What Is Oppositional Defiant Disorder (ODD)?
Oppositional defiant disorder (ODD) is a behavior disorder in which a child displays a pattern of an angry or cranky mood, defiant or combative behavior, and vindictiveness toward people in authority. The child's behavior often disrupts their daily routine, including activities within the family and at school.
It's not unusual for children -- especially those in their "terrible twos" and early teens -- to defy authority every now and then. They may express their defiance by arguing, disobeying, or talking back to their parents, teachers, or other adults. When this behavior lasts longer than 6 months and is more extreme than what’s usual for the child's age, it may mean the child has ODD.
Estimates suggest that 2% to 16% of children and teens have ODD. In younger children, this disorder is more common in boys. In teens it happens about equally in boys and in girls. It typically begins by age 8.
Many children and teens with ODD also have other behavioral problems, like attention deficit disorder, learning disabilities, mood disorders (such as depression), and anxiety disorders. Some children with oppositional defiant disorder go on to have a more serious behavior disorder called conduct disorder. With conduct disorder, a child shows antisocial behavior such as bullying, stealing, and cruelty to animals and people.
Oppositional Defiant Disorder Symptoms
Sometimes it can be hard to tell the difference between a strong-willed child and one who's showing symptoms of oppositional defiant disorder. Here are some signs to look for:
- Throwing repeated temper tantrums
- Excessively arguing with adults, especially those with authority
- Actively refusing to comply with requests and rules
- Trying to annoy or upset others, or being easily annoyed by others
- Blaming others for their mistakes
- Having frequent outbursts of anger and resentment
- Being spiteful and seeking revenge
- Swearing or using obscene language
- Saying mean and hateful things when upset
- Showing vindictive behavior (seeking to hurt others) at least twice in the past 6 months.
In addition, many children with ODD are moody, easily frustrated, and have low self-esteem. They also may abuse drugs and alcohol.
ODD Causes and Risk Factors
The exact cause of ODD is not known, but a combination of biological, genetic, and environmental factors may contribute to the condition.
- Brain chemistry: ODD 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 and other mental illnesses.
- 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.
- Family history: Many children and teens with ODD have close family members with mental illnesses, including mood disorders, anxiety disorders, and personality disorders. This suggests that a risk of getting this condition 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.
- Peers: Attention from peers or others may sometimes reinforce ODD behaviors.
As with adults, mental illnesses in children are diagnosed based on symptoms that suggest a particular illness like ODD. If symptoms are present, the doctor will begin an evaluation by doing a complete medical history and physical exam. Although there are no lab tests to specifically diagnose ODD, the doctor may sometimes use tests such as neuroimaging studies or blood tests if they suspect there may be a medical reason for the behavior problems that happen. The doctor also will look for signs of other conditions that often go along with this disorder, such as ADHD and depression.
If the doctor cannot find a physical cause for the symptoms, they will likely refer the child to a child and adolescent psychiatrist or psychologist, mental health professionals who are specially trained to diagnose and treat mental illnesses in children and teens. Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate a child for a mental illness. The doctor bases their diagnosis on reports of the child's symptoms and observation of the child's attitude and behavior. The doctor often must rely on reports from the child's parents, teachers, and other adults because children often have trouble explaining their problems or understanding their symptoms.
Oppositional Defiant Disorder Treatments and Home Care
Treatment is based on many things, including the child's age, how severe symptoms are, and the child's ability to take part in and tolerate specific therapies. Treatment usually consists of a combination of the following:
- Psychotherapy: This type of counseling aims to help the child develop more effective coping, social, and problem-solving skills, plus ways to express and control anger. A type of therapy called cognitive behavioral therapy aims to change the child's thinking (cognition) to improve behavior.
- Family therapy: This is used to improve interactions and communication among family members. A special therapy technique called parent management training (PMT) teaches parents ways to positively alter their child's behavior. This could involve developing contracts between parent and child that give rewards for positive behaviors and consequences (punishments) for negative behaviors.
- Medication: While there is no medication formally approved to treat ODD, a doctor may prescribe drugs to treat symptoms, like impulsivity. Sometimes, a child with ODD needs medication for other mental illnesses they may also have, such as ADHD or depression.
Strategies you can try at home if your child has ODD:
- Praise specific positive behaviors. Tell your child what you specially liked about what they did, as opposed to a generic "Good job." Offer rewards for good behavior, especially for younger children.
- Assign chores. Give clear instructions and use this as a way to reinforce good behavior.
- Model the behavior you want to see in your child. Make sure you're not shouting at your child or at others in the family.
- Avoid power struggles. Pick your battles. You don't need to react to everything.
- Set limits. Give clear instructions and boundaries. Follow a consistent schedule and routine.
- Spend time together doing things you both enjoy. Also schedule time for the whole family to do fun things together.
- Teach your child to express anger or disappointment without hurting others. Let them know it's OK to be upset but not OK to start throwing things, for example.
- Expect opposition from your child. At least initially, they may not respond positively to these changes at home. But by staying consistent, the behavior should improve.
Children or teens with ODD often have trouble at home, at school, and in their personal lives. This may lead to:
- Doing poorly at school or work
- Antisocial behavior
- Trouble controlling impulses
- Alcohol or drug problems
Children with ODD often have or develop other mental health conditions, including:
- Attention deficit hyperactivity disorder (ADHD)
- Conduct disorder
- Learning disorders
- Communication disorders
When started early, treatment is usually effective. If your child is showing signs of ODD, it’s important to seek care from a qualified mental health professional right away. Without treatment, children with ODD may face rejection by classmates and other peers because of their behavior problems and lack of social skills.
Studies have shown that in 67% of children diagnosed with ODD no longer have the symptoms within 3 years of diagnosis. Another 30% of children go on to develop conduct disorder. The risk of developing conduct disorder goes up if the child was diagnosed with ODD at a preschool age.
In preschool children, there is evidence that early intervention, in the form of Head Start programs or home visits to families at high risk, may help to prevent ODD. In older kids, social skills training or training in conflict resolution or anger management may help, though results are mixed.
Although it may not always be possible to prevent this disorder, recognizing and acting on symptoms when they first appear can ease distress to the child and family and prevent many of the problems linked to the illness. Providing a nurturing and supportive home environment with a balance of love and discipline can help with symptoms and prevent episodes of defiant behavior. Family members can learn steps to take if they see symptoms return.
Oppositional defiant disorder is a behavioral condition where a child or teenager is usually in an angry or cranky mood, defiant and combative to people in authority like parents and teachers. Usually a combination of counseling for the child, family therapy, training for the parents, and sometimes medication are used to treat it.
Is ODD a form of autism?
There is a lot of overlap between the behaviors of children with ODD and children with autism, so it can be difficult to determine which condition a child has. Few studies have been done on the relationship between autism and ODD, so this is something that needs more research. Some experts do think that ODD may be a symptom of autism in some children, although other children who don't have autism may be diagnosed with ODD.
Is ODD a form of ADHD?
Attention deficit hyperactivity disorder (ADHD) is the most common psychiatric disorder that children who have oppositional defiant disorder also have. But researchers think that ADHD and ODD are separate disorders.