Adolescent Rebellion: Is It Normal or Is It ODD?

Oppositional defiant disorder, or ODD, is one of the most commonly encountered disorders in children and adolescents, occurring in 1 percent to 16 percent of children, depending on the criteria used, according to Maggie Blackburn, M.D. At the same time, however, ODD is somewhat enigmatic.

In her Oct. 4 seminar "When Good Kids Make Bad Choices," Blackburn, who is an assistant professor of family medicine and rural health at Florida State University Medical School, Tallahassee, discussed how ODD differs from normal adolescent behavior. She also looked at why it is important to identify ODD and at what family physicians can do to help patients through the process to land safely on the other side with their families and children intact.

"Up to 67 percent of children will work through ODD and ultimately be OK," said Blackburn. "Much of what you can do is about keeping the kids safe from themselves."

It's important not to rush to judgment, she noted. "Normal adolescent behavior is all about testing limits," said Blackburn. However, kids with ODD don't display these behaviors simply in response to a change. In these children, troublesome behaviors go beyond normal adolescent rebellion. Indictors that a child may have ODD include behavior that

"ODD is a multifactorial complex involving psychosocial, community, and attachment and parenting issues," said Blackburn. It frequently coexists with other conditions, such as anxiety, attention-deficit hyperactivity disorder and substance abuse. "Teasing out those other issues can be difficult," said Blackburn. "If your interventions for ODD aren’t having the expected response, that’s a red flag to look for something else."

Blackburn also suggested some tactics for physicians to use when interacting with adolescents who may have ODD. "It’s important to establish a therapeutic alliance with these kids as soon as you can, as well as with the family," she said. Gaining trust is tremendously challenging, but it is imperative to have an effect. Express respect for the child. Be clear from the start that the patient is a decision-maker. Although you cannot give adolescents the final say-so, they need to feel that their opinion matters. "You want to be able to negotiate for an agenda for change," said Blackburn.

"As family doctors, you are in the position to notice behavioral issues early. You know how the family works. You also know the community, how it impacts the children and what resources it can provide," said Blackburn. "One of the most important services you can offer to your patients -- both child and parent -- is to encourage patience."