Oppositional Defiant Disorder

What Is Oppositional Defiant Disorder (ODD)?

Oppositional defiant disorder (ODD) is an extreme behavior disorder defined by chronic aggression, frequent outbursts, defiance, and a tendency to irritate others. 40 percent of children with ADHD or ADD also show signs of ODD. Could your child be one of them?

Oppositional Defiant Disorder (ODD) and ADHD plays with a toy sword.
A boy with oppositional defiant disorder (ODD) plays with a toy sword.

What Is Oppositional Defiant Disorder?

Oppositional defiant disorder (ODD) is a childhood behavior disorder defined by a persistent pattern of hostile, vindictive, and defiant behavior toward authority figures. Children with ODD are frequently irritable, argumentative, and disobedient. ODD may be diagnosed if this behavior lasts 6 months or longer.

ODD impacts between 1 and 16 percent of children and adolescents in the general population, but is far more common among patients with attention deficit hyperactivity disorder (ADHD). In fact, 4 out of every 10 children with ADHD also show signs of ODD.

ODD may begin in childhood or adolescence and may progress into conduct disorder if left untreated. Treatment for ODD typically involves a combination of psychotherapy and medication.

Worried your child or teenager may have ODD?

Oppositional Defiant Disorder Explained

An oppositional, defiant child will often lose his temper, argue with adults, actively defy requests or rules set by adults, deliberately annoy people, and blame others for misbehavior. He will engage in angry, violent, and disruptive conduct directed at the adults in his life — parents, teacher, physicians, and other authority figures. And he may seem to feel most comfortable in the midst of a conflict, which is upsetting and exhausting for everyone involved — even the child himself. The ODD-diagnosed child is not merely an argumentative or difficult child; he or she is vindictive, rageful and deliberately antagonistic.

The symptoms of ODD may look different for girls and boys, in whom the condition is more common. Boys with ODD tend to be more physically aggressive and have explosions of anger while girls often lie, refuse to cooperate, and otherwise express symptoms in indirect ways. ODD is usually diagnosed in early childhood; some patients outgrow the condition by age eight or nine.

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Consult with a physician if you recognize the symptoms below in your child, and seek help immediately for violent or self-harming behavior that could be dangerous.

Oppositional Defiant Disorder Symptoms

  • Physical aggression
  • Verbal abuse
  • Explosions of anger
  • Deliberately annoying others
  • Vindictive behavior
  • Frequent arguments
  • Defiance of rules and laws

All children defy their parents and lash out from time to time. To merit an ODD diagnosis, however, a patient must exhibit a consistent pattern of negative, hostile, and defiant behavior that lasts at least six months.

Types of Oppositional Defiant Disorder

Physicians typically see two types of ODD.

Childhood onset is present from an early age, and can make children very difficult to raise. Early intervention and treatment can effectively address symptoms of ODD and prevent it from progressing into a more serious condition like conduct disorder.

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Adolescent-onset ODD begins out of the blue in the middle- and high-school years. Once-loving children become impossible to live with. Home and school become places of almost constant conflict.

Can a Child Outgrow Oppositional Defiant Disorder?

Adults can have oppositional defiant disorder, too. The condition may persist for a lifetime just as often as it spontaneously disappears. In about 40 percent of cases, adults with ODD become progressively worse and end up developing antisocial personality disorder.

Even when the condition doesn’t worsen, ODD in adults can cause problems in relationships, marriage, and work. Rates of substance abuse, divorce, and employment problems are higher in this population. Therapy and medication are the treatment strategies used most often with adults who have ODD.

Oppositional Defiant Disorder vs. ADHD

Surveys estimate that 5 percent of the general population has ODD, while up to 40 percent of children with ADHD may have the condition. Experts cannot definitely say why ODD and ADHD so commonly overlap.

What Causes Oppositional Defiant Disorder?

The exact cause of ODD is unknown, though many professionals trace it back to a combination of psychological, social, and biological factors. ODD symptoms are often linked to prenatal smoke exposure, toxin exposure, or poor nutrition. ODD is more common in people who have relatives with ODD, ADHD, conduct disorder (CD), mood disorders, or substance abuse problems, though researchers have not pinpointed a specific gene responsible. Traumatic life events, like childhood abuse, can trigger ODD for some people.

Parents and teachers are often the first to identify oppositional behavior in children. Then, the next step is to visit a child psychiatrist or other qualified mental health professional. To diagnose ODD in children accurately, a physician will perform an evaluation to rule out anxiety or mood disorders, which can all cause ODD-like behaviors. These behaviors are only “symptoms” of ODD if they occur more commonly than is normal for individuals of the same age and developmental level, and if they cause clinically significant impairment in social, academic, or occupational functioning.

An evaluating physician may compile a detailed behavior history from parents, teachers, and clinical observation. Talking to as many people as possible about how and where the behavior occurs can help the doctor determine which behaviors are impacting different areas of the child’s life. It also helps to determine if the child is responding to a stressful situation, or if you’re dealing with an ongoing behavioral issue. The physician may use rating scales and questionnaires to make a complete assessment. Diagnosis is time consuming because multiple sources of information must be assessed.

A person with ODD seldom takes responsibility for her behavior and the effect it has on everyone around them. She sees “the problem” lying with anyone but herself. It usually takes a highly qualified physician to determine whether problems at school, work, or home trace back to ODD.

Before diagnosing oppositional defiant disorder, the clinician must rule out conditions such as a mood disorder, personality disorders (particularly borderline, narcissistic and antisocial personality disorders), trauma (physical or sexual abuse), as well as substance abuse. Each of these can cause oppositional behavior and ODD symptoms.

The strain of dealing with ODD affects the entire family, and may strain marital relationships. Fortunately, effective therapies exist for reigning in even the most defiant child or adult. Changing behaviors is not easy, but it can be done — typically with the help of specialized psychotherapy, a physician to supervise treatment, and occasionally medication.

How Do You Discipline a Child with ODD?

Treatment for ODD includes psychotherapy and medication.

Behavior therapy and family/parent training programs are the treatment of choice for ODD. These programs teach loved ones strategies for dealing with upsetting behavior; suggest positive alternative behaviors to replace defiant ones; and establish guidelines for setting clear expectations, consequences, and rewards for behavior. Treatment is most effective when started early in life.

Oppositional Defiant Disorder Treatments

In those cases where a patient doesn’t respond to therapy, medication is sometimes used to “re-wire” ODD behaviors. No medications are FDA-approved for treatment of ODD in the U.S., but clinical experience suggests that most children and adolescents with ODD improve with a low dose of atypical neuroleptics — arippirazole (Abilify) and risperidone (Risperidal), for example. Medication is most effective when paired with therapy programs.

People with mild ODD may report improved symptoms after taking omega-3 fatty acids to regulate mood and emotions, vitamin E to help absorb omega-3s, melatonin to help normalize sleep patterns, or zinc to help neutralize hyperactivity and impulsivity. These alternative therapies are not empirically proven to improve symptoms, however many patients find it helps to devise a holistic treatment plan with their physicians.

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Oppositional Defiant Disorder At a Glance

Comorbidity with ADHD · 25 percent of boys with ADHD and 10 percent of girls with ADHD will develop ODD.
· About 40 percent of those children will get progressively worse and develop Conduct Disorder (CD).
Suggestive Symptoms · Often loses temper
· Often argues with adults
· 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
· Often easily annoyed by others
· Often angry and resentful
· Often spiteful or vindictive
· In adults, feeling mad at the world, losing temper regularly, relentlessly defending self when criticized or blamed; may present as spousal abuse or road rage
Professional to See A family therapist or counselor. A child or adolescent psychiatrist will need to prescribe any medication.
Treatments & Medications ·  Psychotherapy, including training or counseling for parents
·  Stimulant medications used for ADHD
·  Atypical antipsych0tics, including aripiprazole (Abilify) or risperidone (Risperidal)
Recommended Resources · AACAP.org
· ConductDisorders.com
· EmpoweringParents.com
· Taking Charge of Anger (#CommissionsEarned), by W. Robert Nay, Ph.D.
· Your Defiant Child (#CommissionsEarned), by Russell A. Barkley, Ph.D.
Your Defiant Teen (#CommissionsEarned), by Russell A. Barkley, Ph.D.
Your Defiant Child: Parenting Easily Frustrated, Chronically Inflexible Children (#CommissionsEarned), by Ross W. Greene, Ph.D.

#CommissionsEarned As an Amazon Associate, ADDitude earns a commission from qualifying purchases made by ADDitude readers on the affiliate links we share. However, all products linked in the ADDitude Store have been independently selected by our editors and/or recommended by our readers. Prices are accurate and items in stock as of time of publication

Oppositional Defiant Disorder: Next Steps

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