Quick Guide to Oppositional Defiant Disorder

What Is ODD?

Oppositional defiant disorder (ODD) is a children’s mental health disorder that involves defying parents, refusing to follow rules, and other serious behavior problems. All children act out sometimes, but kids who have oppositional defiant disorder struggle with their behavior regularly. They are often angry or irritable. Their behavior problems are also more extreme. For example, a child with ODD might yell at authority figures or throw tantrums if they don’t get their way.

One way to tell the difference between typical disruptive behavior and ODD is to examine:

  • How severe the behavior is
  • How long it lasts

In order to be diagnosed with ODD kids need to have had extreme behavior issues for at least six months.

What are the symptoms of ODD?

Children who have ODD will have a pattern of behavior problems. Here are some symptoms:

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

Parents are often pushed to an extreme by these symptoms. In response they may try to be either easier or harder on their child. Unfortunately, neither will improve a child’s behavior. ODD can take a toll on family relationships.

Some children with ODD may also struggle with disruptive behavior in school. Others will only struggle at home with family.

How is ODD diagnosed?

For a child to be diagnosed with ODD, they must have a pattern of disruptive behavior including at least four symptoms from this list:

  • Often loses temper
  • Is often touchy or easily annoyed
  • Is often angry and resentful
  • Often argues with adults
  • Often refuses requests from authority figures or disobeys rules
  • Often deliberately annoys others
  • Often blames others for behavior
  • Has been hurtful on purpose at least twice within the past 6 months

For a diagnosis, these symptoms also need to:

  • Last at least six months
  • Involve at least one person who isn’t a sibling

ODD is typically diagnosed around elementary school ages.

What are the risk factors for ODD?

Kids may be more likely to have ODD if:

  • They have ADHD
  • They struggle to manage emotions like frustration and disappointment
  • They have experienced trauma

How is ODD treated?

ODD is treated with behavioral therapy or a combination of therapy and medication.

Therapy

Improving the parent-child relationship is a priority. This means that parents play a big role in treatment.

Parent training programs can help parents learn to:

  • Set clear expectations
  • Use effective praise when kids meet them
  • Use effective consequences when they don’t

These techniques have been shown to be successful in teaching children how to manage their emotions and improve their behavior, leading to a more positive  relationship with parents.

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

Some children might also benefit from:

  • Social skills training to improve their peer relationships.
  • Cognitive behavioral therapy (CBT) if they are struggling with anxiety or depression.
  • Dialectical behavior therapy (DBT) if they are struggling with extreme emotions.

Medication

There is no FDA-approved medication for ODD. However, medication is sometimes used along with therapy. These include:

  • Antipsychotic medications, if a child is at risk of being removed from school or the home.
  • Stimulant medications, if a child also has ADHD or is struggling with impulsivity.
  • Antidepressant medications, if a child also has depression or anxiety.

Risk for other disorders

A small percentage of children diagnosed with ODD will go on to develop conduct disorder. Conduct disorder is a more severe behavior disorder that includes criminal acts like stealing, setting fires and hurting people. Getting treatment sooner rather than later makes this less likely.