4 Easy-to-Miss Characteristics of Oppositional Defiant Disorder (ODD)
The eight diagnostic criteria that define oppositional defiant disorder (ODD) exclude several of its defining characteristics. Make sure your child’s physician is familiar with this list before evaluating his or her ODD symptoms
Oppositional defiant disorder (ODD) is a neurological condition that makes your child or adolescent seem hard-wired to defy anyone resembling an authority figure.
Oppositional defiant disorder is a common condition occurring in roughly 10% of all children; in kids with ADHD, that number jumps to 40%. In fact, it is exceedingly rare to find a child with ODD who does not also have ADHD. The reverse is not true; not everyone with ADHD will develop ODD.
The DSM-V lists the following eight diagnostic criteria for ODD:
- Often loses temper
- Is often touchy or easily annoyed
- Is often angry and resentful
- Often argues with authority figures or, for children and adolescents, 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 or her mistakes or misbehavior
- Has been spiteful or vindictive at least twice in the past 6 months
To clinically qualify for an ODD diagnosis, a person must exhibit four of the eight criteria present for at least six months, and these ODD symptoms must negatively impact his or her functioning at school, work, or at home.
This simple outline misrepresents the actual look and feel of ODD in four important ways.
1. ODD has two onsets.
Most children aren’t born oppositional. Many parents describe their kids as fairly normal, willing to comply with rules, and happy to go along with others for a portion of their lives.
Then, somewhere around age four or five, childhood onset takes place. The child no longer cares about rewards or punishment; he becomes extremely difficult to raise. Every kid gets angry. Every kid misbehaves. But suddenly, your child exhibits a pervasive pattern of disrespecting and disobeying authority figures. He appears hell-bent on making his parents feel powerless and frustrated.
There is a second onset, called adolescent onset, which occurs right after puberty and may be tied to the emergence of sexual hormones. This transformation may be so dramatic that adolescents are thrown out of the house because their presence becomes so intolerable – or so unsafe – for other members of the family.
2. ODD may occur only in certain settings.
The traditional criteria suggest that a person only has ODD if she is extremely difficult in all areas of life: at school, at home, in public, and with peers.
More recently, medical professionals have recongized that certain children with ODD may behave well at school, and only show symptoms at home. In addition, a child may be oppositional with only one parent, though this occurs less frequently.
3. ODD is genetic.
Oppositional defiant behavior tends to run in families. Studies show that the development of the condition is more heavily influenced by genes than it is by environmental factors.
A child diagnosed with ODD quite frequently has a first-degree relative with ODD. Very commonly that relative is a parent, which may increase difficulties with discipline or increase the risk of divorce.
4. About 40% of the time, ODD progresses into conduct disorder.
ODD may be a precursor to a more serious condition: conduct disorder. This includes all of the previously described symptoms of ODD, plus the following:
- Aggression toward people and animals
- Often bullies, threatens, or intimidates others
- Often initiates physical fights
- Has used a weapon to physically harm others
- Has been physically cruel to people or animals
- Has stolen while confronting a victim
- Has forced someone into sexual activity
- Destruction of property
- Has deliberately engaged in fire setting with the intention of causing serious damage
- Has deliberately destroyed the property of others
- Deceitfulness or theft
- Has broken into someone else’s house, building, or car
- Has lied to obtain goods or favors to avoid obligations
- Has stolen items of non-trivial value
- Serious violations of the rules
- Often stays out at night despite parental prohibitions
- Is often truant from school
- Has run away from home overnight for at least a night
Very dire consequences may follow if parents fail to intervene in addressing the symptoms of ODD in children. Hoping that your child will outgrow ODD is not a strategy.
This advice came from “Manage ODD Now: Important Strategies for Treating Oppositional Defiant Disorder in Kids, Adults, and Families,” ADDitude webinar lead by William Dodson, M.D., in June 2013 that is now available for free replay here.
William Dodson, M.D., is a member of ADDitude’s ADHD Medical Review Panel.