Angry Kids: Oppositional Defiant Disorder in the School Setting

This piece is the 12th in a collaborative series by multiple Vocal creators intended to raise awareness of mental health issues. The prologue that introduces the series was written by Courtney Capone and can be found here. The 11th piece was written by Ella Dorman and can be found here: What is Narcissism? The next one, on the topic of Depression, will be written by Paula Shablo whose profile is here!

Disclaimer: This piece is about mental health awareness and the struggle many people face every single day. It is not meant as a diagnostic tool or to give any medical advice whatsoever. Every individual has their own story and their own treatment plan, so even if you see part of yourself in this piece, it's vital that you seek the help of a trained professional. It IS okay not to be okay.

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The first time I met a student with Oppositional Defiant Disorder (ODD) I was in my second practicum as a student-teacher. Larry - not his name, but let’s call him Larry - was in my grade 9 English class. He had the perfect storm of labels: ODD with a secondary diagnosis of Giftedness. I was warned about him before I even set foot in the classroom. The principal and vice principal, my mentor teacher, the educational assistants; Everyone had a story about how he had screamed at them, cussed them out, flipped a desk in front of them, punched other kids in front of them, threatened to murder them, etcetera. So, by the time I actually met Larry I was worried. I was worried that he would exhibit behaviour I didn’t know how to deal with. And I was worried he might hurt another kid (or adult?!) on my watch and I wouldn’t know how to prevent it. It turned out my fears were unfounded, at least when it came to Larry, but I’ll come back to that.

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Oppositional Defiant Disorder is a disruptive behaviour disorder (DBD) (Ghosh, Ray, & Basu, 2017) usually diagnosed during elementary school. According to the Child Mind Institute, it has the following symptoms:

• Being unusually angry and irritable
• Frequently losing one’s temper
• Being easily annoyed
• Arguing frequently with authority figures
• Refusing to follow rules
• Deliberately annoying others
• Blaming others for mistakes
• Being vindictive (Ehmke, n.d.).

It is important to acknowledge that all children are capable of being (and likely will be) both oppositional and defiant at some point in their life. Discovering their own boundaries, practicing the word “no” and exerting their own independence is a part of usual childhood development. For this reason, the diagnosis of ODD is somewhat controversial, with some believing that without empirical evidence, this diagnosis is the problematic medicalization of “normal” child behaviour (Ghosh et al., 2017). However, there are a few signs that indicate a need for support beyond that provided to the majority of children:

1. The behaviour issues are extreme and they continue for a period of at least 6 months (Ehmke, n.d.). The DSM-5 also requires persistence and frequency of the symptoms: present almost every day for children younger than five and at least once per week for those older than five (Ghosh et al., 2017).

2. The on-going tension, arguments, refusal to follow instructions, and explosive outbursts take a toll on relationships between the child and parent and between the child and their teachers or other caregivers leading to the breakdown of significant relationships (which can cause other problems) (Ehmke, n.d.).

3. Children who have experienced chronic stress and trauma are more likely to develop ODD (Ehmke, n.d.).

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The second student I knew with ODD was only in grade 6. Let’s call him Jacob. The piece about constant arguments and explosive outbursts taking a toll on relationships was especially significant for him. When he arrived at our school, we were told little: he had a history of trauma, he had been expelled from an elementary school in another district, and he had just been returned to his foster parents after a stay at a group home. To say he was dysregulated and volatile would be an understatement. Our team tried to work with Jacob. They really did. And a couple of them even felt attached to him. But he started escalating quickly and ultimately only stayed with us for a few months. Students in his class were afraid of him and the room had to be cleared twice because he was angry, throwing things, and refused to leave the room himself. He was given an opportunity to bake cookies for his classmates (sort of a restorative thing) and he added so much Tabasco sauce and salt that the cookies were inedible. The final straw came when Jacob became violent towards an educational assistant. Her injuries were significant enough for her to seek medical attention and since there was a knife involved, the school employed lockdown procedures and the police were called to remove him from the building. Neither Jacob nor the educational assistant ever returned to our school after that.

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A children’s mental health clinician can make the diagnosis of ODD after a comprehensive psychiatric assessment with both a guardian and the child. It includes questions about the child’s behaviour patterns as well as their family history, medical history, school behaviour, and social interactions (Boston Children’s Hospital, n.d.).

Although it is possible for ODD to resolve on its own as a child matures, there is also a chance it will develop into Conduct Disorder (CD) which is more severe and could involve stealing, setting fires, cruelty to animals and/or people, and other serious criminal actions (Ehmke, n.d.; Boston Children’s Hospital, n.d.).

Training parents and giving them better parenting strategies is a crucial part of treating ODD (BCH, n.d.; Ehmke, n.d., Ghosh et al., 2017). This could be done through a parenting group or through family therapy. Emphasis is placed on repairing the damaged relationship between parent and child. Among other things, parents are taught to have clear household rules with consistent consequences for breaking them and consistent praise for positive behaviours (BCH, n.d.).

Therapy sessions with a clinician for social skills training for the child may also be part of the treatment plan. Although there is no medication specifically for ODD, medication may be prescribed to help when there is a comorbidity. For example, stimulants such as those prescribed for ADHD, antidepressants for depression or anxiety, or antipsychotics to treat aggression and irritability may be deemed appropriate (Ghosh et al., 2017; BCH, n.d.).

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Knowing that there are treatment options and that improvement is possible, it feels to some extent as though we failed Jacob. Something was missing for him and people were hurt as a result. Fortunately, I had a different experience with Larry.

I’m not sure if it was easier for him because he had a few more years of maturity than Jacob, or because of the giftedness, or just because he was living in different circumstances and was a different individual. Whatever the reason, Larry and I got along rather well and were able to successfully work together for the duration of my time with his class. He contemplated the world and the actions of others with insight well beyond his 15 years and he was a seriously talented writer. At the end of our novel study, he wrote me the best piece of wildly inappropriate (for school) fanfiction I’ve ever gotten from a student.

The only time I ever saw Larry start to escalate in class, he came and told me succinctly that he did NOT feel he could handle being in class right now and could he take himself down to the principal’s office to work alone in a quiet space? I thanked him for his honesty, he left, and that was the end of it. It made me wonder why all the other adults had described such conflict with him. Was he really “that bad” or was it just that they hadn’t been listening to him, hadn’t been meeting his needs? Was that why we lost Jacob? Because we just didn’t know how to listen and didn’t know how to meet his needs? I don’t know.

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I wanted to write this piece because our school recently got a call from a mom who was new to the area and shopping around for a school for her daughter. She described her daughter as a complex case - diagnosed with not just ODD, but also complex PTSD and RAD (reactive attachment disorder). She had spent most of her life in a developing country overseas where school included frequent instances of verbal and physical abuse from teachers. Clearly school would be a challenging environment for her and a trauma-informed approach would be critical. Mom wanted to make sure we would be a good fit.

I was on this call with my principal and as we listened to this family's story, I could see that she was thinking about Jacob. My principal did not want this girl at our school. This made me sad because none of these diagnoses were her fault and as a public school, our job is to provide an education to every student who comes through our doors. At the same time, I acknowledge that we are in a small community with limited resources. I couldn’t help but feel uncertain that our coworkers would be able to meet the needs of this student and it would be unfair for her to miss out on connecting with a team elsewhere that was better equipped to support her. The decision was out of our hands and in the end they decided to enroll somewhere else. I hope they are doing well.

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It IS okay not to be okay. If you know a child who is struggling with ODD, with symptoms of anxiety or depression, with PTSD, with any other mental health concerns such as negative self-talk, disordered eating, self-harm, suicidal ideation, or with a difficult life event such as divorce or separation, the death of a family member, bullying or relational aggression, family and/or peers who don’t accept their gender identity, or anything else, here are some options:

1. Consider starting with the child’s school counsellor, if their school has one. They may have the training to provide clinical counselling themselves and if not, they should be able to provide referrals to community-based counsellors in your area.
2. A medical doctor could help rule out any physical cause for your child’s behaviour and symptoms and should also be able to provide referrals for psychiatric help if appropriate.
3. Any child who is struggling can also be provided with access to a crisis line for your local area. For example, Kids Help Phone in Canada.

References

Boston Children’s Hospital. (n.d.). Oppositional Defiant Disorder: Diagnosis & treatments. Retrieved Feb. 18, 2022 from https://www.childrenshospital.org/conditions-and-treatments/conditions/o/oppositional-defiant-disorder/diagnosis-treatments

Ehmke, R. (n.d.). What is Oppositional Defiant Disorder? Child Mind Institute, Inc. Retrieved Feb. 17, 2022, from https://childmind.org/article/what-is-odd-oppositional-defiant-disorder/#full_article

Ghosh, A., Ray, A., and Basu, A. (2017). Oppositional defiant disorder: Current insight. Psychology Research and Behavior Management, 10: 353–367. doi: 10.2147/PRBM.S120582