Oppositional defiant disorder (ODD): Symptoms, types, and treatment
Reviewed by Brooks Baer, LCPC, CMHP
What is oppositional defiant disorder?
Oppositional defiant disorder (ODD) is a childhood behavior disorder characterized by defiance, anger, and hostility toward authority figures. All kids display oppositional behavior from time to time, but children with ODD do so more frequently and intensely. ODD disrupts children’s relationships with family and friends and their ability to learn in school.
The difference between conduct disorder and ODD
ODD involves a pattern of defiant behavior that affects a child’s relationships and learning negatively. Conduct disorder (CD) is a more severe pattern of aggression and blatant disregard for rules and norms. Where a child with ODD may disrupt class with defiant questions or refuse to do their homework, a child with CD may skip school entirely and disrupt class by bullying or fighting their peers. Oppositional defiant disorder often comes before a diagnosis of conduct disorder, but most children with ODD don’t develop conduct disorder.
Symptoms of oppositional defiant disorder
ODD symptoms show up in three general areas: anger and irritability, defiant and argumentative behavior, and spite and vindictiveness.
Anger and irritability
- Throwing temper tantrums
- Intentionally annoying or angering others
- Becoming easily annoyed
- Engaging in physical aggression or violence
Defiant and argumentative behavior
- Questioning and refusing requests
- Intentionally defying rules
- Picking arguments with adults, especially authority figures
- Blaming others for their own mistakes or behavior
Spite and vindictiveness
- Seeking revenge
- Becoming resentful
- Using harsh, hateful, or obscene language when upset
Most children with ODD begin showing signs in preschool or early elementary school. Even symptoms that show up later usually appear before high school. This timeline can help a doctor figure out if your child has ODD or if they’re just showing typical signs of teenage rebellion.
According to the DSM-5, a child has to show symptoms for at least six months to be diagnosed with ODD. Many children throw temper tantrums, ignore rules, and use harsh language from time to time, but they don’t have this disorder. When a doctor or mental health professional diagnoses a child, they look for a life-disrupting pattern of defiant behavior over a period of time.
Keep in mind that an ODD diagnosis may not be your child’s full mental health story. ODD often occurs alongside other disorders, like ADHD, conduct disorder, depression, and anxiety.
Types of oppositional defiant disorder
ODD can look different depending on its severity. With mild cases, symptoms show up in only one setting, such as school or home. In moderate cases, symptoms occur in two settings; and in severe cases, symptoms happen in three or more settings.
How people express their symptoms can also depend on when they were diagnosed. While the disorder is typically diagnosed in early childhood, adolescents can be diagnosed too. It’s extremely rare for ODD to first emerge in adulthood. Adult symptoms more often reflect a continuation of undiagnosed or untreated ODD from childhood.
- Children: Children with the disorder may have temper tantrums, be physically aggressive toward other kids, and break rules at school and at home.
- Adolescents: Teenagers with ODD may lie, disobey orders, question rules in an extreme way, and argue with adults.
- Adults: Many children outgrow the disorder, but some continue showing symptoms into adulthood. Adults with unresolved ODD may struggle with being overly argumentative, physically aggressive, and irritable. They may identify as “contrarians” and struggle to maintain relationships or jobs. Instead of receiving an ODD diagnosis, adults are more likely to be diagnosed with a personality disorder or a mood disorder.
Is my teenager just rebellious, or do they have ODD?
Everyone displays oppositional behavior from time to time. Typically we’re more likely to be angry, defiant, or spiteful when we’re stressed, hungry, sick, or tired.
Teenagers in particular are learning 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, not ODD, that result in defiant behaviors in teenagers.
If your teenager is showing symptoms of ODD, ask your family doctor or a mental health professional for information and advice.
What causes ODD?
This disorder has several possible causes, including:
- Genetics: If a relative has ODD, you may be at greater risk of 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: You may develop ODD if you have relationship issues within your family or if you mirror negative attitudes and behaviors modeled by your parents or siblings. Harsh, coercive, and inconsistent parenting styles are particularly associated with the development of ODD in kids.
Treatment options
ODD is treatable. While there are several treatment options, success relies on having a trusted adult build a healthy relationship with the child or adolescent. Depending on the age of the person with ODD, a doctor may prescribe one or more of the following:
- Psychotherapy: Psychotherapy, also known as talk therapy, can help children, teenagers, and adults learn healthier ways to express and regulate their anger. Cognitive behavioral therapy (CBT) in particular can help identify the thought patterns behind unhelpful emotions and actions.
- Social skills training: Children can benefit from social skills training that teaches them to resolve conflict, build relationships, and interact with peers and adults more appropriately.
- Parent-child interaction therapy (PCIT): This form of treatment combines aspects of play therapy and behavioral therapy. It helps caregivers learn more effective parenting techniques that reduce unwanted behaviors and improve the parent-child relationship.
- Family counseling: It’s often helpful for a child’s family to learn about ODD and how to support positive behaviors. Family therapy can help parents address their child’s symptoms in healthy ways and build a positive relationship.
- Medication: There are no specific medications for ODD. However, its symptoms may overlap with symptoms of other disorders, such as ADHD, so medications for those disorders may reduce some ODD symptoms.
ADHD and ODD
Between a third and a half of kids with ADHD also have ODD, and treating both disorders is important. If your child is prescribed medication for ADHD, it may alleviate some of their ODD symptoms. Similarly, strategies your child learns in therapy for ODD symptoms may also help their ADHD symptoms.
Can a child grow out of ODD?
Most children will outgrow ODD. However, like many impulse control disorders, oppositional defiant disorder is “egosyntonic,” meaning the person diagnosed with it isn’t troubled by their symptoms. Friends, family, peers, and authority figures are the ones who struggle most with the person’s anger, defiance, and spite.
Left untreated, ODD can get worse and lead to more serious problems, like antisocial behavior and substance misuse. Early treatment is often necessary to teach kids new ways of behaving that support healthier outcomes. Browse our directory to find a therapist near you who specializes in oppositional behavior.
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