Even as a baby, your child seems different. He is difficult to soothe, fussy, and incredibly colic. Getting him to eat his food or sleep on time becomes very frustrating events. Temper tantrums become a daily affair and are usually extremely dramatic.

As a young child, he seems to easily lose his temper and is prone to annoying people around him. He constantly argues with you and refuses to follow any requests you make and any rules that you set.

As a teenager, it gets even worse. He constantly procrastinates, dawdles, and claims not to hear requests made of him by the authority figures in his life. He is passive-aggressive in school, but is openly aggressive at home. It is a struggle to get him to pick up after himself, to take baths, or even just groom himself appropriately. He constantly flaunts the curfew set for him and refuses to do homework or even attend school. And when it comes to arguments, he is willing to lose privileges at home if it means he gets to win the discussion.

A lot of that may seem like normal behavior from a kid growing up, and most of the time, it probably is. But when your child’s behavior is so disruptive that it makes him stand out from other kids his age and it affects his social, family, and academic life, then your child probably has Oppositional Defiant Disorder, or ODD.

What causes ODD is something that has not yet been determined, according to Dr. Mark Reysio-Cruz, developmental and behavioral pediatrician at the Capitol Medical Center. According to Dr. Reysio-Cruz, there might be genetic and environmental patterns at play when it comes to determining how a child becomes afflicted with ODD.

"Predisposing factors may include parental rejection and neglect, difficult temperament, inconsistent child-rearing practices with harsh discipline, physical or sexual abuse, lack of supervision, having multiple caregivers, association with a delinquent peer group, and familial psychopathology such as parental criminality or antisocial personality disorder," he says.

The American Academy of Child and Adolescent Psychiatry expounds further on this, especially with regards to the discipline that a child receives in his developing years. According to their book "Your Adolescent", ODD may begin with a parent who cannot dish out consistent methods of disciplining their child.

"As a child matures, increasing negativism, defiance, and noncompliance become misguided ways of dealing with normal separation issues…The more a child reacts in defiant, provocative ways, the more negative feedback he elicits from the parents. In an attempt to achieve compliance, the parents or authority figures remind, lecture, berate, physically punish, and nag the child. But far from diminishing oppositional behavior, these kinds of responses toward the child tend to increase the rate and intensity of non-compliance. Ultimately, it becomes a tug-of-war and a battle of wills,’�?the book further emphasizes.

"When such patterns typify parent-child relationships, discipline is often inconsistent. At times, parents may explode in anger with efforts to control and discipline. At other times, they may withhold appropriate punishments and consequences so that these soon become hollow threats. As the child continues to provoke and defy, parents lose control. Then, feeling regret and guilt, especially if they’ve become verbally or physically explosive, the parents may become excessively rewarding in order to undo what they now perceive to have been, excessive discipline or harsh consequences."

Dr. Reysio-Cruz emphasizes that ODD is not a stand alone diagnosis.

"Experts say that ODD often co-occurs with attention deficit hyperactivity disorder, learning disabilities, conduct disorder, substance use/abuse, and mood disorders."

The first step towards dealing with a child with ODD is distinguishing the difference between a child who has ODD and someone who is just acting out.

"In simple acting out, there is mild negative impact where no one is hurt, no property is damaged, and parents do not significantly alter their plans," explains Dr. Reysio-Cruz. "Opposition means a willful refusal to comply with a person’s request by arguing or having negative attitudes. It peaks during early childhood and early adolescence and is seen more in boys than girls."

For a child to be diagnosed with ODD, Dr. Reysio-Cruz says that the following criteria have to be met:

�?There is a pattern of negativistic, hostile, and defiant behavior lasting at least six months, during which four or more of the following are present: often loses temper, often argues with adults, often actively defies or refuses to comply with adults�?requests or rules, often deliberately annoys people, often blames others for his or her mistakes or misbehavior, is often touchy or easily annoyed by others, is often angry and resentful, is often spiteful or vindictive.

�?The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning

�?The behaviors do not occur exclusively during the course of a psychotic or mood disorder

�?Criteria are not met for conduct disorder, and if the individual is 18 or older, criteria are not met for antisocial personality disorder

Dealing with ODD requires a number of behavior modification and management techniques. The American Academy of Child and Adolescent Psychiatry outlines a number of these techniques in "Your Adolescent".

Parent Training Programs. Some parents are helped through formal parent training programs. In these sessions, parents learn strategies for managing their adolescent’s behavior. These are practical approaches to dealing with an adolescent with ODD. The emphasis is on observing the adolescent and communicating clearly. Parents are taught negotiating skills, techniques of positive reinforcement, and other means of reducing the power struggles and establishing more effective and consistent discipline.

Individual Psychotherapy. The therapeutic relationship is the foundation of successful therapy. It can provide the difficult adolescent with a forum to explore his feelings and behaviors with a non-judgmental adult.

The therapist may be able to help the youngster with more effective anger management, thus decreasing the defiant behavior. The therapist may employ techniques of cognitive-behavioral therapy to assist the teen with problem-solving skills and in identifying solutions to interactions that seem impossible to the teenager. The support gained through therapy can be invaluable in counterbalancing the frequent messages of failure to which the adolescent with ODD is often exposed. When conducted by a child and adolescent psychiatrist, individual psychotherapy may be accompanied by the use of antidepressant and anti-anxiety medications.

Family Therapy. Problems with family interactions are addressed in family therapy. Family structure, strategies for handling difficulties, and the ways parents inadvertently reward non-compliance are explored and modified through this therapy. This approach can also address the family stress usually generated by living with an adolescent with ODD.

Cognitive-Behavioral Therapy. Behavioral therapy may help adolescents control their aggression and modulate their social behavior. Teenagers are rewarded and encouraged for proper behaviors. Cognitive therapy can teach defiant teens self control, self-guidance, and more thoughtful and efficient problem-solving strategies, especially as they pertain to relationships with their peers, parents, and other adults in authority.

Social Skills Training. When coupled with other therapies, social skills training has been effective in helping teens alter their difficult social behaviors that result from their angry and defiant approach to rules. Social skills training incorporates reinforcement strategies and rewards for appropriate behavior to help a teenager learn to generalize positive behavior, that is, apply one set of social rules to other situations. Thus, following the rules of a game may be generalized to rules of the classroom; working together on a team may generalize to working with adults rather than against them.

Through such training, adolescents can learn to evaluate social situa tions and adjust their behavior accordingly. The most successful therapies are those that provide training in the teen’s natural environments-such as in the classroom or in social groups as this may help them apply what they learned directly to their lives.

Medication. Medication is only recommended when the symptoms of ODD occur with other conditions, such as ADHD, OCD, or anxiety disorder. When stimulants are used to treat teens with attention deficit/hyperactivity disorders, they also appear to lessen oppositional symptoms. There is no medication specifically for treating symptoms of ODD when there is no other accompanying emotional or behavioral disorder.

As to the question of whether children with ODD can be mainstreamed into schools, Dr. Reysio-Cruz admits that one can not say for sure whether it will be an easier exercise than mainstreaming other children with different developmental disorders.

"Children with ODD have the right to be educated alongside children without disabilities as long as the regular classroom meets their needs and allows them to make educational progress," he says. "It is difficult to say if they can be mainstreamed more easily than other developmental disorders. What we do know is that children with ODD experience behavior issues, and social and academic concerns."