What is oppositional defiant disorder?

It is not unusual for children—especially those in their “terrible twos” and 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 is excessive compared to what is usual for the child’s age, it might suggest a behavior disorder called oppositional defiant disorder (ODD).

ODD is a condition in which a child displays an ongoing pattern of uncooperative, defiant, hostile, and annoying behavior toward people in authority. This behavior often disrupts the child’s normal daily functioning, including relationships and activities within the family and at school.

Many children and teens with ODD also have other disorders, such as:

  • Attention deficit hyperactivity disorder (ADHD)
  • Learning disabilities
  • Mood disorders (such as depression)
  • Anxiety disorders

Some children with ODD go on to develop a more serious behavior disorder called conduct disorder.

What are the symptoms of ODD?

Symptoms of ODD can be clustered into three categories:

  • Angry/irritable mood:
    • Loses temper easily
    • Having frequent outbursts of anger and resentment
    • Touchy and/or easily annoyed
    • Angry and/or disrespectful
  • Argumentative/defiant behavior
    • Excessively arguing with adults
    • Actively refusing to comply with requests and rules
    • Blaming others for the child’s own mistakes
    • Deliberately trying to annoy or upset others, or being easily annoyed by others
  • Vindictiveness
    • Being spiteful and seeking revenge
    • Saying mean and hateful things when upset

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

What causes ODD?

The exact cause of ODD is not known, but it is believed that a combination of biological, genetic, and environmental factors might play a role.

  • Biological — Some studies suggest that defects in or injuries to certain areas of the brain can lead to behavior disorders. In addition, ODD has been linked to special chemicals in the brain called neurotransmitters. Neurotransmitters help nerve cells in the brain communicate with each other. If these chemicals are out of balance or not working properly, messages might not make it through the brain correctly, leading to symptoms. Further, many children and teens with ODD also have other mental disorders, such as:
    • ADHD
    • Learning disorders
    • Depression
    • Anxiety disorder
    This might contribute to their behavior problems.
  • Genetic — Many children and teens with ODD have close family members with mental disorders, including:
    • Mood disorders
    • Anxiety disorders
    • Personality disorders
    This suggests that at least a vulnerability to ODD may be inherited.
  • Environmental — Factors such as
    • a dysfunctional family life,
    • a family history of mental disorders and/or substance abuse, and
    • inconsistent discipline by parents
    might contribute to the development of behavior disorders.

How common is ODD?

Estimates suggest that 2 percent to 16 percent of children and teens have ODD. In younger children, ODD is more common in boys. In older children, it occurs about equally in boys and in girls. It typically begins by age 8.

How is ODD diagnosed?

As with adults, mental disorders in children are diagnosed based on signs and symptoms that suggest a particular disorder. If symptoms are present, the doctor will begin an evaluation by performing a complete medical history and physical examination.

Although there are no laboratory tests to specifically diagnose conduct disorder, the doctor might use various diagnostic tests—such as blood tests—to rule out physical illness or medication side effects as the cause of the symptoms. The doctor also will look for signs of other disorders that often occur along with ODD, such as ADHD and depression.

If the doctor cannot find a physical cause for the symptoms, he or she might refer the child to a child and adolescent psychiatrist or psychologist. These healthcare professionals 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 disorder. The doctor bases his or her diagnosis on reports of the child’s symptoms and his or her 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.

The doctor then determines if the child’s symptoms point to ODD as described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), published by the American Psychiatric Association, which is the standard reference book for recognized mental illnesses.

How is ODD treated?

Treatment is determined based on many factors, including the child’s age, the severity of symptoms, and the child’s ability to participate in and tolerate specific therapies. Treatment usually consists of a combination of the following:

  • Psychotherapy — Psychotherapy (a type of counseling) is aimed at helping the child develop more effective 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 might 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 the child’s behavior in the home.
  • Medication — Although there is no medication formally approved to treat ODD, various medications might be used to treat some of its distressing symptoms, as well as any other mental disorders that might be present, such as ADHD or depression.

What are the complications associated with ODD?

Children with ODD might experience rejection by classmates and other peers because of their poor social skills and aggressive and annoying behavior. Without treatment, a child with ODD has a greater chance of developing a more serious behavioral disorder called conduct disorder.

What is the outlook for people with ODD?

Milder forms of ODD often get better as the child ages, and treatment often is effective if started early. In some cases, more severe forms of ODD evolve into conduct disorder.

Can ODD be prevented?

Although it might not be possible to prevent ODD, recognizing and acting on symptoms when they first appear can minimize distress to the child and family, and prevent many of the problems associated with the disorder. Family members also can learn steps to take if signs of relapse (return of symptoms) appear. In addition, providing a nurturing, supportive, and consistent home environment with a balance of love and discipline might help reduce symptoms and prevent episodes of defiant behavior.


© Copyright 1995-2017 The Cleveland Clinic Foundation. All rights reserved.

This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 4/16/2014...#9905