What is Oppositional Defiant Disorder?

It’s not unusual for children to experience occasional bad moods and periods of increased irritability, defiance and argumentativeness. But if your child shows a pattern of angry or irritable mood, argumentative and/or defiant behavior, or vindictiveness toward people in authority lasting at least six months, he or she may have oppositional defiant disorder (ODD). In ODD, a child’s behavior is frequently disruptive at school, at home and during daily activities.

Signs and Symptoms

For a diagnosis of ODD, a child must exhibit at least four of the following symptoms for at least six months during interactions with at least one individual who is not a sibling.

• Anger/irritability mood symptoms
• Frequently short-tempered
• Touchy or easily annoyed
• Angry and resentful

• Argumentative/defiant behavior symptoms
• Arguing with adults/authority figures
• Showing defiance or refusing to comply with rules or requests from authority figures
• Deliberately annoying others
• Blaming others for mistakes or misbehavior

• Vindictiveness or spitefulness (at least twice in six months)

For children younger than 5 years, ODD behaviors are defined as those that occur on most days for at least six months. For children 5 years or older, ODD behavior occurs at least once a week for at least six months. ODD typically causes distress in the child and/or family members, peers, teachers and others he or she encounters regularly. Symptoms often impact school performance, relationships and other areas of functioning. ODD can be mild, moderate or severe, and behaviors are not related to other mood or behavioral disorders.

Diagnosis

Diagnosing ODD requires thorough physical and psychological evaluation. Your behavioral health provider will use the criteria for ODD listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, to determine if your child’s symptoms indicate the condition.

Diagnostic tests include:

Physical examination: A provider will perform a physical exam and ask questions about your child’s health to determine if symptoms could be linked to an underlying physical health problem or medication side effects.

Psychiatric evaluation: A behavioral health provider will ask questions about the frequency and intensity of your child’s behaviors and how those behaviors change in different settings and relationships. Your child will also be evaluated for other mental health, learning or communication disorders.

Causes

The cause of ODD is unknown, but researchers believe genetics and certain environmental factors play a role.

Risk Factors

Risk factors that could contribute to ODD include:

Genetics: Some children may have biological differences in the way their nerves and brain function.

Parenting issues: If a child experiences abuse or neglect, harsh or inconsistent discipline, or a lack of parental supervision, he or she may be at an increased risk of ODD.

Other family issues: Parental or family discord, including parental mental health issues or substance abuse, may be a factor.

Temperament: Some children are naturally highly emotionally reactive or have trouble dealing with frustration.

Prevention

ODD cannot be prevented. But positive parenting and early treatment can help improve your child’s behavior and prevent worsening symptoms and disruptions.

Prognosis

With treatment and lifestyle management, ODD resolves in most children.

Treatment

Most kids with ODD benefit from a combination of psychotherapy and behavior training.

Behavior Training

Children and parents can benefit from behavior-changing and skill-building strategies, including:

• Cognitive problem-solving training: This collaborative technique is designed to help your child identify and change thought patterns that lead to behavior problems.
• Parent training: A behavioral health provider with experience treating ODD can help you develop positive parenting skills that are less frustrating for you and your child.
• Parent-child interaction therapy (PCIT): In this method, therapists coach parents while they interact with their children, guiding them through strategies that reinforce the child’s positive behavior.
• Social skills training: This therapy can help your child learn how to interact more positively and effectively with peers.

Psychotherapy

Individual therapy may help your child learn to manage anger and express feelings in a healthier way. Family counseling can help improve communication, collaboration and family relationships.

Complications

Complications of ODD include:

• Antisocial behavior
• Classroom struggles and poor academic performance
• Learning and communication issues
• Problems controlling impulses
• Risks of substance abuse or suicide (in teens and adults if ODD is untreated)