Overview

Even the best-behaved children can be difficult and challenging at times. But if your child or teen has a frequent and persistent pattern of anger, irritability, arguing, defiance or vindictiveness toward you and other authority figures, he or she may have oppositional defiant disorder (ODD).

As a parent, you don't have to go it alone in trying to manage a child with ODD. Doctors, counselors and child development experts can help.

Treatment of ODD involves therapy, training to help build positive family interactions and skills to manage behaviors, and possibly medications to treat related mental health conditions.

Symptoms

Sometimes it's difficult to recognize the difference between a strong-willed or emotional child and one with oppositional defiant disorder. It's normal to exhibit oppositional behavior at certain stages of a child's development.

Signs of ODD generally begin during preschool years. Sometimes ODD may develop later, but almost always before the early teen years. These behaviors cause significant impairment with family, social activities, school and work.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, lists criteria for diagnosing ODD. This manual is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.

DSM-5 criteria for diagnosis of ODD show a pattern of behavior that:

  • Includes at least four symptoms from any of these categories — angry and irritable mood; argumentative and defiant behavior; or vindictiveness
  • Occurs with at least one individual who is not a sibling
  • Causes significant problems at work, school or home
  • Occurs on its own, rather than as part of the course of another mental health problem, such as a substance use disorder, depression or bipolar disorder
  • Lasts at least six months

DSM-5 criteria for diagnosis of ODD include both emotional and behavioral symptoms.

Angry and irritable mood:

  • Often loses temper
  • Is often touchy or easily annoyed by others
  • Is often angry and resentful

Argumentative and defiant behavior:

  • Often argues with adults or people in authority
  • Often actively defies or refuses to comply with adults' requests or rules
  • Often deliberately annoys people
  • Often blames others for his or her mistakes or misbehavior

Vindictiveness:

  • Is often spiteful or vindictive
  • Has shown spiteful or vindictive behavior at least twice in the past six months

These behaviors must be displayed more often than is typical for your child's peers. For children younger than 5 years, the behavior must occur on most days for a period of at least six months. For individuals 5 years or older, the behavior must occur at least once a week for at least six months.

ODD can vary in severity:

  • Mild. Symptoms occur only in one setting, such as only at home, school, work or with peers.
  • Moderate. Some symptoms occur in at least two settings.
  • Severe. Some symptoms occur in three or more settings.

For some children, symptoms may first be seen only at home, but with time extend to other settings, such as school and with friends.

When to see a doctor

Your child isn't likely to see his or her behavior as a problem. Instead, your child will probably believe that unreasonable demands are being placed on him or her. But if your child has signs and symptoms common to ODD that are more frequent than is typical for his or her peers, make an appointment with your child's doctor.

If you're concerned about your child's behavior or your own ability to parent a challenging child, seek help from your doctor, a child psychologist or a child behavioral expert. Your primary care doctor or your child's pediatrician can refer you to the appropriate professional.

Causes

There's no known clear cause of oppositional defiant disorder. Contributing causes may be a combination of inherited and environmental factors, including:

  • Genetics — a child's natural disposition or temperament and possibly neurobiological differences in the way nerves and the brain function
  • Environment — problems with parenting that may involve a lack of supervision, inconsistent or harsh discipline, or abuse or neglect

Risk factors

Oppositional defiant disorder is a complex problem. Possible risk factors for ODD include:

  • Temperament — a child who has a temperament that includes difficulty regulating emotions, such as being highly emotionally reactive to situations or having trouble tolerating frustration
  • Parenting issues — a child who experiences abuse or neglect, harsh or inconsistent discipline, or a lack of parental supervision
  • Other family issues — a child who lives with parent or family discord or has a parent with a mental health or substance use disorder

Complications

Children with oppositional defiant disorder may have trouble at home with parents and siblings, in school with teachers, at work with supervisors and other authority figures, and may struggle to make and keep friends and relationships.

ODD may lead to problems such as:

  • Poor school and work performance
  • Antisocial behavior
  • Impulse control problems
  • Substance use disorder
  • Suicide

Many children with ODD also have other mental health conditions, such as:

  • Attention-deficit/hyperactivity disorder (ADHD)
  • Depression
  • Anxiety
  • Conduct disorder
  • Learning and communication disorders

Treating these other mental health conditions may help improve ODD symptoms. And it may be difficult to treat ODD if these other conditions are not evaluated and treated appropriately.

Prevention

There's no guaranteed way to prevent oppositional defiant disorder. However, positive parenting and early treatment can help improve behavior and prevent the situation from getting worse. The earlier that ODD can be managed, the better.

Treatment can help restore your child's self-esteem and rebuild a positive relationship between you and your child. Your child's relationships with other important adults in his or her life — such as teachers, community supports and care providers — also will benefit from early treatment.

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.
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Oppositional defiant disorder (ODD)