“Oppositional defiant disorder.” 

Your child was struggling with behaviour, and you needed help. You reached out to a professional, you told them your story, and you received an assessment.

You read the words “Oppositional defiant disorder.”

What now?

 

What’s in a name?

Labels help us to explain what is happening. If we describe something accurately, we will know what to do about it as soon as we hear it named.

For example, military personnel are sometimes treated for post-traumatic stress disorder (PTSD.) The name tells you something important: this person has been through a stressful experience, this person continues to suffer, and needs help.  A diagnosis can often help to validate the feeling that something is wrong, and suggest a course of treatment. However, the wrong label can be misleading, biased and worse than useless. For example, what do you think of when you hear the word “battle fatigue”? Would you assume it only affects people in battle? Would you conclude that the sufferer feels tired and needs a rest? “Battle fatigue” is one of the many names people have used to describe PTSD, but as mental health professionals started to understand the effects of trauma, the condition was given a more accurate name.

What does the diagnosis “oppositional defiant disorder” tell us?

As a therapist and as a parent, I don’t find the label “oppositional defiant disorder” helpful at all. I would argue that the label itself does more harm than good, and here’s why:

1) The problem with the term “Oppositional”. Opposed. To what? To anything in particular? When you refuse to cooperate with someone, is it because you prefer to do the opposite of what you are told, or do you have some other reason that seems valid to you? As a parent, how do you help someone who is opposed to you?

2) The problem with the term “Defiant.” Disobedient. Disrespectful. This word places the focus on the adult’s point of view and how they feel about the behaviour in question, but tells us nothing about why the child is reacting that way.

3) The problem with the term “Disorder.”  What does the word “disorder” mean? Is it a permanent condition? The dictionary definition doesn’t help much, but suggests that your child is suffering from a “condition that is not normal or healthy.” You knew that much, or else you wouldn’t have looked for help in the first place, but will it ever get better?

4) The problem with finding “symptoms.” A disorder has to have symptoms, right? A symptom is what happens as a result of an underlying problem, like a fever is the symptom of a cold. However, “oppositional defiant disorder” is not an illness. The label does not cause the problems. The label only describes the behavioural effects of a problem that is left undefined.

5) The problem with finding hope. All of us need hope. Parents who have hope will see more measurable positive change in their child’s behaviour than parents who feel hopeless. The term “disorder” can lead parents to believe that the problem is just part of how their child is. When parents reach out for help with managing challenging behaviour, research shows that optimism matters (see Dr. Mark Durand’s work on Optimistic Parenting.)

6) The problem with finding a treatment. What do you do about Oppositional Defiant Disorder? Where do you start? Do you have to make them stop opposing you? Directly attacking “defiant” behaviour can actually achieve the opposite effect. The more you focus on the frustrating behavioural symptoms, the more difficult your relationship with your child can become.

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7) The problem with finding a starting point. There are so many different reasons that a child could be angry, irritable, or stubborn. The term “Oppositional Defiant Disorder” takes all those moments, all those possibilities, and bundles them into one massive problem without a clear solution. 

8) The problem with blame. The term “Oppositional Defiant Disorder” sounds like a disease your child was born with, or maybe a mental illness that developed along the way (although neither is technically true.) If someone caused this, was it you? Was it your spouse, or a previous caregiver? Without a clear explanation treatment, blame is often the next attempt to make sense of a confusing and troubling situation, but it does absolutely no good at all.

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When you don’t understand the problem, it’s so hard to find a solution.

If it were up to me, your support team (including teachers, doctors, psychologists, counsellors) would focus less on naming or reacting to the behaviour, and spend more time looking at your child’s strengths, needs, and individual relationships. The behaviour we call Oppositional Defiant Disorder is  not simply the result of poor parenting, a neurological disorder, or a genetic quirk. We cannot miss a chance to help children reach their potential, just because their diagnosis sounds like a dead end, but children with challenging behaviour need more than sticker charts, boundaries and persuasion. They need relationship-building opportunities and support in key areas, including strong , emotional skills like expressing anger and coping with frustration, and cognitive skills such as planning, prioritizing and sequencing.

As you start to understand your child’s behaviour as a means of communication, you will start to see less of the “disorder” and “behaviour,” and you will be able to see the amazing, individual, tender-hearted child that has been there all along.

 

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