Oppositional Defiant Disorder (ODD)

What is oppositional defiant disorder?

Oppositional defiant disorder (ODD) is a condition most commonly experienced during childhood and adolescence which causes highly disruptive, defiant and argumentative behavior and inexplicable irritable and angry moods.

Although there is no definitive cure, it can be managed with the help of psychotherapy and with consistent parenting methods until, in most cases, the child grows out of it as they reach adulthood.

Overview of oppositional defiant disorder (ODD)

Children and teenagers with oppositional defiant disorder (ODD) experience highly irritable or angry moods and display argumentative or defiant behavior towards people in authority. Their behavior and mood is so extreme that it can affect day to day activities, both at school and with their families.

It is not completely clear just how many children and young people in the US are affected by ODD, but experts estimate that anywhere between 1 and 16% of school-age children suffer from the disorder. It tends to be more common among boys than girls, and although most children begin to show symptoms between the ages of 6 and 8, some may go undiagnosed until their teenage years.

What is most interesting about ODD is that it is often more distressing for the people around the diagnosed individual than for the person with ODD themselves. Although they may feel angry and irritable more often than is normal, the consequent behavior they exhibit tends to cause greater trouble for those they defy and act out against. For this reason, it is often parents, teachers or authority figures who notice that a child’s behavior is abnormal and is eager to seek diagnosis and treatment for them.

That doesn’t mean to say that children with ODD do not suffer from the disorder. If left untreated, it can cause severe disruption to their education and put pressure on their relationships with parents, guardians, siblings and peers. They may struggle to develop successful social and interpersonal skills which could impact them throughout their childhood and adolescence.

Although ODD is most commonly diagnosed in children and adolescents, it can affect adults, too. Many children are able to outgrow the condition, but in some cases it lingers into adulthood, at which point sufferers report that they feel angry all the time. Sometimes ODD can develop into antisocial personality disorder in adults, a condition which is also often known as ‘sociopathy’ and causes individuals to show consistent disregard for right, wrong and the feelings of others.

Oppositional defiant disorder symptoms

All children and teens can disobey or defy authority and argue with parents from time to time, but often this behavior occurs, particularly in very young children, when they are tired, upset or hungry. In children with oppositional defiant disorder (ODD), the defiant behavior occurs much more frequently and seemingly without due cause.

Typical symptoms of ODD include:

  • Regular temper tantrums
  • Frequent and excessive arguments with adults
  • Refusal to follow rules or requests of adults
  • Persistent questioning or bending of rules
  • Behaving in a way which purposefully annoys or upsets others
  • Blaming mistakes or poor behavior on others
  • Becoming easily irritated or annoyed by others
  • Persistent angry attitude
  • Speaking unkindly or harshly to or about others
  • Vindictive behavior

Adults who suffer from ODD may experience slightly different symptoms to children and adolescents. While they may have more control over their behavior in terms of causing arguments or actively breaking rules, they will still struggle with authority and feel generally angry at the world.

Adult ODD symptoms may include:

  • Feel disliked or misunderstood by others
  • Have a strong dislike for supervisors or managers at work
  • Struggle to accept feedback from others
  • Vehemently defend themselves when they feel criticized
  • Frequently blame others for their mistakes
  • Deem themselves a rebel

In adults, ODD is often very difficult to diagnose since many symptoms overlap with various other mental disorders, such as antisocial behavior disorder, and can also occur as a result of substance abuse.

According to the DSM (Diagnostic and Statistical Manual of Mental Disorders), a child, teenager or adult must have exhibited repeated patterns of multiple symptoms over a period of six months or more in order for ODD to be diagnosed. Sometimes children or teenagers may exhibit some symptoms of ODD as a result of stressful or emotional life events, which is why the symptoms must persist for a significant amount of time to demonstrate that the issues are chronic and not simply in response to environmental factors.

There is more criteria within the DSM that must be fulfilled for a diagnosis of ODD to take place. Firstly, there must be a clear behavioral pattern in their symptoms. They must exhibit key symptoms of a persistent angry or irritable mood, of argumentative or defiant behavior, or of vindictiveness, which in this case means acting in a spiteful way on at least two occasions within a six-month period. This behavior must have been displayed to someone other than the individual’s sibling.

Secondly, the symptoms exhibited must have caused a significant disruption to the individual’s life. It could be their social life, education or occupation which has been negatively impacted, or a combination of all three.

Thirdly, the symptoms must not be linked to other mental health disorders or substance abuse. Certain conditions such as schizophrenia, bipolar disorder and depression can cause behaviors which might appear to be ODD, and if one of these disorders appears to be present in an individual, it is likely that the disorder is to blame rather than ODD.

The DSM also categorizes ODD into three scales of severity; mild, severe and moderate. In mild cases, symptoms of the disorder are limited to just one particular setting, for example at school or at work. Moderate cases are diagnosed when symptoms are present in at least two settings. In severe cases, the symptoms occur in three or more settings.

Oppositional defiant disorder causes

It is not fully understood why oppositional defiant disorder (ODD) occurs, but research has lead experts to believe that there is a combination of biological, genetic and environmental factors at play.

Some studies into behavioral disorders in children have linked them to defects or injuries in key parts of the brain. With ODD, it is thought that abnormal function of neurotransmitters – chemicals which help brain cells to communicate – could be the cause of the disorder. It is also known that many children and adolescents with ODD also have other mental health disorders, such as depression, anxiety disorder and ADHD, which reinforces the evidence that biology plays a big part in the cause of ODD.

It’s not uncommon for children with ODD to have a family history of mental illness. They may have close family members with mood, personality and anxiety disorders. This suggests that genetics may be a contributing factor and those with a family history of mental illness could be at higher risk of developing ODD.

However, it is also understood that environment could contribute to ODD. Many children with ODD have a dysfunctional family life, and in instances where this occurs as a result of mental illness suffered by parents, it is not clear whether it is inherited vulnerability to mental disorder which could cause ODD, or the unstable environment in which the child has grown up.

There is a theory that suggests that the negative symptoms of ODD are learned rather than inherent in children with ODD. For example, a child might adopt a vindictive attitude from one of their parents. It is also believed by some that negative reinforcement methods used by parents or authority figures could result in children learning ODD behaviors. They realize that when they exhibit these behaviors, they receive attention from their parent or the authority figure they are dealing with at the time.

Another theory suggests that ODD is a developmental issue. Many of the behaviors of ODD are experienced naturally between the ages of 1 and 3, when a child is toddling. If a child still exhibits these when they get older, it might be that they are dealing with developmental issues which could have been caused by them struggling to become independent from the main person they were emotionally attached to as a toddler, which is usually a parent.

Oppositional defiant disorder treatment

Oppositional defiant disorder (ODD) is typically treated with therapy rather than medication. There is no evidence to suggest that medications can be effective in treating ODD, but for individuals who have concurrent disorders such as ADD or anxiety disorder, pharmacological treatment for these disorders may also help to alleviate ODD symptoms.

Psychotherapy is often used to help individuals to better manage the symptoms of ODD. Cognitive behavioral therapy in particular can help them to work through their negative feelings, better manage their anger and improve their communication skills. This may not completely cure the ODD, but it can help sufferers to become less impulsive and disruptive so that they can enjoy better relationships.

Family therapy can also be helpful for both children with ODD and their siblings and parents. It can give parents the support they need to adapt their parenting methods to a child with ODD, and give siblings an opportunity to air their grievances and communicate more openly with the child who has ODD.

Finally, peer group therapy may be recommended to help children with ODD to develop their social and interpersonal skills. Group support could help them to connect with others with ODD, which might help them to feel less alone and give them an opportunity to give and receive advice from others going through the same as them. Plus, it’s also a brilliant way to learn appropriate ways to communicate with others and practice anger management and impulse control skills in an understanding, supportive environment.

Oppositional defiant disorder prevention

Since some experts believe that oppositional defiant disorder (ODD) is caused by developmental and environmental factors, it may be possible to prevent the condition, or at least to reduce the severity of it, with some key parenting techniques.

ODD parenting techniques include:

Positive reinforcements

Using positive reinforcements instead of negative reinforcements. Positive reinforcements occur when a motivating or reinforcing stimulus is presented when behavior is shown, such as a parent praising a child for completing their homework. Negative reinforcement occurs when an aversive stimulus is removed when a behavior is shown, such as a parent berating their child until they complete their homework.

Being consistent in providing punishments for bad behavior

If a child is demonstrating poor behavior in an attempt to get attention, consistent punishments can demonstrate to them that it is only negative attention they receive.

Consistently demonstrating positive interactions in the household

Some ODD symptoms might be learned behaviors, so parents should make a concerted effort to communicate positively with others in order to set an example of successful interactions

Reducing environmental triggers

If ODD symptoms seem to get worse in response to certain environmental factors, parents can try to reduce them as much as possible. For example, if lack of sleep worsens their behavior, adopting a consistent bedtime and morning routine might be helpful.