What Is Oppositional Defiant Disorder (ODD)?

Father lecturing misbehaved son

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What Is Oppositional Defiant Disorder?

Oppositional defiant disorder (ODD) is a psychiatric disorder that typically emerges in childhood, between ages 6 and 8, and can last throughout adulthood.

ODD is more than just normal childhood tantrums, and the frequency and severity of ODD causes difficulty at home and at school. What's more, children with ODD often also struggle with learning problems related to their behavior.

Types

There are two types of oppositional defiant disorder:

  •  Childhood-onset ODD: Present from an early age, and requires early intervention and treatment to prevent it from progressing into a more serious conduct disorder
  • Adolescent-onset ODD: Begins suddenly in the middle- and high-school years, causing conflict at home and in school

Symptoms

Children with ODD display behaviors that are challenging for parents and educators. For example, they demonstrate aggression and purposeful misbehavior. They usually have difficulty interacting appropriately with peers and adults. Being argumentative and defiant is also a common problem in children with ODD.

Common signs and symptoms of ODD include:

  • Being easily annoyed
  • Causing conflict
  • Frequent temper tantrums
  • Low tolerance for frustration
  • Lying
  • Moodiness and unprovoked anger
  • Noncompliance with even simple requests
  • No sense of conscience
  • Purposeful irritation of others

It is important to note that with ODD, these symptoms occur in multiple domains and not just at home. Many children engage in oppositional behaviors with their parents but not in any other environment.

Diagnosis

According to the DMS-5, a diagnosis of ODD requires a child to have at least four symptoms from the following categories. The symptoms must occur for at least six months and have a negative impact on social, educational, or occupational functioning:

  • Angry/irritable mood: Often loses their temper, is often angry or resentful, is often touchy or easily annoyed
  • Argumentative/defiant behavior: Often argues with authority figures or adults, 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
  • Vindictiveness: Has been spiteful or vindictive at least twice within the past six months

Your healthcare provider may assess the severity of your child's ODD using the following scale from the DSM-5:

  • Mild: Symptoms are confined to only one setting.
  • Moderate: Some symptoms will be present in at least two settings.
  • Severe: Symptoms will be present in three or more settings.

Causes

While there is no known cause, ODD has been linked to a combination of biological, psychological, and social factors.

Biological factors include:

  • A parent with a history of attention-deficit/hyperactivity disorder (ADHD), ODD, or CD
  • A parent with a mood disorder (such as depression or bipolar disorder)
  • A parent with a substance use disorder
  • A mother who smoked during pregnancy
  • Abnormal levels of neurotransmitters in the brain
  • Exposure to toxins
  • Impairment in the part of the brain responsible for reasoning, judgment, and impulse control
  • Poor nutrition

Psychological factors include:

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

Social factors include:

  • Abuse or neglect
  • Chaotic environment
  • Family instability (such as divorce or frequent moves)
  • Inconsistent discipline
  • Lack of supervision
  • Poverty
  • Uninvolved parents

Sometimes ODD occurs in conjunction with other behavior disorders or mental health issues, including attention-deficit/hyperactive disorder (ADHD), anxiety disorders, depression, bipolar disorder, and language disorders.

Treatment

It is important that intervention begins as early as possible with children with ODD. Without proper intervention, ODD may develop into a conduct disorder.

Therapy

Treatment often involves the following:

  • Cognitive problem-solving skills therapy: Children will learn to manage specific symptoms of ODD and to identify and solve problems that arise from living with ODD.
  • Family therapy: Parents, siblings, and other family members may be invited to attend therapy with the child in order to improve family interactions and relationships.
  • Parent training: Parents or caregivers may be taught behavior management strategies and techniques to reduce misbehavior in the home.
  • Psychotherapy: Individual therapy can help a child learn new skills, such as anger management and impulse control.
  • Social skills training: Formal social skills training can be effective in helping the child with ODD to interact with peers and adults.

It will be important for the child's therapist to work closely with parents and teachers to ensure the effectiveness of a treatment program because behavior techniques that work with most children may be ineffective with children who have ODD.

Medication

While medication alone is not a recommended treatment for ODD, your child may need medication to treat the symptoms of other coexisting conditions like ADHD, anxiety, and mood disorders.

Training

Behavior modification methods can be effective ways to reduce behavior problems in children. Sometimes a clinician will meet with caregivers separately to provide training on the following parenting techniques that can reduce misbehavior.

Treatment will often focus on one or two behavior problems, but the focus should be on reinforcing pro-social behaviors (i.e., keeping hands and feet to self, demonstrating respectful disagreements, etc.).

Form a Positive Relationship

The first step in treatment is building a positive relationship with your child. Most treatments for ODD begin with the parent engaging with the child in child-led play with the parent providing positive reinforcement and engagement.

Set Expectations

Children with ODD often have a goal of annoying parents and teachers and will misbehave to provoke a negative response. It is especially important to set clear expectations rules and to apply them consistently.

Establish a Routine

Having a routine can help children with ODD cope with activities at home such as transitioning from dinner to homework to bedtime. Applying rules and following routines consistently and fairly are important for that reason.

Discipline and Rewards

Provide specific, labeled praise and rewards for the prosocial behaviors you want to see. If the child responds to behavior management systems, use stickers, tokens, or a behavior chart to show progress toward behavior goals. Allow the child to identify rewards they would like to earn.

As the child demonstrates success, offer reinforcement such as spending time in a preferred activity, verbal praise, edible rewards, or items from a prize box.

Social Interaction

When the child interacts with others, make sure there is adequate supervision to ensure that rules can be enforced, and adults can help them interact appropriately. It can be helpful to have the school's counselor to work with peers to help them learn to respond appropriately to the child's behaviors.

Coping

Parents can also help their child better cope with ODD by doing their best to:

  • Avoid giving direct praise that could result in misbehavior, especially if the child has the tendency to do the opposite of what you want them to do. For example, saying, "I like the way you're keeping your hands to yourself," could provoke the child to become physically aggressive.
  • Resist the urge to argue or lecture the child, and try to keep your own temper under control.
  • Avoid letting your child see you become angry, as this may be rewarding to them.
  • Use a matter-of-fact tone of voice without emotion, simply stating the rule that was broken and what the consequences will be.
  • Be consistent and avoid getting into a verbal argument with the child over consequences or what happened.
  • Allow the child to have a place to vent their frustrations. Provide a pillow to punch or to yell into.

Support for Parents

Raising a child with ODD can be emotionally taxing and it's important to seek out opportunities to talk with other parents. No matter how thoughtful and understanding your family and friends, there is something special about talking with other parents who understand day-to-day living with a child with ODD.

In addition to emotional support, online support communities or Facebook groups can help ensure that you're educated on the latest findings and approaches to managing ODD.

If your child is struggling with ODD, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database.

A Word From Verywell

The prognosis for recovery from ODD is unclear. Some children will mature and symptoms of the disorder will subside into adulthood. Others will carry the disorder into adulthood. Meeting the complex needs of these children will require the cooperation of parents and school personnel as well as mental health professionals.

A cooperative, consistent effort at home and school will improve the likelihood of a positive outcome for these children, especially when intervention begins at an early age.

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