Oppositional Defiant Disorder

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, ODD is more common in boys. In older children, 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 ODD go on to have a more serious behavior disorder called conduct disorder.

ODD Symptoms

Symptoms of ODD may include:

• 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 your 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

In addition, many children with ODD are moody, easily frustrated, and have low self-esteem. They also sometimes 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. Further, many children and teens with ODD also have other mental illnesses, such as attention deficit hyperactivity disorder (ADHD), learning disorders, depression, or an anxiety disorder, which may contribute to their behavior problems.
• 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 ODD 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.

ODD Diagnosis

As with adults, mental illnesses in children are diagnosed based on signs and 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 ODD, 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.

ODD Treatment and Home Care

Treatment for ODD 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, and ways to express and control anger. A type of therapy called cognitive behavioral therapy aims to reshape the child's thinking (cognition) to improve behavior.
• Family therapy: This may be used to help improve family interactions and communication among family members. A specialized therapy technique called parent management training (PMT) teaches parents ways to positively alter their child's behavior. Behavior management plans also often involve developing contracts between parent and child that identify rewards for positive behaviors and consequences (punishments) for negative behaviors.
• Medication: While there is no medication formally approved to treat ODD, drugs may sometimes be used to treat symptoms (including being impulsive and cranky). Sometimes, a child with ODD needs medication for other mental illnesses they may have, such as ADHD or depression.

Strategies you can try at home if your child has ODD include:

• Praise specific positive behaviors.
• Offer rewards for good behavior, especially for younger children.
• Model the behavior you want to see in your child.
• Avoid power struggles.
• Pick your battles.
• Set clear limits and boundaries.
• Follow a consistent schedule and routine.
• Spend time together doing things you both enjoy.
• Make sure both parents or other family members are working together consistently.
• Set your child up for success in household chores or other tasks.
• Don’t worry if you don’t see improvement right away.
• Find support for yourself.

ODD Complications

Children or teens with ODD often have trouble at home, at school, and in their personal lives. ODD may lead to:

• Doing poorly at school or work
• Antisocial behavior
• Trouble controlling impulses
• Alcohol or drug problems
• Suicide

Children with ODD often have or develop other mental health conditions, including:

• Attention deficit hyperactivity disorder (ADHD)
• Conduct disorder
• Depression
• Anxiety
• Learning disorders
• Communication disorders

ODD Outlook

When started early, treatment is usually effective. If your child is showing signs of ODD, it’s important that you 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. A child with ODD also has a greater chance of developing a more serious behavioral disorder called conduct disorder.

ODD Prevention

Although it may not be possible to prevent ODD, 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. Family members also can learn steps to take if signs of a relapse (a return of symptoms) appear. Providing a nurturing, supportive, and consistent home environment with a balance of love and discipline may help with symptoms and prevent episodes of defiant behavior.

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