Oppositional Defiant Disorder

What Is Oppositional Defiant Disorder (ODD)?

Oppositional Defiant Disorder (ODD) is one of a group of behavioral disorders called disruptive behavior disorders (DBD) that occur in children and adolescents. These disorders are called this because children who have these disorders tend to disrupt those around them. Oppositional Defiant Disorder (ODD) is one of the more common mental health disorders found in children and adolescents. In children with Oppositional Defiant Disorder (ODD), there is an ongoing pattern of uncooperative, defiant, and hostile behavior toward authority figures that seriously interferes with the child’s day-to-day functioning. All children are oppositional from time to time, particularly when tired, hungry, stressed or upset.  They may argue, talk back, disobey, and defy parents, teachers, and other adults.  Oppositional behavior is often a normal part of development for two to three year olds and early adolescents.  This occurs as they begin to establish a sense of independence from their parents and a greater sense of self.  However, openly uncooperative and hostile behavior becomes a serious concern when it is so frequent and consistent that it stands out when compared with other children of the same age and developmental level and when it affects the child’s social, family and academic life. Even the best-behaved children can be uncooperative and hostile at times, particularly adolescents, but those with Oppositional Defiant Disorder (ODD) show a constant pattern of angry and verbally aggressive behaviors, usually aimed at parents and other authority figures. The most common behaviors that children and adolescents with Oppositional Defiant Disorder (ODD) show are:

•    Defiance
•    Spitefulness
•    Negativity
•    Hostility
•    Verbal aggression

How Common Is Oppositional Defiant Disorder (ODD)?

There is a range of estimates for how many children and adolescents have Oppositional Defiant Disorder (ODD). Evidence suggests that between 1 and 16 percent of children and adolescents have Oppositional Defiant Disorder (ODD). However, there is not very much information on the prevalence of Oppositional Defiant Disorder (ODD) in preschool children, and estimates cannot be made. Oppositional Defiant Disorder (ODD) usually appears in late preschool or early school-aged children. In younger children, Oppositional Defiant Disorder (ODD) is more common in boys than girls. However, in school-age children and adolescents the condition occurs about equally in boys and girls. Although the disorder can seem to occur more often in lower socioeconomic groups, the reality is that Oppositional Defiant Disorder (ODD) affects families of all backgrounds.

What Causes Oppositional Defiant Disorder (ODD)?

The specific causes of Oppositional Defiant Disorder (ODD) are unknown, but many parents report that their child with Oppositional Defiant Disorder (ODD) was temperamentally more rigid and demanding than the child’s siblings from an early age.  Biological, psychological and social factors may have a role.
Biological Factors
Children and adolescents are more susceptible to developing Oppositional Defiant Disorder (ODD) if they have:

  • A parent with a history of attention-deficit/ hyperactivity disorder (ADHD), ODD, or conduct disorder (CD).
  • A parent with a mood disorder (such as depression or bipolar disorder)
  • A parent who has a problem with drinking or substance abuse
  • Impairment in the part of the brain responsible for reasoning, judgment, and impulse control
  • A brain-chemical imbalance
  • A mother who smoked during pregnancy
  • Exposure to toxins
  • Poor nutrition
  • Consistent lack of adequate sleep

Psychological Factors

  • A neglectful or absent parent
  • A poor relationship with one or more parent
  • A difficulty or inability to form social relationships or process social cues

Social Factors

•    Abuse
•    Poverty
•    Neglect
•    Lack of supervision
•    Uninvolved parents
•    Chaotic environment
•    Inconsistent discipline
•    Adoption (“your not my REAL parents so I don’t need to listen to you”)
•    Family instability (such as parental divorce or separation or frequent moves)

What Are the Symptoms of Oppositional Defiant Disorder (ODD)?

In children with Oppositional Defiant Disorder (ODD), there is an ongoing pattern of uncooperative, defiant, and hostile behavior toward authority figures that seriously interfere with the child’s day-to-day functioning.  The symptoms are usually seen in multiple settings, but may be more noticeable at home or at school.

Children with Oppositional Defiant Disorder (ODD) show an ongoing pattern of extreme negativity, hostility, and defiance that:

•    Is constant
•    Lasts at least 6 months
•    Is excessive compared with what is usual for the child’s age
•    Is disruptive to the family and the school
•    Is usually directed toward an authority figure (parents, teachers, principal, coach)

The following behavioral symptoms are associated with Oppositional Defiant Disorder (ODD):

•    Frequent temper tantrums
•    Excessive arguments with adults
•    Actively refusing to comply with requests and rules
•    Often questioning rules
•    Deliberately annoying and upsetting others
•    Often touchy or annoyed by others
•    Blaming others for their mistakes
•    Frequent outbursts of anger and resentment
•    Spiteful attitude and revenge seeking

How Is Oppositional Defiant Disorder (ODD) Diagnosed?

A child presenting with Oppositional Defiant Disorder (ODD) symptoms should have a comprehensive evaluation.  A mental health professional is often called upon if these behaviors create a major disturbance at home, at school, or with peers. Seeking treatment for children and adolescents suspected of having Oppositional Defiant Disorder (ODD) is critical. It may be difficult to improve the symptoms of Oppositional Defiant Disorder (ODD) without treating the coexisting disorder. This disorder is often accompanied by other serious mental health disorders, and, if left untreated, can develop into conduct disorder (CD), a more serious disruptive behavior disorder. Children with Oppositional Defiant Disorder (ODD) who are not treated also are at an increased risk for substance abuse and delinquency.

During the evaluation, the child’s primary care clinician will look for physical or other mental health issues that may cause problems with behavior. If the doctor cannot find a physical cause for the symptoms, he or she may refer the child to a child and adolescent psychiatrist or a mental health professional who is trained to diagnose and treat mental illnesses in children and adolescents. A child and adolescent psychiatrist or a qualified mental health professional usually diagnoses Oppositional Defiant Disorder (ODD).

The mental health professional will determine whether:
•    The behavior is severe
•    The conflicts are with peers or authority figures
•    The behavior is a result of stressful situations within the home
•    The child reacts negatively to all authority figures, or only his or her parents or guardians

Can Oppositional Defiant Disorder (ODD) Occur with Other Conditions?

It is important to look for other disorders which may be present; such as, attention-deficit hyperactivity disorder (ADHD), learning disabilities, mood disorders (depression, bipolar disorder) and anxiety disorders, all of which can lead to or contribute to Oppositional Defiant Disorder (ODD).

How Is Oppositional Defiant Disorder (ODD) Treated?

Treatment of Oppositional Defiant Disorder (ODD) may include: Parent Management Training Programs to help parents and others manage the child’s behavior, Individual Psychotherapy to develop more effective anger management, Family Psychotherapy to improve communication and mutual understanding, cognitive problem-solving skills training and therapies to assist with problem solving and decrease negativity, and Social Skills Training to increase flexibility and improve social skills and frustration tolerance with peers. Medication may be helpful in controlling some of the more distressing symptoms of Oppositional Defiant Disorder (ODD) as well as the symptoms related to coexistent conditions such as ADHD, anxiety and mood disorders. A child with Oppositional Defiant Disorder (ODD) can be very difficult for parents.  These parents need support and understanding.  Parents can help their child with Oppositional Defiant Disorder (ODD) in the following ways:

  • Always build on the positives, give the child praise and positive reinforcement when the child shows flexibility and cooperation.
  • Take a time-out or break if you are about to make the conflict with your child worse, not better.  This is good modeling for your child.  Support your child if he decides to take a time-out to prevent overreacting.
  • Pick your battles.  Since the child with Oppositional Defiant Disorder (ODD) has trouble avoiding power struggles, prioritize the things you want your child to do.  If you give your child a time-out in his room for misbehavior, don’t add time for arguing.  Say, “Your time will start when you go to your room.”
  • Set up reasonable, age appropriate limits with consequences that can be enforced consistently.
  • Maintain other interests so that managing your child with Oppositional Defiant Disorder (ODD) doesn’t take all your time and energy.  Try to work with and obtain support from the other adults (teachers, coaches, and spouse) dealing with your child.
  • Manage your own stress with healthy life choices such as exercise and relaxation.  Use respite care and other breaks as needed

With treatment, children and adolescents with Oppositional Defiant Disorder (ODD) can overcome their difficult behaviors and lead happier, more fulfilling lives.

– Compiled with information from the American Academy of Child & Adolescent Psychiatry