Child Conduct Disorder & Oppositional Defiant Disorder

At NPS we have been working with children and families for over 41 years. All children can be difficult and challenging at times. But if your child or teenager has a frequent and persistent pattern of anger, irritability, arguing, defiance or vindictiveness toward you and other authority figures, he or she may be experiencing what is called oppositional defiant disorder (ODD).

These behaviors can start as early as pre-school and present up through adolescence. With more extreme behaviors, the child/teen may be struggling with behaviors referred to as a conduct disorder (CD). Conduct disorder can start early, before age 10, or in adolescence.

Children who display early-onset conduct disorder are at greater risk for persistent difficulties, however, and they are also more likely to have troubled peer relationships and academic problems. 

Other issues would include:

• A disregard for and aggression toward others
• Pushing
• Hitting and biting in early childhood
• Bullying, cruelty and violence in adolescence. 

What is critical to know is that while these are held as two separate diagnostic labels/categories in the psychiatric field (DSM-5), Dr. Neal recognizes that these are actually symptoms of an underlying issue(s) for the child.  A label never tells the whole story nor does it give enough information to know how to help a child. The exasperating question becomes “why are you doing that?-stop it! ” Yet, the more informed, compassionate question to ask about a child who engages in such behaviors is “what happened to them? Or what is happening to them to cause these behaviors?”

We hold that when children cannot control their emotions or behaviors, there is an underlying unresolved emotional issue from past trauma or current overwhelming situation, or an underlying biochemical imbalance that needs to be addressed. We treat the whole person-mind, body and soul taking an integrative functional medicine approach.

Common Signs Of ODD & CD

Common signs of Oppositional Defiant Disorder (ODD) in children:

• Often loses temper
• Often touchy or easily annoyed
• Often angry and resentful
• Often argues with authority figures
• Often actively defies or refuses to comply with requests from authority figures or with rules
• Often deliberately annoys others
• Often blames others for his or her mistakes or misbehavior
• Has been spiteful or vindictive at least twice within the past 6 months

Common signs of Conduct Disorder (CD) in children:

• Often bullies, threatens or intimidates others
• Often initiates physical fights
• Has a weapon that can cause serious harm to others (ie: bat, brick, knife, gun)
• Has been physically cruel to people
• Has been physically cruel to animals
• Has stolen while confronting a victim (ie: mugging, purse snatching, extortion, armed robbery)
• Has forced someone into sexual activity
• Had deliberately engaged in fire setting with intention of causing serious damage
• Has deliberately destroyed other’s property (other than by fire setting)
• Has broken into someone else’s house, building or car
• Often lies to obtain goods or favors to avoid obligations (ie: scams or cons others)
• Has shoplifted
• Often stays out at night despite parent’s rules, beginning before age 13
• Has run away from home overnight at least twice or once without returning for a lengthy period
• Is often truant from school, beginning before age 13

Which Children Are At Risk For ODD Or CD?

ODD and CD are more common in boys than in girls. Children with the following mental health struggles are also more likely to have ODD or CD:

• Mood or anxiety disorders
• Attention-deficit/hyperactivity disorder (ADHD)
• Past trauma event
• Significant life altering event such as divorce, loss of parent, etc. 

ODD & CD Causes and Risk Factors

The exact cause of ODD/CD is not known, but a combination of biological, genetic and environmental factors may contribute to the condition.

• Brain chemistry: ODD/CD has been linked to certain types of brain chemicals, or neurotransmitters, that don’t work the right way. Neurotransmitters help nerve cells in the brain communicate with each other. If these chemicals are not working properly, messages may not make it through the brain correctly, leading to symptoms of ODD/CD and other mental illnesses. Further, many children and teens with ODD/CD also have other conditions, such as attention deficit hyperactivity disorder (ADHD), learning disorders, depression, or an anxiety disorder, which may contribute to their behavior problems. At NPS, we explore the underlying causes that could be disrupting normal neurotransmitters being produced in the lining of the gut. The recent exploration and understanding of Brain Gut Connection is transforming how we are now treating many different mental and physical conditions in the body.  
• Other brain differences: Some studies suggest that defects in or injuries to certain areas of the brain can lead to serious behavior problems in children.
• Temperament: Kids who have trouble controlling their emotions are more likely to have ODD/CD.
• Family history: Many children and teens with ODD/CD have close family members with mental conditions, including depression, anxiety disorders and personality disorders. This suggests that a risk of getting ODD/CD may be inherited.
• Family issues: Things like a dysfunctional family life, substance abuse and inconsistent discipline by parents or other authority figures may add to the development of behavior disorders.
• Trauma:  traumatic or overwhelming events can trigger ODD/CD behaviors in children. 
• Peers: Attention from peers or engaging in substances or drugs may sometimes reinforce ODD/CD behaviors.

Do You Need A Child Behavioral Psychologist to diagnose ODD or CD

Working with a trained therapist who understands WHY your child is struggling is essential to getting the help you need. We have a comprehensive intake based on decades of working with children that helps to collect information from all areas of a child’s life. We meet with the parent(s), collect information from teachers and at times directly from the child.

We lead with informed compassion for both the child and parent because we understand that the child’s “symptoms are asking us questions that need to be answered.” We do not judge or shame. Dr. Neal sees the behaviors, emotions and thoughts that are out of control as clues to some underlying imbalance emotionally or physiologically. We view the person through the lens of mind, body and soul, which reflects our integrative functional medicine approach.

Does NPS Use Medications to Treat ODD or CD?

Our mission is to promote health and a change in negative behaviors through alternative treatments and natural remedies for ODD and CD and other mental health concerns. 

We do not take a hard-line stance against using mediations. Many people have experienced tremendous relief and a new freedom in their life using medications. 

When someone receives a mental health diagnosis, questions about other options often surface. 

• “Are there alternative treatments for depression?”
• “What are the natural remedies for anxiety?” 
• “My son has ODD and my doctor says he needs to take medication. Are there alternatives to medication?”

The answer is a resounding and hopeful yes! Please click the link for more information about how NPS takes a balanced approach when considering medications vs natural alternative approaches. 

Teaching A Child With ODD or CD

Children who suffer with ODD or CD symptoms will struggle at home, school and in their relationships. They can often be distractible and cannot focus while at school. They will not be able to experience the motivation and concentration needed to complete homework at home. Sometimes, their strong emotional or physical reactions will negatively impact their relationships with peers.

This can create chaos in the most normal everyday life in the classroom and homework time at home. It becomes a central stressor for parents and sometimes, even siblings. At NPS, we take a realistic integrative approach in our treatment of ODD/CD. We speak into balancing out realistic expectations of academics at school and homework while in the process of helping a child overcome their struggles.

We support the parent by helping them work with the classroom teacher. We have many years of working closely with schools for accommodations and putting helpful scaffolding around the student to support them. We are familiar with how to set up resources such as 504’s and IEP’s, which offer support for your child in the classroom. 

Anger Management

Anger in a child is often misunderstood as a child just being defiant and wanting their own way. Dr. Neal understands that anger is a symptom of an underlying imbalance that needs to be addressed. Most children will occasionally display this while growing up.

In oppositional defiant disorder or conduct disorder, anger can be a daily, sometimes multiple times a day occurrence. A child can go from zero to 60 in an instant while seemingly being triggered by a minor event. Meltdown episodes are a common frustration for the parent. The goal of counseling is not to only stop the behavior- the goal is to understand WHY a child cannot self regulate emotionally.

What is keeping the “brakes” from kicking in when a child gets frustrated? Once it is identified what is hijacking the child’s emotions and behaviors, with proper intervention, the child can then “self” regulate.

Parenting Your Child With Oppositional Defiant Disorder Or Conduct Disorder

At NPS, we work with the whole family, not just the child. We understand that when a child is struggling (like a hanging mobile from a ceiling, when one piece moves, all the other pieces move along with it) the whole family can be impacted by one person in a family.

After we complete an evaluation, we can offer insight as to “why” your child struggles. The real question being answered is what happened or what is happening that is making your child struggle.  

Dr. Neal likes to say that he wants to ring 3 bells for the parent(s) in the diagnostic feedback session after completing the evaluation:  

1. Ring the bell in your intellect, that what he is presenting makes sense to your logic/rational/science part of your brain. 
2. Ring the bell in your heart-that someone is finally understanding why your child is struggling and that your child is being “seen” and you are being “heard” as a parent. Many times Dr. Neal will hear from a parent that he must be watching in the back window of their life because he so accurately describes the what and why of their child’s behaviors. 
3. Ring the bell in your gut as a parent. That part of you that intuitively knows that someone has cracked the code on your child’s struggles and can provide a way to help your child be all he or she is meant to be.  

After the diagnostic feedback session, Dr. Neal will lay out a plan of intervention to address the underlying reasons for the struggles and help you and your family move forward. He has a team and many community connections built over 39+ years. He will cover all options and discuss natural alternatives to medications, which is his first go to.

He is always open and well-versed in the conventional, traditional medication approach. Because there are different factors impacting why a child behaves the way he or she does, there are always multiple factors for helping a child be able to self regulate.

When Should I Call A Counselor?

Call right away if your child:

• Feels extreme depression, fear, anxiety, or anger toward him or herself or others
• Feels out of control
• Hears voices that others don’t hear
• Sees things that others don’t see
• Can’t sleep or eat for 3 days in a row
• Shows behavior that concerns friends, family, or teachers, and others express concern about this behavior and ask you to seek help

Call 911 if your child has suicidal thoughts, a suicide plan, and the means to carry out the plan.

Child Conduct Disorder FAQs

How we, as a counselor talk to a child with ODD/CD

Working with kids with these types of struggles starts at a place of “earning the right to be heard.” Most kids have already received many negative messages for many years from adults about their “bad behavior.” Naturally, they are on guard when they come to our office, assuming one more adult is going to criticize or judge them. Safety, trust and respect is core to building rapport with your child.  

Every human being has the basic need of “I need to be seen, heard and know that what I say to you matters.” Once we build rapport, we can then begin to engage the child in a way that helps him or her learn to self regulate. Because we take an integrative functional medicine approach, talking with the child is only part of the healing process. We work closely with parents on the other healing aspects.  

Disciplining your child with Oppositional Defiant Disorder

This is a greatly misunderstood and frustrating area for parents. Most parents have tried all kinds of approaches, none of which seem to work and some which only make the child escalate or shut down even more. Once we address the underlying issue of what is triggering a child’s opposition to following a parent’s guidance or rules, we find that a child can then self regulate and follow through with what is expected of him or her at home or school. The key is not to focus on trying to change a child’s acting behaviors to start off with. Rather, we go for the core issue of what is getting in the way of a child complying.  

Can a child outgrow Oppositional Defiant Disorder?

Since oppositional defiant disorder is not a normal developmental stage, a child cannot simply “outgrow” it. A child going through the normal “terrible twos” would not be considered ODD. As explained above, these types of ODD behaviors are indicative of some underlying imbalance on a physiological level or some unresolved underlying emotional event.