Oppositional Defiant Disorder (ODD)

What is oppositional defiant disorder (ODD)?

Oppositional defiant disorder (ODD) is a behavior condition in which your child displays a continuing pattern of uncooperative, defiant and sometimes hostile behavior toward people in authority. This behavior often disrupts your child’s normal daily functioning, including relationships and activities within their family and at school.

It’s common for children — especially those two to three years old and in their early teens — to be oppositional or defiant of authority once in a while. They might express their defiance by arguing, disobeying or talking back to adults, including their parents or teachers. When this behavior lasts longer than six months and goes beyond what’s usual for your child’s age, it might suggest that they have ODD.

The majority of children and teens who have ODD also have at least one other mental health condition, including:

• Attention-deficit hyperactivity/disorder (ADHD).
• Anxiety disorders, including obsessive-compulsive disorder (OCD).
• Learning differences.
• Mood disorders, such as depression.
• Impulse control disorders.

About 30% of children with ODD develop a more serious behavior condition called conduct disorder. ODD behaviors can continue into adulthood if ODD isn’t properly diagnosed and treated.

What is conduct disorder?

Conduct disorder (CD) is a condition in which your child or adolescent shows an ongoing pattern of aggression toward others. They also show serious violations of rules and social norms at home, in school and with peers.

These rule violations may involve breaking the law. Children with CD are more likely to get injured and may have difficulties getting along with peers.

Signs of conduct disorder include:

• Frequently breaking serious rules, such as running away from home, staying out at night when told not to or skipping school.
• Being aggressive in a way that causes harm, such as bullying, fighting or being cruel to animals.
• Lying, stealing or damaging other people’s property on purpose.

What’s the difference between ODD and ADHD?

Approximately 40% of children with attention-deficit/hyperactivity disorder (ADHD) also have oppositional defiant disorder or a related conduct disorder. While these two conditions commonly occur together, they’re distinct conditions.

ODD is related to a child’s conduct and how they interact with their parents, siblings, teachers and friends. ADHD is a neurodevelopmental disorder that causes a person to be easily distracted, disorganized and excessively restless.

Who does oppositional defiant disorder affect?

ODD most commonly affects children and teenagers, but it can also affect adults. It most commonly begins by age 8.

Some children outgrow ODD or receive proper treatment for it, while others continue to have symptoms through adulthood.

Children assigned male at birth (AMAB) are more likely to have ODD in their younger years than children assigned female at birth (AFAB). But teenagers who were AMAB and AFAB are affected equally.

Your child is more likely to develop ODD if they have the following risk factors:

• A history of child abuse or neglect.
• A parent or caregiver who has a mood disorder or who has substance or alcohol use disorders.
• Exposure to violence.
• Inconsistent discipline and lack of adult supervision.
• Instability in their family, such as divorce, moving to different houses often and changing schools frequently.
• Financial problems in their family.
• Parents who have or have had ODD, attention-deficit/hyperactivity disorder (ADHD) or behavioral problems.

How common is oppositional defiant disorder?

Researchers estimate that oppositional defiant disorder affects 2% to 11% of children. This range is so wide because some children may be misdiagnosed as having conduct disorder, and teenagers, as a population, are often underdiagnosed.

The prevalence of ODD declines with increasing age.

What are the signs and symptoms of oppositional defiant disorder (ODD)?

Signs and symptoms of oppositional defiant disorder usually begin by age 8. Symptoms usually remain stable between the ages of 5 and 10 and typically, but not always, decline afterward.

The symptoms are often apparent in multiple settings but may be more noticeable at home or school.

Signs and symptoms of ODD can be grouped into three categories:

• Anger and irritability.
• Argumentative and defiant behavior.
• Vindictiveness.

In addition, many children with ODD are moody, easily frustrated and have low self-esteem. They also might misuse drugs and alcohol.

Anger and irritability

Signs of anger and irritability are part of the diagnosis of ODD. If your child has ODD, they may:

• Lose their temper easily.
• Have frequent outbursts of anger and resentment.
• Be touchy and/or easily annoyed by others.
• Be frequently angry and/or disrespectful.

Argumentative and defiant behavior

Argumentative and defiant behavior is part of the diagnosis of ODD. If your child has ODD, they may:

• Excessively argue with adults.
• Actively refuse to comply with requests and rules.
• Blame others for their own mistakes.
• Deliberately try to annoy or upset others.

Vindictiveness

Signs of vindictiveness in ODD include:

• Being spiteful and seeking revenge.
• Saying mean and hateful things when angry or upset.

What causes oppositional defiant disorder (ODD)?

Researchers believe that the cause of oppositional defiant disorder is a complex combination of biological, genetic and environmental factors:

• Genetic factors: Research suggests that genetics account for about 50% of the development of ODD. Many children and teens with ODD have close family members with mental health conditions, including mood disorders, anxiety disorders and personality disorders. Further, many children and teens with ODD also have other mental health conditions, such as ADHD, learning differences, or depression and anxiety disorder, which suggests a genetic link between the conditions.
• Biological factors: Some studies suggest that changes to certain areas of your brain can lead to behavior disorders. In addition, ODD has been linked to issues with certain neurotransmitters, which help nerve cells in your brain communicate with each other. If these chemicals are out of balance or not working properly, messages might not make it through your brain correctly, leading to symptoms.
• Environmental factors: Having a chaotic family life, childhood maltreatment and inconsistent parenting can all contribute to the development of ODD. In addition, peer rejection, deviant peer groups, poverty, neighborhood violence and other unstable social or economic factors may contribute to the development of ODD.

How is oppositional defiant disorder diagnosed?

Mental health professionals diagnose oppositional defiant disorder (ODD) if your child meets four or more of the symptom criteria as described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) for at least six months. The DSM-5, published by the American Psychiatric Association, is the standard reference book for recognized mental illnesses. The symptoms must also be severe and disruptive to daily life.

Your child will likely need to see a child and adolescent psychologist or psychiatrist if they’re showing signs of ODD. These mental health professionals use specially designed interview and assessment tools to evaluate your child for a mental health condition.

Psychiatrists and psychologists often rely on reports from the child’s parents, siblings, friends and teachers to get a full understanding of their behavior.

Your child’s psychologist or psychiatrist will carefully assess your child. They must distinguish oppositional defiant disorder from the following conditions, which may cause similar symptoms:

• Mild to moderate oppositional behaviors.
• Untreated attention-deficit/hyperactivity disorder (ADHD).
• Mood disorders.
• Anxiety disorders and obsessive-compulsive disorder (OCD).

How is oppositional defiant disorder treated?

Treatment for ODD varies based on many factors, including:

• Your child’s age.
• The severity of their symptoms.
• Your child’s ability to take part in and tolerate specific therapies.
• If your child has other conditions, such as ADHD, learning differences and/or OCD.

Treatment of ODD should involve your child, your family and their school.

Treatment usually consists of a combination of the following:

• Parent management training (PMT).
• Psychotherapy (talk therapy).
• School-based interventions.

Parent management training for ODD

Parent management therapy (PMT) is the main treatment for oppositional behaviors. It teaches parents ways to change their child’s behavior in the home by using positive reinforcement to decrease unwanted behaviors and promote healthy behaviors.

There are different types of training programs, which usually involve multiple sessions over several weeks. During the sessions, parents learn to identify problem behaviors, as well as positive interactions, and to apply punishment or reinforcement as appropriate.

PMT has been shown to decrease conduct problems in multiple contexts and family backgrounds significantly.

Psychotherapy for ODD

Psychotherapy (talk therapy) is a term for a variety of treatment techniques that aim to help you identify and change troubling emotions, thoughts and behaviors. Working with a mental health professional, such as a psychologist or psychiatrist, can provide support, education and guidance to your child and your family.

Common types of psychotherapy that help treat ODD include:

• Cognitive behavioral therapy (CBT): This is a structured, goal-oriented individual type of therapy. A therapist or psychologist helps your child take a close look at their thoughts and emotions. Your child will come to understand how their thoughts affect their actions. Through CBT, your child can unlearn negative thoughts and behaviors and learn to adopt healthier thinking patterns and habits. CBT-based anger management training is useful in treating anger problems in children with ODD. In older children, problem-solving skills training and perspective-taking are helpful therapy strategies.
• Family-focused therapy: This therapy is for children with ODD and their caregivers. During this treatment, your child and family will join together in therapy sessions of psychoeducation regarding ODD, communication improvement and problem-solving skills. It can help identify factors in your home life that may contribute to or worsen aggressive behaviors.

School-based interventions for ODD

Supportive interventions to improve school performance, peer relationships and problem-solving skills are very useful in the treatment of ODD.

These interventions may include:

• Education and tools for your child’s teacher(s) to improve classroom behavior.
• Techniques to prevent oppositional behavior or the worsening of such behavior.
• Other methods that help your child follow classroom rules and acceptable social interactions.

Medications for ODD

Although there isn’t medication formally approved to treat ODD, your child’s healthcare provider or psychiatrist might prescribe certain medications to treat other conditions they may have, such as ADHD, OCD or depression. If left untreated, these conditions can make the symptoms of ODD worse.

Can oppositional defiant disorder be prevented?

Although it might not be possible to prevent oppositional defiant disorder, recognizing and acting on symptoms when they first appear can minimize distress to your child and family. It can also help prevent many of the problems associated with the disorder. Family members can learn steps to take if signs and symptoms return, as well.

In addition, providing a nurturing, supportive and consistent home environment might help reduce symptoms and prevent episodes of defiant behavior.

What is the prognosis (outlook) for oppositional defiant disorder (ODD)?

Children with ODD can experience significant issues in school, at home and in social relationships.

Mild to moderate forms of ODD often improve with age, but more severe forms can evolve into conduct disorder.

A lack of treatment and parental support often leads to a poor prognosis for oppositional defiant disorder, while adequate treatment of coexisting conditions (such as ADHD or OCD), individual and/or family therapy, and positive parenting are associated with a good prognosis.

How do I take care of my child with oppositional defiant disorder?

If your child has oppositional defiant disorder, aside from getting them professional care, you can help them and yourself in the following ways:

• Build on the positives: Give your child praise and positive reinforcement when they show flexibility or cooperation.
• Take a time-out or break when needed: If you’re about to make the conflict with your child worse instead of better, take a break and step away. This also sets a good example for your child. Support your child if they decide to take a break to prevent escalating a negative situation.
• Be consistent: Set reasonable, age-appropriate limits with consequences for poor behavior that can be enforced consistently. Be consistent about rules as well.
• Take care of yourself: Maintain interests and hobbies that you enjoy and practice self-care. Try to work with and gain support from the other adults who are interacting with your child.

When should my child see their healthcare provider about oppositional defiant disorder?

If your child has been diagnosed with oppositional defiant disorder, and their behavior becomes more severe or disrupts family or school life, talk to their mental health provider.

If your child displays behavior that harms or endangers others, such as other children or animals, it’s important to find them immediate care.

A note from Cleveland Clinic

Children and teens who are defiant or very disruptive can be very challenging for parents. While it’s normal for young children and teens to show defiant behavior from time to time, frequent and disruptive behavior may indicate oppositional defiant disorder (ODD).

Starting treatment early for ODD is important, and the first step to treatment is to talk with a healthcare provider or a mental health provider. Don’t be afraid to ask your healthcare provider questions. They’re available to help.