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.
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.
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.
Symptoms of ODD can be grouped into three categories:
In addition, many children with ODD are moody, easily frustrated and have low self-esteem. They also might abuse drugs and alcohol.
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.
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:
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.
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.
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.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or healthcare provider. Please consult your healthcare provider for advice about a specific medical condition. This document was last reviewed on: 04/25/2019