Diagnosis

To determine whether your child has oppositional defiant disorder, the mental health provider can do a comprehensive psychological evaluation. This evaluation will likely include an assessment of:

  • Your child's overall health
  • The frequency and intensity of your child's behaviors
  • Your child's behavior across multiple settings and relationships
  • The presence of other mental health, learning or communication disorders

Related mental health issues

Because ODD often occurs along with other behavioral or mental health problems, symptoms of ODD may be difficult to distinguish from those related to other problems. It's important to diagnose and treat any co-occurring problems because they can create or worsen ODD symptoms if left untreated.

Treatment

Treating oppositional defiant disorder generally involves several types of psychotherapy and training for your child — as well as for parents.  Treatment often lasts several months or longer.

Medications alone generally aren't used for ODD unless another disorder co-exists. If your child has co-existing conditions, particularly ADHD, medications may help significantly improve symptoms.

The cornerstones of treatment for ODD usually include:

  • Parent training. A mental health provider with experience treating ODD may help you develop parenting skills that are more positive and less frustrating for you and your child. In some cases, your child may participate in this type of training with you, so that everyone in your family develops shared goals for how to handle problems.
  • Parent-child interaction therapy (PCIT). During PCIT, therapists coach parents while they interact with their children. In one approach, the therapist sits behind a one-way mirror and, using an "ear bug" audio device, guides parents through strategies that reinforce their children's positive behavior. As a result, parents learn more-effective parenting techniques, the quality of the parent-child relationship improves and problem behaviors decrease.
  • Individual and family therapy. Individual counseling for your child may help him or her learn to manage anger and express feelings in a healthier way. Family counseling may help improve your communication and relationships, and help members of your family learn how to work together.
  • Cognitive problem-solving training. This type of therapy is aimed at helping your child identify and change thought patterns that lead to behavior problems. Collaborative problem-solving — in which you and your child work together to come up with solutions that work for both of you — can help improve ODD-related problems.
  • Social skills training. Your child also might benefit from therapy that will help him or her learn how to interact more positively and effectively with peers.

As part of parent training, you may learn how to manage your child's behavior by:

  • Giving clear instructions and following through with appropriate consequences when needed
  • Recognizing and praising your child's good behaviors and positive characteristics to promote desired behaviors

Although some parenting techniques may seem like common sense, learning to use them in the face of opposition isn't easy, especially if there are other stressors at home. Learning these skills will require consistent practice and patience.

Most important in treatment is for you to show consistent, unconditional love and acceptance of your child — even during difficult and disruptive situations. Don't be too hard on yourself. This process can be tough for even the most patient parents.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

Lifestyle and home remedies

At home, you can begin chipping away at problem behaviors of oppositional defiant disorder by practicing these strategies:

  • Recognize and praise your child's positive behaviors. Be as specific as possible, such as, "I really liked the way you helped pick up your toys tonight."
  • Model the behavior you want your child to have.
  • Pick your battles and avoid power struggles. Almost everything can turn into a power struggle, if you let it.
  • Set limits and enforce consistent reasonable consequences.
  • Set up a routine by developing a consistent daily schedule for your child. Asking your child to help develop that routine may be beneficial.
  • Build in time together by developing a consistent weekly schedule that involves you and your child spending time together.
  • Work with your partner or others in your household to ensure consistent and appropriate discipline procedures. Enlist support from teachers, coaches and other adults who spend time with your child.
  • Assign a household chore that's essential and that won't get done unless the child does it. Initially, it's important to set your child up for success with tasks that are relatively easy to achieve and gradually blend in more important and challenging expectations. Give clear, easy-to-follow instructions.
  • Be prepared for challenges early on. At first, your child probably won't be cooperative or appreciate your changed response to his or her behavior. Expect behavior to temporarily worsen in the face of new expectations. This is called an "extinction burst" by behavior therapists. Remaining consistent in the face of increasingly challenging behavior is the key to success at this early stage.

With perseverance and consistency, the initial hard work often pays off with improved behavior and relationships.

Coping and support

Being the parent of a child with oppositional defiant disorder isn't easy. Counseling for you can provide you with an outlet for your frustrations and concerns. In turn, this can lead to better outcomes for your child because you'll be more prepared to deal with problem behaviors.

Maintaining your health through relaxation, supportive relationships, and effective communication of your concerns and needs are important elements during treatment of ODD.

Preparing for your appointment

You may start by seeing your child's doctor. After an initial evaluation, your doctor may refer you to a mental health professional who can help make a diagnosis and create the appropriate treatment plan for your child.

What you can do

Before your appointment, make a list of:

  • Signs and symptoms your child has been experiencing, and for how long.
  • Your family's key personal information, including factors that you suspect may have contributed to changes in your child's behavior. Include any stressors that your child or close family members recently experienced, particularly with regard to parental separation or divorce and differences in expectations and parenting styles.
  • Your child's key medical information, including other physical or mental health conditions with which your child has been diagnosed.
  • Any medication, vitamins and other supplements your child is taking, including the dose.
  • Questions to ask the doctor so that you can make the most of your appointment.

When possible, both parents should be present with the child. Or, take a trusted family member or friend along. Someone who accompanies you may remember something that you missed or forgot.

Questions to ask the doctor at your child's initial appointment include:

  • What do you believe is causing my child's symptoms?
  • Are there any other possible causes?
  • How will you determine the diagnosis?
  • Should my child see a mental health provider?

Questions to ask if your child is referred to a mental health provider include:

  • Does my child have oppositional defiant disorder?
  • Is this condition likely temporary or long lasting?
  • What factors do you think might be contributing to my child's problem?
  • What treatment approach do you recommend?
  • Is it possible for my child to grow out of this condition?
  • Does my child need to be screened for any other mental health problems?
  • Is my child at increased risk of any long-term complications from this condition?
  • Do you recommend any changes at home or school to encourage my child's recovery?
  • Should I tell my child's teachers about this diagnosis?
  • What else can my family and I do to help my child?
  • Do you recommend family therapy?
  • What can we, the parents, do to cope and sustain our ability to help our child?

Don't hesitate to ask additional questions during your appointment.

What to expect from your doctor

Be ready to answer your doctor's questions. That way you'll have more time to go over any points you want to talk about in-depth. Your doctor may ask:

  • What are your concerns about your child's behavior?
  • When did you first notice these problems?
  • Have your child's teachers or other caregivers reported similar behaviors in your child?
  • How often over the last six months has your child been spiteful or vindictive, or blamed others for his or her own mistakes?
  • How often over the last six months has your child been easily annoyed or deliberately annoying to others?
  • How often over the last six months has your child argued with adults or defied or refused adults' requests?
  • How often over the last six months has your child been visibly angry or lost his or her temper?
  • In what settings does your child demonstrate these behaviors?
  • Do any particular situations seem to trigger negative or defiant behavior in your child?
  • How have you been handling your child's disruptive behavior?
  • How do you typically discipline your child?
  • How would you describe your child's home and family life?
  • What stresses has the family been dealing with?
  • Has your child been diagnosed with any other medical conditions, including mental health conditions?
Feb. 06, 2015
References
  1. Oppositional defiant disorder. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. Arlington, Va.: American Psychiatric Association; 2013. http://www.psychiatryonline.org. Accessed Nov. 20, 2014.
  2. Highlights of changes from DSM-IV-TR to DSM-5. American Psychiatric Publishing. http://www.dsm5.org/Pages/Default.aspx. Accessed Nov. 21, 2014.
  3. Gabbard GO. Textbook of Psychotherapeutic Treatments. Arlington, Va.: American Psychiatric Publishing; 2014. http://psychiatryonline.org/doi/full/10.1176/appi.books.9781585625048.gg40. Accessed Nov. 21, 2014.
  4. Hales RE, et al. The American Psychiatric Publishing Textbook of Psychiatry. 6th ed. Washington, D.C.: American Psychiatric Publishing; 2014. http://www.psychiatryonline.org/resourceToc.aspx?resourceID=5. Accessed Nov. 21, 2014.
  5. Facts for families: Children with oppositional defiant disorder. American Academy of Child & Adolescent Psychiatry. http://www.aacap.org/aacap/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/Children_With_Oppositional_Defiant_Disorder_72.aspx. Accessed Nov. 21, 2014.
  6. Oppositional defiant disorder guide. American Academy of Child & Adolescent Psychiatry. http://www.aacap.org/aacap/Families_and_Youth/Resource_Centers/Oppositional_Defiant_Disorder_Resource_Center/Home.aspx. Accessed Nov. 21, 2014.
  7. Tervo RC (expert opinion). Mayo Clinic, Rochester, Minn. Dec. 16, 2014.
  8. Qaadir A (expert opinion). Mayo Clinic, Rochester, Minn. Jan. 26, 2015.

Oppositional defiant disorder (ODD)