Oppositional Defiant Disorder
Oppositional defiant disorder (ODD) is an extreme behavior disorder defined by chronic aggression, frequent outbursts, defiance, and a tendency to irritate others. Children with ODD are frequently irritable, argumentative, and disobedient. This behavior often disrupts your child’s normal daily functioning, including relationships and activities within their family and at school.
It’s common for children — especially those two to three years old and in their early teens — to be oppositional or defiant of authority once in a while. They might express their defiance by arguing, disobeying or talking back to adults, including their parents or teachers. When this behavior lasts longer than six months and goes beyond what’s usual for your child’s age, it might suggest that they have ODD.
There are two types of oppositional defiant disorder:
• Childhood-onset ODD: Present from an early age, and requires early intervention and treatment to prevent it from progressing into a more serious conduct disorder
• Adolescent-onset ODD: Begins suddenly in the middle- and high-school years, causing conflict at home and in school
Sign & Symptoms –
Signs of ODD generally begin during preschool years. Sometimes ODD may develop later, but almost always before the early teen years. These behaviors cause significant impairment with family, social activities, school and work.
Common signs and symptoms of ODD include –
• Being easily annoyed
• Causing conflict
• Frequent temper tantrums
• Low tolerance for frustration
• Moodiness and unprovoked anger
• Noncompliance with even simple requests
• No sense of conscience
• Purposeful irritation of others
Researchers believe that the cause of oppositional defiant disorder is a complex combination of biological, genetic and environmental factors:
• Genetic factors: Research suggests that genetics account for about 50% of the development of ODD. Many children and teens with ODD have close family members with mental health conditions, including mood disorders, anxiety disorders and personality disorders. Further, many children and teens with ODD also have other mental health conditions, such as ADHD, learning differences, or depression and anxiety disorder, which suggests a genetic link between the conditions.
• Biological factors: Some studies suggest that changes to certain areas of your brain can lead to behavior disorders. In addition, ODD has been linked to issues with certain neurotransmitters, which help nerve cells in your brain communicate with each other. If these chemicals are out of balance or not working properly, messages might not make it through your brain correctly, leading to symptoms.
• Environmental factors: Having a chaotic family life, childhood maltreatment and inconsistent parenting can all contribute to the development of ODD. In addition, peer rejection, deviant peer groups, poverty, neighborhood violence and other unstable social or economic factors may contribute to the development of ODD.
Risk Factors –
Your child is more likely to develop ODD if they have the following risk factors –
• A history of child abuse or neglect.
• A parent or caregiver who has a mood disorder or who has substance or alcohol use disorders.
• Exposure to violence.
• Inconsistent discipline and lack of adult supervision.
• Instability in their family, such as divorce, moving to different houses often and changing schools frequently.
• Financial problems in their family.
• Parents who have or have had ODD, attention-deficit/hyperactivity disorder (ADHD) or behavioral problems.
Children and teenagers with oppositional defiant disorder may have trouble at home with parents and siblings, in school with teachers, and at work with supervisors and other authority figures. Children with ODD may struggle to make and keep friends and relationships.
ODD may lead to problems such as:
Many children and teens with ODD also have other mental health disorders, such as:
• Attention-deficit/hyperactivity disorder (ADHD)
• Conduct disorder
• Learning and communication disorders
According to the DMS-5, a diagnosis of ODD requires a child to have at least four symptoms from the following categories. The symptoms must occur for at least six months and have a negative impact on social, educational, or occupational functioning –
▪︎ Angry and irritable mood:
• Often and easily loses temper
• Is frequently touchy and easily annoyed by others
• Is often angry and resentful
▪︎ Argumentative and defiant behavior:
• Often argues with adults or people in authority
• Often actively defies or refuses to comply with adults’ requests or rules
• Often deliberately annoys or upsets people
• Often blames others for his or her mistakes or misbehavior
• Is often spiteful or vindictive
• Has shown spiteful or vindictive behavior at least twice in the past six months
Your healthcare provider may assess the severity of your child’s ODD using the following scale from the DSM-5 –
• Mild. Symptoms occur only in one setting, such as only at home, school, work or with peers.
• Moderate. Some symptoms occur in at least two settings.
• Severe. Some symptoms occur in three or more settings.
For some children, symptoms may first be seen only at home, but with time extend to other settings, such as school and with friends.
Treatment for ODD is based on many things, including the child’s age, how severe symptoms are, and the child’s ability to take part in and tolerate specific therapies.
Treatment usually consists of a combination of the following –
• Psychotherapy: This type of counseling aims to help the child develop more effective coping, social, and problem-solving skills, and ways to express and control anger. A type of therapy called cognitive behavioral therapy aims to reshape the child’s thinking (cognition) to improve behavior.
• Family therapy: This may be used to help improve family interactions and communication among family members. A specialized therapy technique called parent management training (PMT) teaches parents ways to positively alter their child’s behavior. Behavior management plans also often involve developing contracts between parent and child that identify rewards for positive behaviors and consequences (punishments) for negative behaviors.
• Medication: While there is no medication formally approved to treat ODD, drugs may sometimes be used to treat symptoms (including being impulsive and cranky). Sometimes, a child with ODD needs medication for other mental illnesses they may have, such as ADHD or depression.
Strategies you can try at home if your child has ODD include –
• Praise specific positive behaviors.
• Offer rewards for good behavior, especially for younger children.
• Model the behavior you want to see in your child.
• Avoid power struggles.
• Pick your battles.
• Set clear limits and boundaries.
• Follow a consistent schedule and routine.
• Spend time together doing things you both enjoy.
• Make sure both parents or other family members are working together consistently.
• Set your child up for success in household chores or other tasks.
• Don’t worry if you don’t see improvement right away.
• Find support for yourself.
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