Oppositional Defiant Disorder Basics

In this guide you’ll learn the signs and symptoms of oppositional defiant disorder, how it’s diagnosed and how it’s treated.

ODD: What Is It?

All children act out sometimes, but children who have oppositional defiant disorder (ODD) have a well-established pattern of behavior problems that are more extreme than their peers. One way to distinguish between typical disruptive behavior and ODD is how severe the behavior is and how long it lasts. In order to be diagnosed with ODD kids need to have had extreme behavior issues for at least six months.

ODD: What to Look For

Children who have ODD will have a well-established pattern of behavior problems, including the following symptoms:

  • 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

When responding to these repeated behavior problems, parents are often pushed to an extreme and may become either more permissive or more coercive. Unfortunately, neither extreme will effectively change their child’s behavior, and instead may inadvertently lead to more negative interactions and hostile patterns of behavior that become routine. One hallmark of ODD is the toll it takes on family relationships.

Some children with ODD may also struggle with disruptive behavior in school, but it isn’t uncommon for a child to only struggle at home with family members.

ODD: Diagnosis

For a child to be diagnosed with ODD he must have a pattern of disruptive behavior including at least four symptoms from the following categories:

Angry/Irritable Mood

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

Argumentative/Defiant Behavior

  • Often argues with adults
  • Often actively defies or refuses to comply with requests from authority figures or with rules
  • Often deliberately annoys others
  • Often blames others for his mistakes or misbehavior

Vindictiveness

  • Has been spiteful or vindictive at least twice within the past 6 months

In order to be diagnosed with ODD a child must have had a pattern of behavior problems lasting at least six months and involving at least one individual who is not a sibling.

Clinicians will evaluate the frequency, intensity and duration of a child’s symptoms, as well as the impairment caused by them, when making a diagnosis. This will involve taking a detailed history of the child’s behaviors in various situations. Since children with ODD may show symptoms only in one setting — usually at home — and are more likely to be defiant in interactions with adults and peers they know well, the symptoms may not be in evidence in the clinician’s office.

ODD is typically diagnosed around elementary school ages.

Risk Factors

There is a very high overlap in kids who have ADHD and ODD. Children who have ADHD are prone to be distractible and impulsive, which often sets them on a collision course with behavior expectations. Repeated patterns of negative interactions with parents and other authority figures can lead to developing ODD.

Children who had a lot of difficulty soothing themselves as toddlers and continue to struggle to manage emotions like frustration and disappointment as they mature may be at risk of developing ODD.

Experiencing life stress and trauma can also be a risk factor for developing ODD.

ODD: Treatment

ODD is treatable, usually with behavioral therapy or a combination of behavioral therapy and medication.

Psychotherapeutic: When treating a child for ODD, repairing the parent-child relationship is a priority. This means that parents play a big role in treatment. Parent training programs are frequently recommended to help parents learn to train their child’s behavior through setting clear expectations and consistently praising kids when they follow through and using effective consequences when they don’t.

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 or cognitive behavioral therapy (CBT) if they are struggling with anxiety or depression. Children struggling with extreme emotional dysregulation may benefit from dialectical behavior therapy (DBT).

Pharmacological: There is no FDA-approved medication for ODD. However, antipsychotic medications like Abilify (aripiprazole) and Risperdal (risperidone) are frequently prescribed if a child is at risk of being removed from school or the home.

Stimulant medication may be prescribed if a child also has ADHD or is struggling with excessive impulsivity. Children with underlying depression or anxiety may be prescribed an antidepressant (SSRI).

ODD: 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.