What is oppositional defiant disorder (ODD)?

ODD is a behavior disorder, usually diagnosed in childhood, that is characterized by uncooperative, defiant, negativistic, irritable, and annoying behaviors toward parents, peers, teachers, and other authority figures. Children and adolescents with ODD are more distressing or troubling to others than they are distressed or troubled themselves.

What causes oppositional defiant disorder?

While the cause of ODD is not known, there are two primary theories offered to explain the development of ODD. A developmental theory suggests that the problems begin when children are toddlers. Children and adolescents who develop ODD may have had a difficult time learning to separate and become autonomous from the primary person to whom they were emotionally attached. The "bad attitudes" characteristics of ODD are viewed as a continuation of the normal developmental issues that were not adequately resolved during the toddler years. Learning theory suggests, however, that the negativistic characteristics of ODD are learned attitudes, reflecting the effects of negative reinforcement techniques used by parents and authority figures. The use of negative reinforcement by parents is viewed as increasing the rate and intensity of oppositional behaviors in the child as it achieves the desired attention, time, concern, and interaction with parents or authority figures.

Who is affected by oppositional defiant disorder?

Behavior disorders are, by far, the most common reason for referrals to mental health services for children and adolescents. Oppositional defiant disorder is reported to affect 1% to 16% of the school-age population. ODD is more common in boys than in girls.

What are the symptoms of oppositional defiant disorder?

Most symptoms seen in children and adolescents with oppositional defiant disorder also occur at times in children without this disorder, especially around the ages or 2 or 3, or during the teenage years. Many children, especially when they are tired, hungry, or upset, tend to disobey, argue with parents, or defy authority. However, in children and adolescents with oppositional defiant disorder, these symptoms occur more frequently and interfere with learning, school adjustment, and, sometimes, with the child's relationships with others.

Symptoms of oppositional defiant disorder may include:

• Frequent temper tantrums

• Excessive arguments with adults

• Refusal to comply with adult requests

• Always questioning rules; refusal to follow rules

• Behavior intended to annoy or upset others, including adults

• Blaming others for one's own misbehaviors or mistakes

• Easily annoyed by others

• Frequently having an angry attitude

• Speaking harshly, or unkindly

• Seeking revenge

The symptoms of ODD may resemble other medical conditions or behavior problems. Always consult your child's healthcare provider for a diagnosis.

How is oppositional defiant disorder diagnosed?

Parents, teachers, and other authority figures in child and adolescent settings often identify the child or adolescent with ODD. However, a child psychiatrist or a qualified mental health professional usually diagnoses ODD in children and adolescents. A detailed history of the child's behavior from parents and teachers, clinical observations of the child's behavior, and, sometimes, psychological testing contribute to the diagnosis. Parents who note symptoms of ODD in their child or teen can help by seeking an evaluation and treatment early. Early treatment can often prevent future problems.

Further, oppositional defiant disorder often coexists with other mental health disorders, including mood disorders, anxiety disorders, conduct disorder, and attention-deficit/hyperactivity disorder, increasing the need for early diagnosis and treatment. Consult your child's healthcare provider for more information.

Treatment for oppositional defiant disorder

Specific treatment for children with oppositional defiant disorder will be determined by your child's healthcare provider based on:

• Your child's age, overall health, and medical history

• Extent of your child's symptoms

• Your child's tolerance for specific medications or therapies

• Expectations for the course of the condition

• Your opinion or preference

Treatment may include:

• Individual psychotherapy. Individual psychotherapy for ODD often uses cognitive-behavioral approaches to improve problem solving skills, communication skills, impulse control, and anger management skills.

• Family therapy. Family therapy is often focused on making changes within the family system, such as improving communication skills and family interactions. Parenting children with ODD can be very difficult and trying for parents. Parents need support and understanding as well as help in developing more effective parenting approaches.

• Peer group therapy. Peer group therapy is often focused on developing social skills and interpersonal skills.

• Medication. While not considered effective in treating ODD, medication may be used if other symptoms or disorders are present and responsive to medication.

Prevention of oppositional defiant disorder in childhood

Some experts believe that a developmental sequence of experiences occurs in the development of oppositional defiant disorder. This sequence may start with ineffective parenting practices, followed by difficulty with other authority figures and poor peer interactions. As these experiences compound and continue, oppositional and defiant behaviors develop into a pattern of behavior. Early detection and intervention into negative family and social experiences may be helpful in disrupting the sequence of experiences leading to more oppositional and defiant behaviors. Early detection and intervention with more effective communication skills, parenting skills, conflict resolution skills, and anger management skills can disrupt the pattern of negative behaviors and decrease the interference of oppositional and defiant behaviors in interpersonal relationships with adults and peers, and school and social adjustment. The goal of early intervention is to enhance the child's normal growth and development, and improve the quality of life experienced by children or adolescents with oppositional defiant disorder.