Oppositional Defiant Disorder

Overview

What is oppositional defiant disorder?

Oppositional defiant disorder (ODD) is a condition in which a child displays a continuing 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.

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 goes beyond what is usual for the child’s age, it might suggest that the child has ODD.

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

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

How common is oppositional defiant disorder?

ODD typically begins by age 8. It is estimated that 2 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.

Symptoms and Causes

What causes oppositional defiant disorder?

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, and anxiety disorder.
  • Genetic: As ODD may be inherited, it is important to note that many children and teens with ODD have close family members with mental disorders, including mood disorders, anxiety disorders, and personality disorders.
  • Environmental: Factors such as a chaotic family life, a family history of mental disorders and/or substance abuse, and inconsistent discipline by parents.

What are the symptoms of oppositional defiant disorder?

Symptoms of ODD can be grouped into three categories:

  • Angry/irritable mood:
    • Loses temper easily
    • Frequent outbursts of anger and resentment
    • Touchy and/or easily annoyed
    • Angry and/or disrespectful
  • Argumentative/defiant behavior:
    • Excessively argues with adults
    • Actively refuses to comply with requests and rules
    • Blames others for the child’s own mistakes
    • Deliberately tries to annoy or upset others, or is easily annoyed by others
  • Vindictiveness
    • Is spiteful and seeks revenge
    • Says mean and hateful things when angry or upset

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

Diagnosis and Tests

How is oppositional defiant disorder diagnosed?

As with adults, mental disorders in children are diagnosed based on signs and symptoms that suggest a particular disorder. If the child has symptoms, 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 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 provider bases a 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.

The doctor then determines if the child’s symptoms point to ODD as it is described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, which is the standard reference book for recognized mental illnesses.

Management and Treatment

How is oppositional defiant disorder treated?

Treatment for ODD is determined based on many factors, including the child’s age, how severe the 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: Psychotherapy (a type of counseling) is designed to help 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 change 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 other disorders or symptoms that would make a child’s behavior worse.

What are the complications associated with oppositional defiant disorder?

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

Prevention

Can oppositional defiant disorder 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 symptoms return.

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.

Outlook / Prognosis

What is the prognosis (outlook) for children who have oppositional defiant disorder?

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

Last reviewed by a Cleveland Clinic medical professional on 04/25/2019.

References

  • American Academy of Child and Adolescent Psychiatry. Oppositional Defiant Disorder. (https://www.aacap.org/AACAP/Families_and_youth/Facts_for_Families/FFF-Guide/Children-With-Oppositional-Defiant-Disorder-072.aspx) Accessed 4/30/2019.
  • American Academy of Family Physicians. Oppositional Defiant Disorder. (https://familydoctor.org/condition/oppositional-defiant-disorder/) Accessed 4/30/2019.
  • American Academy of Child and Adolescent Psychiatry. Frequently Asked Questions. (https://www.aacap.org/aacap/Families_and_Youth/Resource_Centers/Oppositional_Defiant_Disorder_Resource_Center/FAQ.aspx) Accessed 4/30/2019.
  • Centers for Disease Control and Prevention. Behavior or Conduct Problems in Children. (https://www.cdc.gov/childrensmentalhealth/behavior.html) Accessed 4/30/2019.

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