Jezzy and her mom enjoy reading books and doing art together.

Amongst her struggles, Jezzy has a good heart. When a local restaurant closed, she wanted to make them a sign to reopen. Her mom said it took her over an hour and lots of crying to explain that wouldn’t help the situation.

“The one thing I say about Jezzy is she is the type of child that every mother wants their daughter to grow up to be, except she’s like that already,” Bonita said. “That strong, independent woman that no one is every going to walk all over, except she’s only seven.”


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