Oppositional defiant disorder (ODD): Symptoms and treatments
Reviewed by therapist.com team
Written bytherapist.com team
Last updated: 10/13/2022
What Is Oppositional Defiant Disorder?
Oppositional defiant disorder (ODD) is a childhood behavior disorder characterized by defiance, anger, and hostility toward authority figures. Although all children display oppositional behavior from time to time, children with ODD display these behaviors more frequently and intensely. ODD also disrupts children’s relationships with family and friends as well as their ability to learn in school.
Symptoms of ODD are expressed both behaviorally and emotionally in three general categories: anger and irritability, defiant and argumentative behavior, and spite and vindictiveness.
- Throwing temper tantrums
- Intentionally annoying or angering others
- Becoming easily annoyed
- Exhibiting physical aggression or violence
- Questioning and refusing requests
- Intentionally defying rules
- Picking arguments with adults, especially authority figures
- Blaming others for their own mistakes or behavior
- Seeking revenge
- Becoming resentful
- Using harsh, hateful, or obscene language when upset
Most children with ODD begin to show signs of the disorder in preschool or early elementary school. Even symptoms that show up later tend to display before high school. This timeline can help doctors determine if your child has ODD or if they’re simply displaying typical signs of teenage rebelliousness.
Additionally, the DSM-5 criteria for ODD stipulates at least six months of symptomatic behavior. Many children throw temper tantrums, defy rules, and use harsh language from time to time, but they don’t have ODD. When a doctor diagnoses a child with ODD, they are looking for a pattern of defiant behavior over a period of time that disrupts the child’s ability to learn and form relationships.
Keep in mind that ODD has a high rate of comorbidity with other disorders, like ADHD, conduct disorder, depression, and anxiety. An ODD diagnosis may not be the full story for your child.
ODD may look differently depending on the severity of the case. With mild cases, symptoms only display in one setting, such as at school or at home. Moderate cases display symptoms in two settings, and severe cases display symptoms in three or more settings.
How people with ODD express their symptoms can also depend on the age at which they are diagnosed. Although ODD is a behavioral disorder typically diagnosed during early childhood, adolescents can also be diagnosed with ODD. It is extremely rare for the disorder to first emerge in adulthood. Instead, adult ODD symptoms more often reflect a continuation of the disorder that was undiagnosed or untreated in childhood.
- Children: ODD in children often manifests in terms of temper tantrums, physical aggression toward other children, and defiance of rules both at school and at home.
- Adolescents: ODD in teens may be displayed through lying, disobedience, extreme questioning of rules, and arguing with adults.
- Adults: Although many children outgrow ODD, others continue to exhibit symptoms into adulthood. Adults with unresolved ODD may struggle with being overly argumentative, physically aggressive, and petulant. They may identify as a “contrarian” and struggle to maintain relationships or jobs. Rather than receive a diagnosis of ODD, adults are more likely to be diagnosed with a personality or mood disorder.
There are multiple potential causes of ODD, including:
- Genetics: If someone in your family has ODD, you may be at a greater risk for developing the disorder.
- Biochemistry: ODD may be caused by chemical imbalances in your brain.
- Trauma or abuse: You may develop ODD as a response to trauma or abuse.
- Family issues: Children may develop ODD if they have relational issues within their family or if they mirror negative attitudes and behaviors perpetuated by parents or siblings. Harsh, coercive, and inconsistent parenting styles are particularly associated with the development of ODD among children.
The good news is that ODD is treatable. While there are several interventions for ODD, it’s important to note that the key ingredient to success is having a trusted adult build a healthy relationship with that child or adolescent. Depending on the age of the child (or adult) with ODD, your doctor may prescribe one or more of the following treatments:
- Psychotherapy: Psychotherapy, also known as talk therapy, can help children, teenagers, and adults with ODD learn healthier ways to express and regulate their anger. Cognitive behavioral therapy (CBT) in particular can help identify the thought patterns that drive unhelpful emotions and actions. Click here to find a CBT therapist for ODD near you.
- Social skills training: Children diagnosed with ODD can benefit from social skills training that teaches them how to resolve conflict, build relationships, and interact with peers and adults more appropriately.
- Parent-child interaction therapy: Also known as PCIT, this form of treatment combines aspects of play therapy and behavioral therapy. With the use of modeling and live coaching, this therapy helps caregivers learn more effective parenting techniques that improve the parent-child relationship and deter unwanted behaviors.
- Family counseling: If a child is diagnosed with ODD, it is often helpful for their family to learn more about the disorder and how to support positive behaviors. Family therapy can help parents learn how to address their child’s ODD symptoms in healthy ways and build positive relationships within the family.
- Medication for other disorders: There are no specific medications to treat ODD. However, symptoms of ODD may overlap with symptoms of other disorders, such as ADHD. Medications for other disorders may end up alleviating some of the symptoms of ODD.
Most children will outgrow ODD. However, like many impulse control disorders, ODD is egosyntonic, meaning that the person diagnosed with the disorder is not troubled by their symptoms. It is their friends, family, peers, and authority figures who struggle most with that person’s anger, defiance, and spiteful behavior.
Therefore, left untreated, ODD can worsen and result in more serious problems, like antisocial behavior and substance use. Early treatment is often necessary to teach children new ways of behaving that support healthier outcomes. Click here to find a therapist who specializes in childhood ODD near you.
Everyone displays oppositional or defiant behavior from time to time. Typically, we are more prone to angry, defiant, or spiteful behaviors when we are stressed, hungry, sick, or tired.
Teenagers in particular are learning how to balance the individuality and responsibility of young adulthood for the first time. Many are still learning how to prioritize self-care basics, like getting enough sleep and eating well. It’s often the stressful new experiences of adolescence that produce defiant behaviors in teenagers, not ODD.
However, that doesn’t mean your teenager may not have ODD, even if they were not formally diagnosed as a child. If you have questions about your teenager’s behavior, reach out to your family practitioner for information and advice.
ODD constitutes a pattern of defiant behavior that negatively affects a child’s relationships and ability to learn. Conduct disorder (CD) is a more severe pattern of aggression and blatant disregard for rules and norms. Where a child with ODD may refuse to do their homework or disrupt class with defiant questions, a child with CD may skip school entirely or disrupt class by bullying or fighting their peers. Although oppositional defiant disorder often precedes a diagnosis of conduct disorder, most children with ODD do not develop conduct disorder.
Your child may have both ADHD and ODD. Between one-third and one-half of children with ADHD also have ODD.
Treating both disorders is important to help your child succeed. For example, if your child is prescribed medication for their ADHD, it may also help alleviate some of their ODD symptoms. Similarly, CBT strategies that your child learns in therapy for their ODD symptoms may help them with their ADHD symptoms.
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