Oppositional defiant disorder (ODD) is a disruptive behavior disorder that is primarily diagnosed in childhood. Youths with ODD have a frequent and persistent pattern of defiance, hostility, vindictiveness, or obstinacy toward parents, teachers, peers, and other authority figures.
Oppositional Defiant Disorder: What Does It Mean?
Oppositional defiant disorder is classified as a disruptive behavior disorder because children with ODD usually disrupt the people around them. ODD is one of the most prevalent mental health issues among young people. The condition is marked by a consistent pattern of defiant, obstinate, vindictive, hostile, uncooperative, or disobedient behavior, especially toward people in authority. Children with ODD generally have more temper tantrums or other angry outbursts than their peers.
Defiant Definition
Defiant behavior is characterized by a clear disposition to resist, challenge, or fight. Youths with ODD may argue with adults, refuse to comply with rules, deliberately upset others, or blame other people for their actions.
Obstinate Definition
Obstinacy is a hallmark symptom of oppositional defiant disorder. Children with ODD may resist change and stubbornly stick to their argument, opinion, or course of action even if given valid reasons to desist.
Vindictive Definition
Vindictiveness is a purposeful attempt to cause pain or anguish. Youths with oppositional defiant disorder may intentionally hurt authority figures or peers, especially if they view it as an act of revenge.
Stats: How Many Suffer from this Disorder?
Studies suggest 1-16% of youths have oppositional defiant disorder. Onset typically begins during late preschool or early school-aged years. Among younger children, ODD is more prevalent in boys than girls. However, the condition is equally prevalent among both genders in school-aged children.
Oppositional defiant disorder affects children from all backgrounds. However, ODD seems to be more common among youths in lower socioeconomic groups.
What Causes Oppositional Defiant Disorder?
There is no specific cause of ODD. Nevertheless, mental health professionals believe a combination of biological, social, and psychological factors may contribute to the development of the condition.
Possible biological factors include:
- A parent with depression, bipolar disorder, or other mood disorders
- A parent with oppositional defiant disorder, conduct disorder, or ADHD
- A parent with drug or alcohol addiction
- A chemical imbalance in the brain
- Impairment in the part of the brain responsible for judgment or impulse control
- Poor nutrition
- A mother who smoked while pregnant
- Exposure to toxins
Possible social factors include:
- Childhood abuse
- Poverty
- Neglect
- Poor supervision
- A chaotic or unstable environment
- Inconsistent discipline
Possible psychological factors include:
- An absent parent
- A poor relationship with one or both parents
- Difficulty in forming social relationships
- Difficulty in processing social cues
Signs and Symptoms of Oppositional Defiant Disorder
Many of the signs and symptoms of oppositional defiant disorder are expressed by children who do not have the condition. This is especially true when children are hungry, upset, or tired. Even well-behaved children will have periods where they disobey, defy, or challenge authority. However, children with ODD experience these symptoms more often.
Symptoms of oppositional defiant disorder include:
- Refusing to do as instructed
- Arguing with authority figures
- Frequent temper tantrums
- Using unkind words
- Frequent questioning of rules
- Intentionally annoying others
- Seeking revenge
- Blaming others for one’s own actions
- Irritability
What are the Common Behaviors/Characteristics?
Oppositional defiant disorder is marked by a continuous pattern of hostile, defiant, stubborn behavior toward people in authority that disrupts the daily functioning of affected youths. While oppositional behavior is common among children, youths with ODD have frequent symptoms that stand out compared with peers of the same age and developmental level. Oppositional defiant disorder can affect a child’s family, academic, or social life.
Some studies indicate girls may show different symptoms of ODD than boys. While boys are more likely to argue and lose their temper, girls may lie, be uncooperative, or show their aggression in indirect ways.
Testing: What are the Diagnostic Criteria Per the DSM 5?
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) provides guidelines for diagnosing ODD. These behavioral and emotional symptoms must last for at least 6 months:
- Irritable or angry mood – loses temper easily, is easily annoyed by others, is often resentful
- Defiant and argumentative behavior – constantly argues with adults or people in authority, often refuses to follow the rules, intentionally upsets other people, blames others for his or her own mistakes
- Vindictiveness – is often spiteful, has displayed spiteful behavior at least twice in the past 6 months
Symptoms of ODD may vary in intensity. In mild ODD, symptoms tend to occur in only one setting such as at home, school, or with peers. Moderate ODD has some symptoms that appear in at least two settings. In cases of severe ODD, symptoms appear in at least three settings.
Oppositional Defiant Disorder and Other Conditions
A mental health professional will need to conduct a comprehensive psychological evaluation to determine if your child has oppositional defiant disorder. This is essential because ODD may occur with other mental health issues such as anxiety disorders, mood disorders, or learning disorders. Some of the symptoms of oppositional defiant disorder may be difficult to distinguish from these co-occurring issues. Additionally, youths who do not have ODD may display some symptoms of the condition on occasion.
ODD vs Conduct Disorder
Mental health experts believe oppositional defiant disorder may be a precursor to conduct disorder (CD). Conduct disorder is a more serious condition that may lead to destructive antisocial behavior. While the onset of ODD typically begins during preschool years, CD tends to appear when children are older.
ODD vs Intermittent Explosive Disorder
Oppositional defiant disorder is defined by disobedient, defiant, and hostile behavior toward people in authority. Intermittent explosive disorder (IED) is characterized by repeated, sudden episodes of violent, impulsive, aggressive behavior or verbal outbursts that are significantly out of proportion to the situation.
While ODD generally affects children, IED typically occurs in older people. Signs of intermittent explosive disorder include domestic abuse, road rage, breaking objects, or throwing objects. IED can have a major negative impact on a person’s school life, career, and relationships. It may also result in financial and legal issues.
Related Conditions
Children with ODD may have comorbid issues such as attention deficit hyperactivity disorder (ADHD), anxiety, depression, and bipolar disorder. Of all the conditions that coexist with oppositional defiant disorder, ADHD is the most common. Youths with both ODD and ADHD tend to be more disruptive, aggressive, and usually have lower academic performance than children with ODD alone.
Oppositional Defiant Disorder In Adults/Children
Oppositional defiant disorder generally appears in young children. If left untreated, it may develop into conduct disorder or contribute to the onset of antisocial personality disorder later in life.
Example Case of Oppositional Defiant Disorder
Richard, 8, arrives with his mother at the office of a local psychologist. Richard’s mother explains that he has been arguing with teachers and throwing temper tantrums at school. While Richard’s mother rarely experiences these issues at home, the disruptive behaviors have been much more frequent in the classroom.
The school’s guidance counselor recommended Richard be taken to a mental health professional who specializes in pediatric care. After speaking with Richard’s mother, the psychologist learns that she and Richard’s father both have anxiety issues.
The psychologist diagnoses Richard with oppositional defiant disorder and recommends treatment involving a combination of family therapy, school-based intervention, and parent management training. One year later, Richard is having fewer outbursts, making more friends, and improving his academic performance.
How to Deal/Coping With Oppositional Defiant Disorder
Oppositional defiant disorder can disrupt the lives of children, parents, and their close associates. The family may need counseling to learn about the condition, develop effective coping strategies, manage distress, and build supportive relationships.
Contact your child’s healthcare provider if your child:
- Is out of control
- Is usually anxious, fearful, or angry with himself, herself, or others
- Has sleep or eating issues for three consecutive days
- Is hearing or seeing things others cannot hear or see
- Behaves in a manner that deeply concerns family, friends, or teachers
Ensure you have a contact number for your child’s healthcare provider in case you need assistance after office hours.
Look out for These Complications/Risk Factors
Young people with oppositional defiant disorder may have issues with parents at home, teachers in school, or supervisors at work. They have difficulty making friends and maintaining close relationships. ODD may contribute to future problems such as language disorders, learning disorder, conduct disorder, impulsive control issues, antisocial personality disorder, mood issues, substance abuse issues, and suicidal ideation.
Children with poor emotional regulation, a history of abuse or neglect, unstable home environment, and a family history of mental health disorders are at higher risk of developing oppositional defiant disorder.
Oppositional Defiant Disorder Treatment
ODD treatment is often focused on learning the skills to build positive family interactions and manage disruptive behaviors. Effective forms of psychotherapy include parent-child interaction therapy (PCIT), family therapy, cognitive behavioral therapy (CBT), and peer-group therapy.
In addition to psychotherapy, treatment may also include social skills training, problem-solving training, parental training, and medication. Treatment of ODD usually lasts for at least several months. There is no definite way to prevent oppositional defiant disorder. However, early treatment goes a long way toward keeping ODD under control.
Possible Medications for ODD
Medication alone is not an effective treatment for oppositional defiant disorder. However, some children with ODD may benefit from medication prescribed to treat coexisting conditions such as anxiety, depression, and ADHD.
Home Remedies to help ODD
There are no home remedies that have been clinically proven to help with oppositional defiant disorder.
Living with ODD
Living with ODD can be challenging for families. However, there are strategies that may help reduce your child’s problem behaviors. These include:
- Praising your child’s positive behaviors
- Avoiding power struggles
- Giving clear instructions
- Performing the behavior you want your child to display
- Establishing a daily routine for your child
- Spending time with your child
- Assisting with school work
- Assigning household chores
- Not overreacting to challenges
- Keeping all appointments with your child’s healthcare provider
- Keeping in touch with other parents who have children with ODD
- Working with your child’s healthcare provider and school to develop an effective treatment plan
Insurance Coverage for ODD
Oppositional defiant disorder is a diagnosable behavior condition. Your child’s health insurance plan may cover the cost of treatment. Contact your child’s insurance provider to verify coverage and obtain any necessary information or authorization before you visit your child’s healthcare provider.
How to Find a Therapist
Speak with your child’s doctor if you believe your child is showing symptoms of oppositional defiant disorder. If the physician is unable to find any physical cause for the symptoms, he or she may refer you to a mental health professional with expertise in pediatric issues.
What Should I be Looking for in an LMHP?
Making a diagnosis of oppositional defiant disorder is not always easy. Working with a therapist who is trained to treat disruptive behavior disorders is very important. The therapist should also be able to communicate well with the child and parents. This is crucial as some parents may become defensive when asked about their parenting style and some children may see their behaviors as justified.
If your therapist is able to cultivate a close, trusting relationship with your child and the rest of the family, this will make successful treatment much more likely. If your family is not comfortable with your therapist, it may be best to ask for a referral.
Questions to Ask a Potential Therapist
Questions you can ask your child’s therapist include:
- Does my child have ODD?
- Are there any coexisting mental health issues?
- What factors may have contributed to my child’s condition?
- Is my child at risk for any long-term complications?
- What adjustments do you think may improve my child’s behavior?
- How long is this condition likely to last?
- Should I inform my child’s teachers about the condition?
- What can my family do to improve my child’s circumstances?
- Is family therapy recommended?
Oppositional Defiant Disorder Resources and Support Helpline
There are a variety of resources to help children with oppositional defiant disorder. If your child is thinking about suicide or harming others, please call any of the following numbers right away:
- 911 or your local emergency services number
- The National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) to speak with a mental health professional
Other helpful resources include:
- ODD Family Guide
Programs:
Program Name Age Range Contact
Information Incredible Years Up to 8 years www.IncredibleYears.com
Triple P-Positive Parenting Program Up to 13 years http://www5.triplep.net
Parent-Child Interaction Therapy (PCIT) Up to 8 years www.pcit.org
Center for Collaborative Problem Solving Up to 18 years www.explosivechild.com The Adolescent Transitions Program (ATP) 11 to 13 years http://cfc.uoregon.edu/atp.htm
Oppositional defiant disorder can lower a child’s quality of life. However, effective psychotherapy can give children and adolescents the skills they need to overcome their difficult behaviors and reach their full potential.
References
Iliades, C. (2014, November 14). Understanding impulse control and conduct disorders. Retrieved from https://www.psychiatryadvisor.com/anxiety/understanding-impulse-control-and-conduct-disorders/article/383763/
Mayo Clinic Staff. (2015, August 25). Intermittent explosive disorder. Retrieved from https://www.mayoclinic.org/diseases-conditions/intermittent-explosive-disorder/symptoms-causes/syc-20373921
Mayo Clinic Staff. (2018, January 25). Oppositional defiant disorder (Odd). Retrieved from https://www.mayoclinic.org/diseases-conditions/oppositional-defiant-disorder/symptoms-causes/syc-20375831
Oppositional defiant disorder. (2013). Retrieved from https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Children-With-Oppositional-Defiant-Disorder-072.aspx
Oppositional defiant disorder (ODD) in children. (n.d.). Retrieved from https://www.hopkinsmedicine.org/healthlibrary/conditions/mental_health_disorders/oppositional_defiant_disorder_90,P02573
Oppositional defiant disorder resource center. (n.d.). Retrieved from https://www.aacap.org/aacap/Families_and_Youth/Resource_Centers/Oppositional_Defiant_Disorder_Resource_Center/Home.aspx