What Is Oppositional Defiant Disorder?
While most children display disobedient, stubborn, and irritable conduct at times, children with oppositional defiant disorder may exhibit a pattern of confrontational, angry, and potentially harmful behavior. This behavior disorder can present significant challenges for a child and their caretakers and is often associated with other developmental and mental health disorders. Below, we’re providing an overview of oppositional defiant disorder—including its symptoms and causes—and discussing ways you can help a child in your life who may be living with this condition.
An overview of oppositional defiant disorder
Oppositional defiant disorder (ODD) primarily affects children and is characterized by feelings of anger and confrontational, uncooperative, and antagonistic behavior. ODD goes beyond the typical acting out and disobedience that almost all children display occasionally, potentially creating significant challenges in a child’s life. ODD can lead to conflict in the family, academic struggles, and mental and physical health concerns. It is estimated that ODD affects around 3% of children.
The effects of this condition can be particularly damaging because of how they may negatively influence a child’s home life and success at school—two of the most critical components of a child's development. Additionally, ODD is tied to anxiety, attention-deficit/hyperactivity disorder, conduct disorder, depression, and learning disabilities. Generally, oppositional defiant disorder begins to manifest around age eight, and research suggests that it lasts less than three years for the majority of children.
Symptoms of oppositional defiant disorder
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), oppositional defiant disorder is characterized by “a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months”. To be diagnosed with the disorder, a child typically must display at least four symptoms from a list of eight provided by the DSM, which include:
- Frequent inability to control temper
- Frequent anger and resentment
- Frequent arguments with parents or others in positions of authority
- Frequent refusal to follow rules or instructions from people in positions of authority
- Purposeful annoyance of others
- Malicious or vindictive behavior (occurring twice in a 6-month period)
For children four and under, the above behaviors should be present more days than not for a minimum of six months. For children five and over, the behaviors should be present at least once a week for a minimum of six months.
If you believe a child you know is living with ODD, a healthcare professional can provide them with screenings and determine whether further testing, diagnosis, and treatment are necessary.
What causes ODD?
Though there is no unified theory explaining the cause of oppositional defiant disorder, it is thought that environmental, genetic, and biological factors can contribute to its development. One of the primary environmental contributors to ODD is parenting that is inconsistent, harsh, or neglectful. Additionally, economic factors, an individual’s peer group, and violence in the community can contribute to a child developing the disorder.
Genetics are thought to play a significant role in the development of oppositional defiant disorder. The relationship between ODD and conditions like ADHD and depression has also been connected to genetics.
Additionally, ODD has been linked to cases of traumatic brain injury. In a study of 134 children who experienced traumatic brain injuries, 8.2% developed ODD. The existence of certain mental health and neurodevelopmental disorders—such as depression, anxiety disorders, and ADHD—can also increase the risk of a child experiencing oppositional defiant disorder. ADHD is considered an especially significant risk factor for ODD. It is estimated that 40-50% of individuals with ADHD will also develop ODD.
Managing oppositional defiant disorder
Oppositional defiant disorder can present serious complications in the lives of a young person and their caretakers. However, with the right approach, its effects can be limited so that the child can control their emotions, develop problem-solving skills, and grow. Treatment for ODD can also help caretakers implement effective parenting strategies.
Because ODD can look different depending on the child, the approaches parents take may vary. Many factors can influence the severity and longevity of the disorder; and some children experience symptoms only in certain settings, such as at school or at home, while others display signs in a variety of contexts. Depending on how ODD manifests, treatment may consist of a combination of parent-implemented management strategies, individual therapy, school-based interventions, and other forms of care.
The following are strategies for helping a child with ODD control their emotions, manage symptoms of comorbid conditions, and interact with others in a healthy manner.
Parent management training
Because an individual’s upbringing is one of the primary contributing factors to ODD, techniques centered around parenting are considered the first-line forms of care for the disorder. Parent management training is one such approach, focusing on helping caretakers implement consistent, healthy parenting behaviors. Studies show that parent management training is an efficacious method of treating ODD.
Parent management training is often based on teaching parents proactive and strategic parenting styles. This is often accomplished through videos or other instructional materials. Commonly utilized parenting strategies include praising and rewarding positive behavior and appropriately discouraging negative behavior.
Parents are also often urged to model healthy conduct for their children. Children tend to observe and subsequently emulate the behavior they are exposed to most frequently. So, witnessing positive and healthy behaviors on the part of their parent or guardian can be crucial. When resolving a conflict or addressing undesirable behavior, it is often important for parents to remain calm and engage with their children—and each other—in a constructive manner, using appropriate language.
Parent-child interaction therapy
Parent-child interaction therapy (PCIT) is a modality that involves both the child living with ODD and their caretaker. During this type of therapy, the parent will typically interact with the child—who is usually playing—while under supervision by a professional (often, someone certified or trained in PCIT). As this happens, the therapist communicates instructions through an earpiece, allowing them to provide guidance to the parent as they engage with their child.
Parent-child interaction therapy is typically recommended for children aged 2-7. Usually, PCIT is administered across 10-20 hour-long sessions, though the duration of treatment may vary. This strategy can help children improve their self-esteem, become more sociable, and control their emotions. Research suggests that, in addition to helping decrease behavioral challenges in children, PCIT leads to improved parenting skills.
Because children spend a large portion of their time in school, treatment that takes place in and around the classroom can be integral to the management of ODD. Interventions implemented at school may include training for the child’s teachers and administrators, in addition to accommodations such as increased time to finish homework and other assignments. Additionally, a child with ODD may be provided with an individualized education plan (IEP) if they live with a comorbid neurodevelopmental or mental health concern that qualifies them for special education (e.g., ADHD). School-based interventions have been found to be efficacious for ODD, particularly because they allow for consistency between a child’s home and school environments.
For adolescents or those about to enter adolescence, individual psychotherapy can be an effective way of addressing symptoms of ODD. One therapeutic modality that is considered efficacious is cognitive behavioral therapy (CBT), which can help children with ODD control their anger, communicate effectively, and develop healthy, constructive behavioral patterns. Therapists achieve these changes by teaching children how their thoughts, behaviors, and emotions are connected while helping them develop a range of helpful strategies for navigating those connections. In addition to leading to reductions in anger, CBT has been shown to help young people develop useful problem-solving and coping skills.
How online therapy can help
Studies show that online therapy can help parents provide effective solutions to children living with conditions like oppositional defiant disorder. For example, in a study published in the Journal of Consulting and Clinical Psychology, researchers found that online therapy led to significant improvements in symptoms of disruptive behavior disorders in participants, as well as reductions in the burden experienced by parents.
If you’re a busy parent, online therapy has features that can help make mental health care more convenient. With an online therapy platform like BetterHelp, you can address parenting challenges from the comfort of home, through video calls, voice calls, or in-app messaging.
What triggers ODD in a child?
Psychologists do not currently have a complete understanding of the causes and developmental patterns of oppositional defiant disorder. However, research has offered some hints as to how and why behavior problems emerge in children with ODD.
The risk for this condition appears to emerge from a combination of genetic, developmental, and environmental factors, as with most behavior disorders. In many cases, though, instability in family life may be what triggers an at-risk child’s behavior. Potential examples include:
Frequent changes of primary caregiver
Neglect, maltreatment, or abuse
Conflict between parents
Harsh or inconsistent discipline
Witnessing aggressive behavior in the family environment
Lack of parental involvement
Problematic substance use in the family
What are the symptoms of ODD?
The symptoms of oppositional defiant disorder can be grouped into three broad categories. The first class consists of disruptive moods and attitudes, including:
Angry and irritable mood
Frequent temper tantrums
The second broad group of ODD symptoms involves defiance and hostility to authority. Common manifestations include:
Frequent arguments or conflicts with parents, teachers, and other authority figures
Persistent refusal to obey rules or directions
Attempting to annoy others or provoke conflict
Consistently placing blame for behavior on others
Another common symptom of ODD is vindictiveness — a pattern of spiteful and revenge-seeking behavior. This is often directed at sources of authority and discipline in the child’s life. Children with ODD may seek to “get back at” people who have disciplined or corrected them.
Is ODD a form of ADHD?
Oppositional defiant disorder is currently classified by the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) under “disruptive, impulse-control, and conduct disorders”. As such, ODD is not considered a form of ADHD, which is grouped under “neurodevelopmental disorders”. The defiant and hostile behavior characteristic of ODD is distinct from the hyperactivity and difficulties with focus seen in people with ADHD.
However, there appear to be genetic and environmental risk factors between the two conditions. Some studies estimate that ODD occurs alongside ADHD in as many as 60% of cases. Children with ADHD might be more prone to frustration as a result of their challenges with certain kinds of tasks, which could make them more susceptible to resentment and hostility toward authority figures. They might also have a harder time with impulse control.
Research indicates that some of the risk factors for ODD in children with ADHD include:
A more critical attitude from parents
A higher frequency of adverse life events
Lower socioeconomic status
Friendship with peers who display disruptive or defiant behavior
Parents with ADHD
How do I know if my child has ODD?
As with other mental health conditions, a diagnosis of ODD requires an assessment from a licensed mental health provider. It could be a good idea to consult a child psychologist if they display some of the following characteristics:
Disobeying rules and directives most of the time
Starting arguments and conflicts with you, apparently on purpose
Displaying an angry attitude, speaking harshly, insulting you and others for no clear reason
Frequently losing their temper in an explosive, dramatic way
Breaking rules seemingly “just because they can”
Difficulty getting along with other children
Refusing to take responsibility for negative behavior
Seeking to hurt, irritate, or inconvenience you after disciplinary incidents or arguments
Getting annoyed or angry over seemingly small things
Can a child be cured of ODD?
In many cases, ODD can be treated effectively with evidence-based psychosocial methods. Often, the interventions with the best success rate involve training parents, teachers, and other care providers to better manage a child’s problem behaviors. By learning to defuse potential conflicts and motivate better behavior, the adults in a child’s life can often help them act in a more developmentally appropriate manner.
Individual therapy may also be helpful for children with ODD, especially approaches based on cognitive-behavioral therapy (CBT). Methods that have shown significant effectiveness in clinical trials include:
At what age is ODD diagnosed?
ODD can be diagnosed in individuals at least 5 years old, but it’s more commonly assessed when children first enter elementary school — between ages 6 and 8. This is often when differences between affected children and their peer group become most apparent. Characteristic signs of this condition may appear in kids as young as 3 or 4, but in very young children, it can be harder to tell when the frequency of things like temper tantrums is a cause for concern.
Older emergence of ODD is possible, but rare. In most cases, a child’s symptoms are apparent by early adolescence.
Can kids with ODD grow up normal?
Yes, ODD goes away with time in many children. According to the American Academy of Child and Adolescent Psychiatry, around two-thirds of individuals diagnosed with oppositional defiant disorder no longer show signs of the condition three years later. For those who don’t grow out of their oppositional behavior on their own, working with a family or child psychiatrist may help.
What does ODD look like in the classroom?
Oppositional defiant disorder can be dramatically disruptive in a classroom environment. A child with this condition may have severe emotional outbursts, reacting in extreme ways to even minor attempts to correct their behavior. They may also cause disruption deliberately, displaying overt rudeness to teachers or picking fights with classmates.
ODD is frequently associated with poor academic performance. Children with this condition may resist attempts to get them to study or complete homework, and their ability to learn may suffer because they’re frequently ejected from the classroom. A high number of disciplinary incidents is common, and individuals with ODD are often at greater risk for suspension and expulsion.
What is the best medicine for ODD?
The most effective way to treat ODD usually involves a combination of several approaches. Common components include education and training for parents, behavioral therapy with the whole family, and sometimes individualized cognitive-behavioral therapy for the child.
The best treatment strategy may depend on the individual’s age. Younger children can often benefit from structured group activities with multiple parents and children, while older children may do better with family-centered therapeutic activities.
One of the best-studied and most frequently recommended types of treatment for ODD is called parental management training (PMT). There are several forms of this intervention, but all of them involve teaching parents evidence-based techniques for addressing problematic behaviors. In some cases, parent-child interactions are videotaped and reviewed later with an educator who can help identify places where communication breaks down and suggest better approaches.
What happens if ODD goes untreated?
If ODD is not treated, a child’s disruptive, defiant, and hostile behavior may persist into adulthood. This can have serious negative impacts on their long-term life success. They may experience difficulties completing higher education or attaining steady employment. Building and maintaining social relationships may also be challenging.
Untreated oppositional defiant disorder may also place an individual at risk for other mental health disorders. According to some estimates, their chances of developing another type of mental illness may be over 90%. Substance use disorder is a common co-occurring condition with ODD. Some individuals whose behavior is not addressed in childhood may meet the criteria for antisocial personality disorder (ASPD) as adults.
How rare is ODD disorder?
The frequency of oppositional defiant disorder may vary between communities and cultural groups, but researchers estimate that it affects somewhere between 2% and 11% of children. At early ages, ODD appears to be somewhat more common in boys than girls, with a sex ratio of 1.4 to 1. This difference seems to drop off later in life, though — adolescent males and females show approximately equal rates of this disorder.
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