What Is Oppositional Defiant Disorder (ODD)?

When parents start googling behavior issues, one phrase tends to jump out: oppositional defiant disorder (ODD). It’s easy to see why. “The words ‘oppositional’ and ‘defiant’ show up in parents’ vocabulary fairly frequently,” says David Anderson, PhD, a clinical psychologist at the Child Mind Institute. “It’s one of the more aptly named diagnoses that exists.”

Whether your child has oppositional defiant disorder (or ODD) or not, learning about the disorder can be helpful. That’s because the behavior management strategies used in treatment are evidence-based techniques that all parents will benefit from knowing.

It is normal for children to be oppositional and defiant at least some of the time. In fact, it’s a sign of healthy development. So when does a child have oppositional defiant disorder? The diagnosis should not be given, for example, to a toddler who has just discovered that her new favorite word is “no.”

ODD is typically diagnosed around early elementary school ages and stops being diagnosed around adolescence. Kids who have ODD have a well-established pattern of behavior problems. Symptoms include:

• Being unusually angry and irritable
• Frequently losing their temper
• Being easily annoyed
• Arguing with authority figures
• Refusing to follow rules
• Deliberately annoying people
• Blaming others for mistakes
• Being vindictive

All children can have these symptoms from time to time. What distinguishes ODD from normal oppositional behavior is how severe it is, and how long it has been going on for. A child with ODD will have had extreme behavior issues for at least six months.

Another hallmark of ODD is the toll it takes on family relationships. Regular daily frustrations — ignored commands, arguments, explosive outbursts — build up over time, and these negative interactions damage the parent-child bond and reinforce hostile patterns of behavior.

“Kids who have behavioral issues push parents towards the extremes,” says Dr. Anderson. “They push parents to become permissive and they push parents to become hyper-coercive in the hope that a larger amount of control will get the kid to listen.”

Neither of these extremes make for ideal parenting. It is never a parent’s intention to reinforce bad behavior, and we often don’t realize when we’re doing it. Here are two common scenarios:

• You tell your child to stop playing a game and get ready for bed. He ignores your first two requests. By the third time you ask, you’re so mad that you yell.
• You tell your child to stop playing a game and get ready for bed. He throws a tantrum because he wants to keep playing. You don’t want him to be so worked up before bedtime, so you back down and say he can play for another ten minutes — but then he has to go to bed.

In the first scenario, your child learns that yelling is an acceptable way to get a message across. More subtly, he might also be learning that he can continue ignoring those first few requests — when you escalate the situation is when he knows you’re serious.

In the second scenario, your child has learned that throwing a tantrum might give him something that he wants, so he’ll be more likely to do it again in the future.

Both of these scenarios can set families up for future conflicts, and the more they are repeated the more they become familiar patterns of behavior that are harder to break out of. Your child doesn’t have to have ODD for these scenarios to happen, but repeated negative interactions like these make diagnosing a behavior disorder much more likely.

And just like parents aren’t necessarily to blame, neither are the kids, says Dr. Anderson. “Through no conscious effort of the child, he learns through hundreds of trials that this is a way to continue getting what he wants.”

This also explains why kids who have ODD might act out more at home. Dr. Anderson notes, “Kids who have ODD are likely to be more oppositional with people they know well, partly because the pathways are so well worn. Whereas in a place like school, where a kid has less control in general over their environment, the types of behaviors that are common to ODD may not pay off as much.”

There is a very high overlap in kids who have ADHD who are also diagnosed with ODD. Depending on the study, the overlap could be 30 to 50 percent of kids with ADHD also have ODD.

Dr. Anderson explains the connection like this: “Kids with ADHD are biologically loaded to be distractible, to be impulsive, to have difficulty staying in one place for a little while. So kids with ADHD start off doing things that parents perceive as off limits. And then when those kids get negative feedback they start to become even more negatively oriented towards adults.” These repeated patterns of negative interactions can lead to developing ODD.

But another pathway into developing ODD has more to do with a child’s temperament and might be apparent early on. Children who had a lot of difficulty soothing themselves as toddlers and continue to struggle with an age-appropriate ability to control their emotions in the face of disappointment or frustration can sometimes develop ODD. The adults in their environment might be more inclined to accommodate their demands in order to keep the family functioning as harmoniously as possible.

Kids who have experienced a lot of life stress and trauma are also more likely to develop ODD.

It’s important to get treatment to improve the parent-child relationship, which is crucial to the health and happiness of the entire household. It is also important for your child’s future. Some children will grow out of oppositional defiant disorder, but others will continue to have behavior issues, which could lead to peer rejection and difficulty forming healthy relationships, not to mention continued family discord.

They’ll also be less likely to achieve their potential. If something doesn’t go their way, they might think it’s anyone’s fault but theirs. Dr. Anderson says they might also “retreat to the places where they know they can get what they want. That might mean that they try even less, push even more on the people who are closest to them, who they actually care about the most, causing even more frayed relationships.”

A small percentage of kids with ODD go on to develop something called conduct disorder, which is a more severe behavior disorder that includes criminal acts like stealing, setting fires and hurting people. Getting treatment sooner rather than later improves a child’s trajectory.

Parents play a key role in treatment for oppositional defiant disorder. This might be surprising, since children are the ones given the diagnosis, but in ODD the parent-child relationship needs to be repaired, which means both parties need to make changes to get back on track.

All programs have certain goals in common, like helping parents find the middle ground between being too authoritative and too permissive. A behavioral therapist helps parents learn how to train their child’s behavior through setting clear expectations, praising kids when they follow through and using effective consequences when they don’t. Parents also learn to use these strategies consistently — one reason why behavior management strategies sometimes don’t work is because parents try different, conflicting techniques, or don’t stick to one program long enough to see gains. Parents and children will also learn problem solving skills they can rely on when they run into issues.

Parent training programs might include sessions with parents and children working together, or just parents alone. Some different programs include:

• Parent-Child Interaction Therapy (PCIT)
• Parent Management Training (PMT)
• Defiant Teens
• Positive Parenting Program (Triple P)
• The Incredible Years

Clinicians might also recommend social skills training to help improve your child’s peer relationships or cognitive behavioral therapy if she is struggling with anxiety or depression.

There is no FDA-approved medication for ODD, but medications are sometimes used as an adjunct to behavioral therapy. Anti-psychotic medications like Abilify (aripiprazole) and Risperdal (risperidone), which have been shown to reduce aggression and irritability, are frequently used in cases where a child is at risk of being removed from the school or home. Stimulant medication may be used if a child has excessive impulsivity, including those who have an ADHD diagnosis. Antidepressants (SSRIs) may be helpful if a child has underlying depression or anxiety.

Regardless of the treatment plan your therapist recommends, parents will need to provide a lot of encouragement. “Make no mistake, kids do not often just suddenly wake up with the insight that they wish their behavior was better and then ask all the adults in their life how they can change,” warns Dr. Anderson. “They’ll stick with whatever behavior is working for them, even if it’s not working that well.”

But once the family dynamic begins to change, and kids (and parents) begin to feel more confident in their ability to get along, everyone will be a lot happier.