What Is Oppositional Defiant Disorder?

Medically reviewed by Melissa Guarnaccia
Updated February 21, 2024by BetterHelp Editorial Team
Oppositional defiant disorder (ODD) is a condition that primarily affects children and often manifests as uncooperative, defiant, and hostile behavior toward peers and authority figures.
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Do you have a child with 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
  • Irritability
  • 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 
  • Scapegoating
  • 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

School-based treatment

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. 

Individual therapy

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

Do you have a child with oppositional defiant disorder?

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. 

Takeaway

Oppositional defiant disorder is a serious behavior disorder that can create significant complications in the lives of children who experience it. Despite these challenges, though, the effects of the condition can be managed by providing the child with a supportive, calming environment and useful strategies for managing their emotions. If you’re looking for the guidance and support of a professional as you navigate the parenting world, consider connecting with a licensed therapist online. With the right help, you can take the next step toward a healthy parent-child relationship and mental and emotional wellness.

Learn to manage impulsive behaviors

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