Diagnosis

To determine whether your child has oppositional defiant disorder, the mental health professional will likely do a comprehensive psychological evaluation. 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.

Your child's evaluation will likely include an assessment of:

  • Overall health
  • Frequency and intensity of behaviors
  • Emotions and behavior across multiple settings and relationships
  • Family situations and interactions
  • Strategies that have been helpful — or not helpful — in managing problem behaviors
  • Presence of other mental health, learning or communication disorders

Treatment

Treatment for oppositional defiant disorder primarily involves family-based interventions, but it may include other types of psychotherapy and training for your child — as well as for parents. Treatment often lasts several months or longer. It's important to treat any co-occurring problems, such as a learning disorder, because they can create or worsen ODD symptoms if left untreated.

Medications alone generally aren't used for ODD unless your child also has another mental health disorder. If your child has coexisting disorders, such as ADHD, anxiety or depression, medications may help improve these symptoms.

The cornerstones of treatment for ODD usually include:

  • Parent training. A mental health professional with experience treating ODD may help you develop parenting skills that are more consistent, positive and less frustrating for you and your child. In some cases, your child may participate in this training with you, so everyone in your family develops shared goals for how to handle problems. Involving other authority figures, such as teachers, in the training may be an important part of treatment.
  • Parent-child interaction therapy (PCIT). During PCIT, a therapist coaches parents while they interact with their child. 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 child'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 therapy for your child may help him or her learn to manage anger and express feelings in a healthier way. Family therapy 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 may also benefit from therapy that will help him or her be more flexible and 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 consistently in the face of opposition isn't easy, especially if there are other stressors at home. Learning these skills will require routine 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." Providing rewards for positive behavior also may help, especially with younger children.
  • Model the behavior you want your child to have. Demonstrating appropriate interactions and modeling socially appropriate behavior can help your child improve social skills.
  • Pick your battles and avoid power struggles. Almost everything can turn into a power struggle, if you let it.
  • Set limits by giving clear and effective instructions and enforcing consistent reasonable consequences. Discuss setting these limits during times when you're not confronting each other.
  • 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 together with your partner or others in your household to ensure consistent and appropriate discipline procedures. Also 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. 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

It's challenging to be the parent of a child with oppositional defiant disorder. Ask questions and try to effectively communicate your concerns and needs to the treatment team. Consider getting counseling for yourself and your family to learn coping strategies to help manage your own distress. Also seek and build supportive relationships and learn stress management methods to help get through difficult times.

These coping and support strategies can lead to better outcomes for your child because you'll be more prepared to deal with problem behaviors.

Preparing for your appointment

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

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.

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 and transitions that your child or close family members recently experienced, such as parental separation or divorce and differences in expectations and parenting styles.
  • Your child's school performance, including grades and patterns of academic strengths and weaknesses. Include any learning disorder assessments and any special education services.
  • Your child's key medical information, including other physical or mental health disorders with which your child has been diagnosed.
  • Any medication, vitamins, herbal products and other supplements your child is taking, including the dosages.
  • Questions to ask the doctor so that you can make the most of your appointment.

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 professional?

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

  • Does my child have oppositional defiant disorder or another mental health 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?
  • Does my child need to be screened for any other mental health disorders?
  • Is my child at increased risk of any long-term complications from this condition?
  • Do you recommend any changes at home or school to improve my child's behavior?
  • 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?

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. Here are examples of questions that 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 had an angry and irritable mood, shown argumentative and defiant behavior, or been vindictive?
  • 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 stressors has the family been dealing with?
  • Has your child been diagnosed with any other medical or mental health conditions?
Jan. 25, 2018
References
  1. Oppositional defiant disorder. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. Arlington, Va.: American Psychiatric Association; 2013. http://dsm.psychiatryonline.org. Accessed Nov. 28, 2017.
  2. Gabbard GO, ed. Oppositional defiant disorder. In: Gabbard's Treatments of Psychiatric Disorders. 5th ed. Arlington, Va.: American Psychiatric Publishing; 2014. https://psychiatryonline.org/doi/10.1176/appi.books.9781585625048.gg40. Accessed Nov. 28, 2017.
  3. Oppositional defiant disorder (ODD). Merck Manual Professional Version. http://www.merckmanuals.com/professional/pediatrics/mental-disorders-in-children-and-adolescents/oppositional-defiant-disorder-odd. Accessed Nov. 28, 2017.
  4. Facts for families: Children with oppositional defiant disorder. American Academy of Child and 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. 28, 2017.
  5. Oppositional defiant disorder: A guide for families. American Academy of Child and Adolescent Psychiatry. http://www.aacap.org/aacap/Families_and_Youth/Resource_Centers/Oppositional_Defiant_Disorder_Resource_Center/Home.aspx. Accessed Nov. 28, 2017.
  6. Oppositional defiant disorder. American Association for Marriage and Family Therapy. https://www.aamft.org/iMIS15/AAMFT/Content/Consumer_Updates/Oppositional_Defiant_Disorder.aspx. Accessed Nov. 28, 2017.
  7. Dulcan MK, ed. Oppositional defiant disorder and conduct disorder. In: Dulcan's Textbook of Child and Adolescent Psychiatry. 2nd ed. Arlington, Va.: American Psychiatric Association; 2016. http://psychiatryonline.org. Accessed Nov. 28, 2017.
  8. Sawchuk CN (expert opinion). Mayo Clinic, Rochester, Minn. Jan. 2, 2018.

Oppositional defiant disorder (ODD)