Oppositional Defiant Disorder

What is oppositional defiant disorder (ODD)?

Oppositional defiant disorder (ODD) is a behavior disorder that starts in childhood but may continue into adolescence and adulthood. It is characterized by unruly, hostile, angry and argumentative behavior towards the parent(s) and other authoritative figures. Children with ODD often seem easily irritated and may do things to intentionally annoy others. They refuse to obey rules or listen to what adults ask, and often have an angry attitude. They may be vengeful and speak unkindly to others.

Even though temper tantrums may be expected at a young age, these behaviors go beyond what is typical and carry on past an age when such behaviors usually taper off in most children. Thus, because the behaviors often continue after the age of 4, they become a cause for concern, as the tantrums start to disrupt early life (including activities within the family) and school.

Sometimes the signs of ODD only show up in a particular scenario or with one specific individual. For example, children with ODD might only show symptoms at home or around people with whom they are most familiar.

Children with ODD have strained relationships with parents, peers, and teachers. As a result, they are more likely to have higher rates of coexisting mood disorders and are at a greater risk of developing antisocial personality disorders later in life. ^[1]

Symptoms of oppositional defiant disorder in children

Oppositional defiant disorder signs begin during preschool years. As a result, it may be challenging to distinguish between a strong-willed or troublesome child and one with ODD. At times, ODD may develop a little later, but it is generally apparent before the early teen years.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) sets forth the criteria for diagnosing ODD, listing emotional and behavioral symptoms exhibited for at least six months. Further, children and teens must show at least four of the symptoms for at least six months to meet the diagnostic criteria for ODD.

Argumentative and defiant behavior

• Actively refusing to obey or comply with adults, persons of authority, or rules.
• Arguing excessively, throwing temper tantrums, and playing power games.
• Easily annoyed and actively trying to annoy or upset others.
• Often blaming others for their mistakes or misbehavior.

Angry and irritable mood

• Losing one’s temper frequently and quickly.
• Easily annoyed and irritated.
• Rapidly get angry and show resentment.

Vindictiveness

• Acting spiteful and vindictive at least twice over a period of six months.

ODD can be classified in three ways according to the number of settings the symptoms in which they appear.

1. Mild – symptoms are shown in one setting (e.g., only at home or only at school; only with peers)
2. Moderate – at least some symptoms seen in at least two settings
3. Severe – at least some symptoms seen in at least three or more settings

With children with ODD, challenging behaviors go beyond the norm considered for their developmental age. An extreme form of ODD, called conduct disorder, can be a coexisting condition. Other conditions that can exist with ODD are most commonly attention deficit hyperactivity disorder (ADHD), anxiety, and depression. ^[2]

When should I see a doctor if I think my child has ODD?

It’s normal for kids to be challenging or defiant sometimes. Still, those with ODD will exhibit such behaviors most of the time. Children who are diagnosed early often have better outcomes. When in doubt, watch for these particular behaviors.

Tantrums associated with the ‘terrible twos’ often occur between 18-30 months and generally become less frequent after the child turns three. ^[3]

ODD can be diagnosed as early as between the ages of four and eight because the condition starts to interfere with family life and school.^[4] You will notice that your child argues unnecessarily and has frequent bouts of anger, are easily annoyed and will not accept even basic requests of discipline, are vengeful and spiteful; and have difficulty forming friendships. These symptoms seem to be continuous over six months.

What causes ODD?

While the causes of ODD are unknown, experts have two main theories for its development:

• The Developmental Theory proposes that the issues begin when children are toddlers. For example, children may become too emotionally attached to a parent or other individual they are close to, and they find it difficult to establish independence from them. As a result, these children are more likely to develop ODD.
• The Learning Theory asserts that the problematic symptoms of ODD are learned behaviors that mirror punishment methods used by parents or authoritative figures. Here, it is proposed that negative reinforcement aggravates ODD behaviors. It is thought that the child’s attitude worsens because the behavior results in attention and reaction from the disciplining figures.^[5]

Treatment for oppositional defiant disorder in children

ODD treatment depends on the severity of symptoms, the child’s age, and their ability to participate or tolerate treatment. A combination of treatments is often suitable:

• Psychotherapy: individual talk therapy/counselling with a mental health professional helps the ODD child with coping abilities. They are taught social skills and problem-solving mechanisms to better control their anger, express anger in a less harmful way, and reshape their thinking for improved behavior.
• Family therapy: parent management training (PMT) teaches parents to identify and reward positive behavior, and effectively forms a contract that lets the child know there are consistent consequences for negative behavior. Other programs include Incredible Years, Parent-Child Interaction Therapy, and Positive Parenting Program.
• Medication: therapy is the prefered method of treating ODD, however medicines might be used in cases where the person is agressive or disruptive. A psychiatrist might prescribe antidepressants, mood stabilizers, or stimulants depending on the particular case.^[7]

Helping a child live with oppositional defiant disorder

Treatment and therapy early on can prevent future problems. In order to help the ODD child have a better quality of life:

• Stick to appointments with the healthcare provider and participate in the child’s care, including family therapy sessions.
• Keep good communication with the child’s care team. This may involve social workers, psychologists, counselors, and also teachers.
• Join a support group of parents with ODD children.
• Care for one’s own physical and mental health to prevent becoming overwhelmed and excessively frustrated.^[8]

Frequently asked questions about ODD

How do I handle ODD in the classroom?

Creating an environment conducive to learning for students with different learning abilities and other issues is challenging at the best of times. When a classroom has a student with ODD, this may influence everybody. Teachers need strategies to minimize this disruption consistently.

Classroom strategies include:

• Stay informed on the condition and build a relationship with the student and the student’s parents.
• Understand what the child enjoys and help them work towards earning a reward rather than leading by punishment. ODD children work well with a reward system. Be clear and consistent.
• Create opportunities for the ODD children to demonstrate what they do well.
• Choose battles carefully. Avoid disagreements from turning into a power struggle.
• Prepare ODD children individually when there is going to be a schedule change or an activity that is out of the norm.
• Create a quiet space in the classroom where an ODD child can decompress for a predetermined amount of time.
• Keep the learning space safe for all the other students.
• Take a moment to calm down or redirect frustration when needed.^[9]

What is the long-term outlook if my child has ODD?

When it comes to ODD, treatment is usually effective, especially if help is sought when first noticing the symptoms. A mental health professional can guide you so the condition can be kept in check. ODD patients may have problems making friends and may experience rejection from peers or siblings. Thus, it is essential to tackle ODD before the child can develop more severe behavioral disorders or encounter more challenging situations.

How common is ODD?

ODD is estimated in about 2-11% of the population worldwide. Such a variation is shown because this diagnosis often depends on informant sources (e.g., parents and teachers) for reporting symptoms.

ODD occurs more often in preadolescent males than in females. In adolescence and adulthood, the difference between genders is less marked.^[10]

Is ODD the same as ADHD?

Although both conditions can coexist, there are differences between a child with ODD and one with ADHD. While an initial behavior may look the same (e.g., a child causing trouble or trying to annoy another child in class), the subsequent reaction will differ.

An ODD child will be aggressive and not feel remorseful about it. The ODD means they might even place the blame on someone else or brag about it. On the other hand, the actions of an ADHD child will be impulsive and hyperactive, but they will later feel sorry about it.

In class, an ODD child can stay still but would rather not; they may choose to be disruptive. An ADHD child will have trouble keeping still due to a lack of focus and may be unable to sit quietly, even if they wish to do so. ^[11]

Which children are at risk of developing ODD?

Boys are more at risk of developing ODD than girls. ODD is also more common in those with other mood or anxiety disorders, such as antisocial/conduct disorder or attention-deficit/ hyperactivity disorder (ADHD).^[6]

How can I prevent my child from developing ODD?

Because the cause of ODD is unknown, it is impossible to prevent this behavioral disorder. However, early diagnosis and treatment are the most helpful ways of not letting the condition get out of hand or progress.