Oppositional Defiant Disorder: Child Behaviors to Know

Medically reviewed by Michael MacIntyre, MD

Oppositional defiant disorder (ODD) is a clinical behavior disorder. It consists of a characteristic and pervasive pattern of behavior lasting at least six months that includes irritable mood, argumentative or defiant behavior, or vindictiveness.

Children with ODD have difficulty with self-regulation and controlling their temper. Parents may feel incredibly overwhelmed with their children’s behavior. While some controversial research shows there may be a genetic component, this isn’t always the case,

This article will discuss oppositional defiant disorder, its causes, and treatment.

What Does an Oppositional Defiant Disorder Diagnosis Mean?

A diagnosis of the behavioral disorder ODD is typically made by a mental health practitioner for children—a psychiatrist or psychologist, for example. They may speak to family members and teachers, do a mental health exam, and observe the child in a variety of settings to get a thorough understanding of their behavior.

A thorough assessment is needed because some behaviors of ODD are common in childhood, especially in very young children and teens. These include frequent temper tantrums, talking back to adults, and questioning authority.

In children with ODD, these symptoms happen more frequently and are significant enough that they negatively impact relationships, school and learning, and social situations.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) contains diagnostic criteria for ODD. The first criterion is a pattern of angry or irritable moods, argumentative behavior, or vindictiveness that lasts at least six months, with at least four of the following symptoms from these categories, with at least one person who isn't a sibling:

• Angry/irritable mood: Frequently loses temper, easily annoyed, frequently resentful

• Argumentative/defiant behavior: Frequently argues with or defies those in authority positions, purposely annoys other people, blames others for their own mistakes or behavior

• Vindictiveness: Has been spiteful or vindictive at least twice within six months

The other criteria are:

• The behavior has negative impacts on the individual's social, school, or work functioning.

• The behavior is not due to a psychotic disorder, substance abuse, depression, or bipolar disorder.

There is no specific tool made for diagnosing ODD, but several tools for diagnosing other disorders can be used to help make a more accurate diagnosis. These can include:

• Child Behavior Checklist: Screens for attention deficit hyperactivity disorder (ADHD), ODD, conduct disorder, depression, anxiety, and other behaviors

• Conners 3: Can screen for ADHD, as well as ODD and conduct disorder

• Swanson, Nolan, and Pelham Teacher and Parent Rating Scale: Screens for ADHD and has questions for ODD, conduct disorder, generalized anxiety disorder, and other disorders

• Vanderbilt ADHD Diagnostic Parent Rating Scale: Screens for ADHD and can measure symptoms of ODD, conduct disorder, anxiety, and depression
  

Symptoms: ODD Behavior in Children

Symptoms of ODD in children can look like general behaviors of childhood, as well as several other mental and/or behavioral disorders. The frequency and intensity of the behaviors and their effect on relationships, learning, and everyday life should be noted. Symptoms can include:

• Frequent temper tantrums

• Arguing with adults

• Refusing to do what’s asked of them by adults

• Questioning and refusing to comply with rules

• Doing annoying or upsetting behaviors

• Blaming others for their own misbehaviors

• Being easily annoyed by other people

• Frequent angry attitude

• Speaking unkindly

• Vindictive attitude or wanting revenge

Any possibility of coexisting mental or behavioral disorders should be explored since addressing and treating these disorders can also help with ODD behaviors.

ODD can often overlap with conditions and neurodevelopmental differences such as autism and ADHD. They can have symptoms that mimic each other, but these are discrete disorders that should not be confused with one another.

This is why an appropriate diagnosis by an experienced mental health professional is essential.

When Children Grow Up

As children with ODD get older, if their ODD is untreated, and especially if they have coexisting mental disorders, they are at higher risk for depression and substance abuse.

For some individuals, their diagnosis may change to conduct disorder, which involves much more serious, aggressive, and even violent behavior. A child with ODD will not necessarily evolve into an adult with conduct disorder, but it’s necessary to seek treatment as early as possible and monitor behavior over the years.

It's important to be aware of ableism when evaluating children’s behavior. Children with communication disorders, chronic pain, or learning disabilities, for example, may act in certain ways that appear to be defiant or questioning but are a manifestation of their disability or condition.

Children acting from a trauma response, or developmental trauma disorder (DTD), may also exhibit dysregulation (inability to control emotional responses), lack of attachment, and ODD behavior but may not have ODD.

Oppositional Defiant Disorder: Effects at School

Educators must be cautious when assuming a diagnosis of ODD in school. Society has certain beliefs about how children should act in certain settings and which behaviors are ideal.

Children who question “too much” in school are seen as disruptive and oppositional. But instead, they may be gifted or twice-exceptional (clinically gifted and also have a disability diagnosis) or have a diagnosis like ADHD.

For those with a clinical diagnosis of ODD, this can impact school because they refuse to comply with their teachers’ requests or refuse to do work, lash out at other students, defy authority and rules, and may be mean to other children.

Oppositional Defiant Disorder: Effects at Home

At home, a child with ODD might challenge everything, from what’s for breakfast to getting dressed for the day to doing homework after school. They may be quick to anger, hostile toward parents and siblings, and aggressive with or mean to family members. This can lead to difficult family relationships and a feeling of uneasiness in the home.

Risk Factors for Oppositional Defiant Disorder

There are a variety of risk factors for ODD. Having risk factors does not necessarily mean a person will develop a disorder, but it simply increases the chance for the condition. Risk factors for ODD can include:

• Parental nicotine use

• Prenatal nutritional deficiencies

• Developmental delays

• Parental psychological issues and behaviors, including maternal aggression, abuse, harsh punishments

• Unresponsive parents

• Insecure attachment

• Poverty

• Lack of structure

• Peer rejection

• Community violence

It should be noted that supportive environments have been found to be a protective factor for ODD. A parenting style that results in an unstable home, unstable parent-child relationships, and weak attachments can be a risk factor for ODD.

If a parent is not responsive or supportive, is aggressive and inconsistent with discipline, or is overly harsh with discipline, the child is less likely to be positively attached or feel supported.

Underlying Causes of Oppositional Defiant Disorder

There is no known cause for ODD. Many experts suspect that there is a cumulative effect of a variety of risk factors from biological, psychological, and social issues. There are some things that can be protective and reduce the risk or severity of ODD, which illustrates that this is not as clear-cut as some would like to think.

There have been familial clusters of ODD, which could point to a possible genetic component, but this is variable and not certain.

How to Help Children With Oppositional Defiant Disorder

If the behavior is a pattern that’s causing significant impairment in one or more areas of a child's life, see a professional for an evaluation. A child with ODD is not intentionally trying to be challenging. This is a clinical behavior disorder that requires treatment and understanding. Without disorder-specific treatment, “help” won’t do much.

Treatment for ODD usually includes:

• Behavioral therapy (or medication and behavioral therapy, if there are co-existing disorders), cognitive behavioral therapy for mood disorders, or dialectical behavior therapy

• Parent training programs to improve the relationship and parenting skills, including things like parent-child interaction therapy (PCIT), Parent Management Training (PMT), and Positive Parenting Program (Triple P)

• Social skills training

Appropriate treatment is essential, and this includes social support for them as well. Knowing they have a safe space and are supported can have a positive effect.

At home, having a strong relationship with your child is important, as are things like setting clear household rules, praising positive behaviors, and being consistent with consequences (like loss of privileges if rules are broken or negative behaviors occur).

Specialists to See for Suspected Oppositional Defiant Disorder

While a qualified child mental health professional can provide a diagnosis, specialists to see can depend on the kind of treatment you pursue. Cognitive behavioral therapy (CBT) and family therapy require CBT and family therapists, respectively.

Medication is not typically a first-line treatment for ODD, but if coexisting mental or behavioral disorders require medication, a psychiatrist should prescribe it.

In a school setting, let the teachers and any other associated staff, like the child study team, know about your child’s diagnosis so that you can work with them to create a supportive educational plan for your child.

Discipline and ODD: What to Avoid

Children with ODD also often have an anxiety disorder, and so they may feel a need for control. This can result in power struggles with authority figures, which is something to be avoided.

Don’t make complicated rules or create too many rules for the home or classroom. Pick the rules you prioritize the most, outline them clearly, and what the consequences are for breaking them.

Avoid an overly relaxed household. Structure is important because a chaotic environment contributes to a lack of self-regulation, making ODD worse. Have structured bedtimes, meal times, healthy foods, and physical activity.

Children with ODD want to engage in conflict. Speak calmly with the child and do not participate in an argument with them. Let them know about any expectations or consequences, and then end the discussion. If you are in the wrong or have broken a household or classroom rule, admit that to them and apologize.

Don’t reduce them to negative pathology. Celebrate any positive behaviors, especially prolonged positive behavior. Recognize successes and acknowledge their hard work. It’s also important to connect with the child during times of calm and to work toward establishing a stable relationship.

Support for Parents of Children With ODD

Because of the misconceptions about ODD, as well as societal assumptions of what children should be like and how they should behave, parenting a child with suspected ODD can be challenging. Talk with your pediatrician or counselor about support groups for you and your partner, or find online support groups.

Managing your own stress can also help with emotions and parenting choices. Get exercise, eat a healthy diet, get outside, and utilize relaxation techniques.

Summary

Oppositional defiant disorder is a clinical behavioral disorder characterized by a consistent pattern of challenging behaviors, frequent bursts of anger, purposefully hostile behavior, and challenging authority. The specific cause is unknown, though many social and developmental factors might influence its development.

While there is no cure, treatment is necessary for any progress to be made. This includes behavioral therapy, parent training and parenting modification, social skills training, and support. If there are coexisting disorders like depression, anxiety, or ADHD, medication for those disorders may be prescribed.

Both parents and children need support, training, and guidance in treating ODD.