Oppositional Defiant Disorder – Causes, Signs and symptoms

Oppositional Defiant Disorder

Also called: Oppositional Defiance Disorder


Oppositional defiant disorder (ODD) is a condition in which a child displays disobedient, hostile and defiant behavior toward authority figures. Although it is normal for a child to exhibit such behavior on occasion, children with ODD display a level of defiance outside the bounds of normal behavior that causes clinically significant impairment in social, academic, or occupational functioning.  Symptoms exhibited by children with ODD can be emotionally taxing for parents and others who interact with the child.

The causes of ODD are unknown, but are thought to be the result of a combination of several factors, including heredity, environmental factors and the child’s individual temperament. Typical symptoms include negativity, defiance, disobedience and hostility toward authority figures. Children may act up anywhere but are most likely to defy adults or peers that they know well in familiar settings such as at home and in school.

Diagnosis of ODD requires a comprehensive evaluation. A physician may use questionnaires or interviews with parents, teachers, babysitters, coaches and others who may describe witnessing behaviors in the child that are typically associated with ODD. Other potential causes of symptoms will have to be ruled out before a diagnosis of ODD can be made. In many cases, an associated mental disorder such as attention deficit hyperactivity disorder (ADHD), depression or a learning disability will also be diagnosed.

Detecting ODD early is the key to effective treatment. Behavior therapy that helps children learn to modify their conduct is the chief method of treating ODD. Parents can also help a child with ODD by offering support, structure and discipline. Parents can work with a mental health professional to learn techniques that will help them better cope with their child’s behavior.

About ODD

Oppositional defiant disorder (ODD) is an ongoing pattern of uncooperative, defiant or hostile behavior by a child toward figures of authority. Children with this disorder exhibit stubbornness and unwillingness to give into peers and adults that is so severe that it interferes with their ability to function on a day-to-day basis.

All children sometimes disobey parents and other authority figures. But in some cases, this behavior becomes a habitual pattern that may cause major problems at home and in school. Children with ODD can be so defiant that virtually anything can trigger a tantrum or argument. This can be emotionally taxing for everyone in the family.

Between 5 percent and 15 percent of all school-age children have ODD, according to the American Academy of Child and Adolescent Psychiatry. This behavior goes beyond the boundary of normal childhood disobedience and must continue for a period of at least six months. ODD usually occurs by the time a child is 8 years old and typically appears no later than early adolescence. It is more common in boys than girls prior to puberty, but tends to be present in equal numbers in boys and girls after puberty. ODD may occur with other psychiatric conditions, such as anxiety, mood disorders (e.g., depression) or attention deficit hyperactivity disorder (ADHD). ODD may be present in children before they go on to develop conduct disorder, a condition marked by repetitive and persistent antisocial behavior that violates the rights of others. However, many children with ODD do not ever develop conduct disorder.

Potential causes of ODD

The causes of oppositional defiant disorder (ODD) are unknown, and may be the result of a combination of factors. Heredity appears to play a role, as children are more likely to develop ODD if at least one parent has a history of ODD, mood disorder, conduct disorder, attention deficit hyperactivity disorder (ADHD), antisocial personality disorder or a substance abuse problem.

Environmental factors may also play a role in the development of ODD. For example, children who live with parents who have serious marital problems are more likely to develop ODD. A child’s inherent temperament also has a strong influence on whether or not they develop ODD.

Certain traits have been highly correlated to ODD. For example, boys who have troublesome temperaments and who exhibit high motor activity in their preschool years are at greater risk for developing ODD. Other risk factors known to increase the odds of an ODD diagnosis include:

  • Discipline that is too harsh or inconsistent
  • Exposure to violence
  • Family instability (e.g., financial problems, troubled marriage)
  • History of abuse or neglect
  • Improper supervision
  • Unstable environment (e.g., frequent moves or school changes)
  • Relationship problems with one or more parents

Signs and symptoms of ODD

Symptoms of oppositional defiant disorder (ODD) may occur in any environment, but are most likely to occur at home and in school. Negativity, defiance, disobedience and hostility toward authority figures are all hallmarks of this disorder. Symptoms are similar in both boys and girls, although boys may exhibit more confrontational behavior and may experience more persistent symptoms.

Children with ODD may have regular temper tantrums and engage in frequent arguments with adults. They may persistently test the limits imposed upon them, then fail to accept responsibility for their actions. They may deliberately annoy others and engage in spiteful and vindictive behavior toward peers and others. They are also easily annoyed themselves. Although children with ODD may be verbally aggressive, they tend to avoid the physical aggressiveness displayed by those with conduct disorder.

Other symptoms that may be displayed by children with ODD include:

  • Low self-esteem, or over-inflated self-esteem
  • Frequent mood changes
  • Use of inappropriate language
  • Use of alcohol, tobacco and/or drugs

Children with ODD are most likely to act out when they are around adults or peers that they know well. This means that their behavior may not be as evident in situations where they are being diagnosed by a physician.

Diagnosis methods for ODD

Oppositional defiant disorder (ODD) requires a comprehensive evaluation. A physician will likely perform a complete physical examination and compile a thorough medical history. Since teens who abuse drugs display a wide variety of behavioral problems, a urine or blood toxicology screen may be obtained.

Patients with ODD are frequently diagnosed with other concurrent disorders, such as attention deficit hyperactivity disorder (ADHD), anxiety, mood disorders (e.g., depression), learning disabilities and communication disorders. Oftentimes, it can be difficult to distinguish whether symptoms are the result of ODD or one of these associated disorders. Therefore, children who present with ODD symptoms are usually referred to a child and adolescent psychiatrist, who can diagnose and treat ODD and any coexisting psychiatric condition. Other specialists may be consulted, including child development professionals and other behavioral experts. 

The physician may use questionnaires or interviews with parents, teachers, babysitters, coaches and others who may describe behaviors typically associated with the condition.

To meet the criteria for diagnosis of ODD as established by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM), a child must exhibit abnormal, negative, hostile, defiant and annoying behavior that lasts at least six months and seriously interferes with day-to-day functioning. The diagnosis also requires at least four of the following:

  • Frequent loss of temper
  • Frequent arguments with adults
  • Defiance or refusal to comply with adult requests or rules
  • Deliberate provocation of others
  • Blaming of others for own mistakes or misbehavior
  • Easily annoyed by others
  • Anger and resentment
  • Spitefulness or vindictiveness

In addition, the behavioral disturbance must cause a clinically significant impairment to social, academic or occupational functioning and must not occur during the course of a psychotic disorder or mood disorder. Finally, the patient’s behavior must not meet the criteria for conduct disorder or – if the patient is 18 or older – for antisocial personality disorder.

Treatment options for ODD

The earlier oppositional defiant disorder (ODD) is detected, the more likely it is that treatment will be effective. Behavior therapy that helps children learn to modify their conduct is the chief method of treating ODD. Social skills training and individual and family-based psychotherapy are also often used to treat this disorder.

Parental training can be an equally important part of treatment. Parents can help a child with ODD by combining support and love with structure and discipline. Parents can work with a mental health professional to learn techniques that will help them better cope with their child’s behavior. It is important to set limits and impose reasonable punishments when these limits are violated. At the same time, parents are urged to create circumstances that do not leave their child feeling threatened. For example, parents who offer an obstinate child a choice between at least two positive options allow the child to feel a sense of control.

Other examples of effective parenting skills when faced with ODD include:

  • Provide effective time-outs
  • Avoid power struggles
  • Stay calm in the face of the child’s unruly behavior
  • Reinforce positive behavior by offering praise or reward

Parents who use these techniques may initially encounter resistance from their child. However, over time these techniques are often effective. Further, support from other adults (e.g., teachers, coaches, spouse) can help parents deal with their child’s ODD.It is also important to treat other mental health conditions that may be associated with ODD. In some cases, treating these conditions will also alleviate symptoms of ODD.

Questions for your doctor regarding ODD

Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions related to oppositional defiant disorder (ODD):

  1. How can I tell if my child’s defiant behavior is normal or a possible indicator of ODD?
  2. What specific behaviors should I watch for that might indicate a problem?
  3. Do I need to contact my child’s teachers, babysitters or other people who might be able to help you make the proper diagnosis?
  4. My child acts up more often at home and in school than anywhere else. Is this normal?
  5. Is it possible that factors inside the home are responsible for my child’s ODD?
  6. What are some of the other risk factors for ODD?
  7. Based on your examination, is it possible that my child has another emotional disorder related to ODD?
  8. What steps can I take to help my child meet the day-to-day challenges of ODD?
  9. Are there tools or techniques I can learn to help me better cope with my child’s ODD?
  10. If my child has ODD, does that mean that it will likely progress to conduct disorder?
  11. Should another medical professional be involved in my child’s treatment plan?
  12. Does my child’s teacher and/or school need any special information about my child’s diagnosis?
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