Oppositional defiant disorder (ODD)

Overview

Even the best-behaved children can be difficult and challenging at times. But oppositional defiant disorder (ODD) includes a frequent and ongoing pattern of anger, irritability, arguing and defiance toward parents and other authority figures. ODD also includes being spiteful and seeking revenge, a behavior called vindictiveness.

These emotional and behavioral issues cause serious problems with family life, social activities, school and work. But as a parent, you don't have to try to manage a child with ODD alone. Your health care provider, a mental health professional and a child development expert can help.

Treatment of ODD involves learning skills to help build positive family interactions and to manage problem behaviors. Other therapy, and possibly medicines, may be needed to treat related mental health conditions.

Symptoms

Sometimes it's difficult to recognize the difference between a strong-willed or emotional child and one with oppositional defiant disorder. It's common for children to show oppositional behavior at certain stages of development.

Symptoms of ODD generally begin during preschool years. Sometimes ODD may develop later, but almost always before the early teen years. Oppositional and defiant behaviors are frequent and ongoing. They cause severe problems with relationships, social activities, school and work, for both the child and the family.

Emotional and behavioral symptoms of ODD generally last at least six months. They include angry and irritable mood, argumentative and defiant behavior, and hurtful and revengeful behavior.

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 follow adults' requests or rules.
• Often annoys or upsets people on purpose.
• Often blames others for their own mistakes or misbehavior.

Hurtful and revengeful behavior

• Says mean and hateful things when upset.
• Tries to hurt the feelings of others and seeks revenge, also called being vindictive.
• Has shown vindictive behavior at least twice in the past six months.

Severity

ODD can be mild, moderate or severe:

• 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, problem behavior also may happen in other settings, such as school, social activities and with friends.

When to see a doctor

Your child isn't likely to see their own behavior as a problem. Instead, your child will probably complain about unreasonable demands or blame others for problems.

If you think your child may have ODD or other problem behavior, or you're concerned about your ability to parent a challenging child, seek help from a child psychologist or a child psychiatrist with expertise in behavior problems. Ask your child's pediatrician or other health care provider for a referral to a mental health provider.

Causes

There's no known clear cause of oppositional defiant disorder. Causes may include a combination of genetic and environmental factors:

• Genetics. A child's natural personality or character — also called temperament — may contribute to developing ODD. Differences in the way nerves and the brain function also may play a role.
• Environment. Problems with parenting that may involve a lack of supervision, inconsistent or harsh discipline, or abuse or neglect may contribute to developing ODD.

Risk factors

Oppositional defiant disorder is a complex problem. Possible risk factors for ODD include:

• Temperament — a child who has a temperament that includes difficulty managing emotions, such as reacting with strong emotions to situations or having trouble tolerating frustration.
• Parenting issues — a child who experiences abuse or neglect, harsh or inconsistent discipline, or a lack of proper supervision.
• Other family issues — a child who lives with parent or family relationships that are unstable or has a parent with a mental health condition or substance use disorder.
• Environment — problem behaviors that are reinforced through attention from peers and inconsistent discipline from other authority figures, such as teachers.

Complications

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 and teens with ODD may struggle to make and keep friends and relationships.

ODD also may lead to other problems, such as:

• Poor school and work performance.
• Antisocial behavior.
• Legal problems.
• Impulse control problems.
• Substance use disorder.
• Suicide.

Many children and teens with ODD also have other mental health conditions, such as:

• Attention-deficit/hyperactivity disorder (ADHD).
• Conduct disorder.
• Depression.
• Anxiety disorders.
• Learning and communication disorders.

Treating these other mental health conditions may help reduce ODD symptoms. It may be difficult to treat ODD if these other conditions are not evaluated and treated appropriately.

Prevention

There's no sure way to prevent oppositional defiant disorder. But positive parenting and early treatment can help improve behavior and prevent the situation from getting worse. The earlier that ODD can be managed, the better.

Treatment can help restore your child's self-esteem and rebuild a positive relationship between you and your child. Your child's relationships with other important adults in their life — such as teachers and care providers — also will benefit from early treatment.