Oppositional Defiant Disorder
Oppositional defiant disorder (ODD) is a disruptive behavior disorder in children and teenagers characterized by patterns of unruly and argumentative behavior and hostile attitudes toward authority figures. Some parents may find it difficult to recognize ODD, thinking they simply have a stubborn, emotional, or strong-willed child. The behavior of a child with ODD is much more extreme and disruptive than normal, however, and occurs much more frequently than the type of childhood stubbornness, whininess, and rebellion that often occurs at different stages of a child’s development.
ODD is diagnosed when a child or teenager constantly behaves in extremely negative, hostile, and defiant ways that disrupt their home, school, and social lives and continues for at least six months. Symptoms appear as early as the late preschool years. Children with ODD usually direct their anger, resentment, and spiteful behavior toward their parents, teachers, or other authority figures, though they may also have problems with their peers. They are often uncooperative, vindictive, and easily annoyed; they refuse to follow rules, throw tantrums, blame others for their mistakes, seek revenge, misbehave, or disturb others on purpose. ODD symptoms may be directed at one person or many people and may occur only at home, at school, or may occur in a number of settings.
The absolute cause of ODD is unclear but a mix of biological, social, and psychological factors appears to put children at risk. These risk factors include poverty (although ODD can occur in families of any economic status), experiencing a traumatic transition, having a parent with a mood, addictive, or behavioral disorder, having a bad relationship with a parent, having a neglectful or abusive parent, or a parent who is an overly harsh disciplinarian, or other family instabilities. At least one study found that ODD symptoms are worse in children who struggle with peer acceptance in addition to family issues.
It is generally up to the parent to seek treatment, since the child is unlikely to understand that there is a problem. Referrals for psychological evaluation and treatment often come from a medical doctor who has performed an examination and ruled out a physical cause. Since many children with ODD have coexisting conditions, such as mood or anxiety disorders, ADHD, learning disorders, or language disorders, it is important to determine whether this is the case, or if the child’s poor behavior is simply in response to a temporary situation. Once the condition or situation is established, the appropriate course of treatment can begin. A combination of therapies is generally used to treat ODD, including behavioral and family therapies, parental training, and sometimes medication. In addition to treating the child, therapy attempts to rebuild the parent-child relationship and teach parents new techniques for dealing with the child’s behavior. Treatment is essential, and the earlier the better to help prevent ODD from developing into a more serious conduct disorder, mental health disorder, or criminal behavior.
ODD A Guide for Families by the American Academy of Child and Adolescent Psychiatry (AACP). 2009 AACAP Practice Parameter for the Assessment and Treatment of Children and Adolescents with Oppositional Defiant Disorder.
Tung I and Lee SS. Negative parenting behavior and childhood oppositional defiant disorder: Differential moderation by positive and negative peer regard. Aggressive Behavior. January 2014;40(1):79-90. First published online 5 August 2013.
Greene RW, Biederman J, Zerwas S, et al. Psychiatric comorbidity, family dysfunction, and social impairment in referred youth with oppositional defiant disorder. The American Journal of Psychiatry. July 2002;159(7):1214-1224.
American Psychiatric Association. Understanding Mental Disorders: Your Guide to DSM-5. 2015. American Psychiatric Publishing.
Last reviewed 02/07/2019