Oppositional Defiance Disorder (ODD) is a disruptive behavior disorder, characterized by a pattern of irritable mood and argumentative, vindictive or defiant behavior that lasts for longer than 6 months. Should an ODD diagnosis be considered a parenting fail? Dr. Erina White wants you to know two things: you’re not alone, and you’re not a bad parent.
A Diagnosis, or a Label?
What troubles White is twofold: Not enough is known about ODD, yet the diagnoses of ODD are on the rise. “ODD has become a catch-all phrase for when a kid is acting out and people can’t figure out why,” White, who alternates between clinical research at Boston Children’s Hospital and instructing at Harvard Medical School, says. “I struggle with ODD in terms of the biomarkers, in large part because it’s a pretty massive diagnosis for a kid.”
At best, an ODD diagnosis provides an opportunity to identify the root causes of behavioral problems. At worst, it can be a polarizing label that causes more problems than it solves.
“What I’ve seen happening with families that come to us with a child who has an ODD diagnosis is it stigmatizes both kids AND parents,” White says. “The label doesn’t offer any solutions, it just makes you feel bad.”
White adds, “ODD isn’t like depression or ADHD [attention-deficit/hyperactivity disorder], where there are biomarkers that can be identified and medication can be used to help modify behavior. I have trouble with practitioners diagnosing ODD when they don’t have any other information.”
An ODD diagnosis shouldn’t be used as a holistic representation of the entire child, White says. “In my experience, more than 95% of the time, what comes out of an assessment has nothing to do with ODD and everything to do with something else.”
White emphasizes the importance of avoiding labels as a panacea for a host of other underlying issues. “In today’s day and age, the more we can move beyond labeling and into how we can provide support, the better,” she says. “You’re not a bad parent and haven’t done anything ‘wrong’. I’m a proponent of ‘let’s figure it out together’, which is a much warmer, stronger and solution-based approach.”
White is also vice president of Parent Services and the Clinical Services director at Mightier, a company with an offering of bioresponsive video games for kids aged 6-14. Additionally, she’s a family coach specializing in the development of self-regulation.
White says the most common underlying emotional states that trigger a behavioral response are fear and anxiety. “Anxiety in children can manifest as stubbornness and rigidity,” she says.
Unearth the source of these feelings and you can begin to find solutions. “Once you’ve acknowledged and normalized the child’s feelings and parents realize they’re not alone, you can work towards a game plan.”
The technology behind Mightier has been tested in three clinical trials, which collectively showed a 40% reduction in oppositional behaviors with 45 minutes of Mightier practice each week over a 12-week period.
Mightier’s video games teach calming skills by employing a “biofeedback algorithm” to monitor players’ heart rates. As the heart rate moves from blue (calm) to red (agitation), the games get even more challenging. This helps reinforce the connection between heart rate and emotions. In more stimulating moments, an avatar named ‘Dr. Dragon’ helps the child practice calming skills to get back into the blue zone.
The game modality makes the cognitive lesson behind it both interesting and engaging. According to the website, “Mightier’s algorithm takes the challenging moments already built into the game and turns them into key learning opportunities. By practicing calming skills in the game, kids are building the muscle memory needed to call on them when faced with challenges in the real world.”
Ultimately, sessions are taken offline and the self-regulating skills the child has learned are applied through a combination of skill-building challenges and cognitive behavioral therapy.
“Through these sessions, parents and children learn patterns that lead up to the behavior,” White says.
Although it might not feel like it in the moment, White says it’s a gift when our children act out or show defiance.
“Something like ODD becomes a much harder process to work through once they’ve reached adolescence or adulthood. The earlier ODD is addressed, the sooner it becomes an opportunity to work together as a family and to model better patterns of behavior. It makes the future seems a bit brighter.”
ODD Diagnosis — Sources:
Dr. Erina White, researcher at Boston Children’s Hospital, professor at Harvard Medical School and vice president of Parent Services, Clinical Services director at Mightier
American Academy of Child and Adolescent Psychiatry
American Family Physician