Oppositional Defiant Disorder
What is oppositional defiant disorder (ODD)?
ODD is a behavior disorder, usually diagnosed in childhood. It is characterized by
uncooperative, defiant, negativistic, irritable, and annoying behaviors toward parents,
peers, teachers, and other authority figures. Children and adolescents with ODD are
more distressing or troubling to others than they are distressed or troubled themselves.
What causes oppositional defiant disorder?
The cause of ODD is not known. Yet there are two primary theories offered to explain
the development of ODD. A developmental theory suggests that the problems begin when
children are toddlers. Children and adolescents who develop ODD may have had a difficult
time learning to separate and become independent from the main person to whom they
were emotionally attached. The "bad attitudes" characteristics of ODD are viewed as
normal developmental issues that are continuing beyond the toddler years. Learning
theory suggests, however, that the negativistic characteristics of ODD are learned
attitudes. They reflect the effects of negative reinforcement methods used by parents
and authority figures. The use of negative reinforcement by parents is viewed as increasing
the rate and intensity of oppositional behaviors in the child. This is because these
behaviors are achieving the desired attention, time, concern, and interaction with
parents or authority figures.
Who is affected by oppositional defiant disorder?
Behavior disorders are, by far, the most common reason for referrals to mental health
services for children and adolescents. Oppositional defiant disorder is reported to
affect 1% to 16% of the school-age population. ODD is more common in boys than in
What are the symptoms of oppositional defiant disorder?
Most symptoms seen in children and adolescents with oppositional defiant disorder
also happen at times in children without this disorder, especially around the ages
or 2 or 3, or during the teenage years. Many children, especially when they are tired,
hungry, or upset, tend to disobey, argue with parents, or defy authority. However,
in children and adolescents with oppositional defiant disorder, these symptoms happen
more often and interfere with learning, school adjustment, and, sometimes, with the
child's relationships with others.
Symptoms of oppositional defiant disorder may include:
Frequent temper tantrums
Excessive arguments with adults
Refusal to comply with adult requests
Always questioning rules; refusal to follow rules
Behavior intended to annoy or upset others, including adults
Blaming others for one's own misbehaviors or mistakes
Easily annoyed by others
Frequently having an angry attitude
Speaking harshly, or unkindly
The symptoms of ODD may resemble other medical conditions or behavior problems. Always
talk with your child's healthcare provider for a diagnosis.
How is oppositional defiant disorder diagnosed?
Parents, teachers, and other authority figures in child and adolescent settings often
identify the child or adolescent with ODD. However, a child psychiatrist or a qualified
mental health professional usually diagnoses ODD in children and adolescents. A detailed
history of the child's behavior from parents and teachers, clinical observations of
the child's behavior, and, sometimes, psychological testing contribute to the diagnosis.
Parents who note symptoms of ODD in their child or teen can help by seeking an evaluation
and treatment early. Early treatment can often prevent future problems.
Further, oppositional defiant disorder often coexists with other mental health disorders,
including mood disorders, anxiety disorders, conduct disorder, and attention-deficit/hyperactivity
disorder. This increases the need for early diagnosis and treatment. Consult your
child's healthcare provider for more information.
Treatment for oppositional defiant disorder
Specific treatment for children with oppositional defiant disorder will be determined
by your child's healthcare provider based on:
Your child's age, overall health, and medical history
Extent of your child's symptoms
Your child's tolerance for specific medicines or therapies
Expectations for the course of the condition
Your opinion or preference
Treatment may include:
Individual psychotherapy. Individual psychotherapy for ODD often uses cognitive-behavioral approaches to improve
problem solving skills, communication skills, impulse control, and anger management
Family therapy. Family therapy is often focused on making changes within the family system. These
changes include improving communication skills and family interactions. Parenting
children with ODD can be very difficult and trying for parents. Parents need support
and understanding as well as help in developing more effective parenting approaches.
Peer group therapy. Peer group therapy is often focused on developing social skills and interpersonal
Medicine. While not considered effective in treating ODD, medicine may be used if other symptoms
or disorders are present and responsive to medicine.
Prevention of oppositional defiant disorder in childhood
Some experts believe that a developmental sequence of experiences happens in the development
of oppositional defiant disorder. This sequence may start with ineffective parenting
practices, followed by difficulty with other authority figures and poor peer interactions.
As these experiences compound and continue, oppositional and defiant behaviors develop
into a pattern of behavior. Early detection and intervention into negative family
and social experiences may be helpful in disrupting the sequence of experiences leading
to more oppositional and defiant behaviors. Early detection and intervention with
more effective communication skills, parenting skills, conflict resolution skills,
and anger management skills can disrupt the pattern of negative behaviors. They can
also decrease the interference of oppositional and defiant behaviors in interpersonal
relationships with adults and peers, and school and social adjustment. The goal of
early intervention is to enhance the child's normal growth and development, and improve
the quality of life experienced by children or adolescents with oppositional defiant