What is oppositional defiant disorder (ODD) in children?

Oppositional defiant disorder (ODD) is a type of behavior disorder. It's mostly diagnosed in childhood. Children with ODD show a pattern of uncooperative, defiant, and hostile behavior toward peers, parents, teachers, and other authority figures. They are more troubling to others than they are to themselves.

What causes ODD in a child?

Experts don’t know what causes ODD. But there are 2 main theories for why it occurs:

• Developmental theory. This theory suggests that the problems start when children are toddlers. Children and teens with ODD may have had trouble learning to become independent from a parent or other main person to whom they were emotionally attached. Their behavior may be normal developmental issues that are lasting beyond the toddler years.

• Learning theory. This theory suggests that the negative symptoms of ODD are learned attitudes. They mirror the effects of negative reinforcement methods used by parents and others in power. The use of negative reinforcement increases the child’s ODD behaviors. That’s because these behaviors allow the child to get what they want: attention and reaction from parents or others.

Which children are at risk for ODD?

ODD is more common in boys than in girls. Children with these mental health problems are also more likely to have ODD:

• Mood or anxiety disorders

• Conduct disorder

• Attention-deficit/hyperactivity disorder (ADHD)

What are the symptoms of ODD in a child?

Most symptoms seen in children and teens with ODD also happen at times in other children without it. This is very true for children around ages 2 or 3, or during the teen years. Many children tend to disobey, argue with parents, or defy authority. They may often behave this way when they are tired, hungry, or upset. But in children and teens with ODD, these symptoms happen more often and are more severe. They also interfere with learning and school adjustment. And in some cases, they disrupt the child’s relationships with others.

Symptoms of ODD may include:

• Having frequent temper tantrums

• Arguing a lot with adults

• Refusing to do what an adult asks

• Always questioning rules and refusing to follow rules

• Doing things to annoy or upset others, including adults

• Blaming others for the child’s own misbehaviors or mistakes

• Being easily annoyed by others

• Often having an angry attitude

• Speaking harshly or unkindly

• Seeking revenge or being vindictive

ODD can be mild, moderate, or severe:

• Mild ODD. The symptoms occur only in 1 setting (home or school).

• Moderate ODD. The symptoms are seen in at least 2 settings (home and school).

• Severe ODD. The symptoms occur in 3 or more settings (for instance at home or school, with peers, or in public).

Many of these symptoms can be caused by other mental health problems. Make sure your child sees a healthcare provider for a diagnosis.

How is ODD diagnosed in a child?

If you see symptoms of ODD in your child or teen, get a diagnosis right away. Early treatment can often prevent future problems.

Before a mental health referral is made, your child's healthcare provider will want to rule out any other health problems. Once this is done, a child psychiatrist or qualified mental health expert can diagnose ODD. They will talk with you and your child's teachers about your child’s behavior. They may also watch your child. In some cases, your child may need mental health testing.

For a child to be diagnosed with ODD, symptoms must be present for at least 6 months. A certain number of symptoms must also be present and observed during interactions with at least 1 person who is not a sibling. The criteria used for children younger than age 5 is slightly different. Providers will also figure out if your child's behavior is outside a range of normal behaviors expected for their developmental level, culture, and gender.

Extreme defiance can also occur because of certain situations. And it can be a sign of an undiagnosed learning disability. So it's important that all possibilities are looked at closely before making a diagnosis.

How is ODD treated in a child?

Early treatment can often prevent future problems. Treatment will depend on your child’s symptoms, age, and health. It will also depend on how bad the ODD is.

Children with ODD may need to try different therapists and types of therapies before they find what works for them. Coordination between healthcare providers, family, and school is key to treatment success. Treatment may include:

• Cognitive-behavioral therapy. A child learns to better solve problems and communicate. They also learn how to control impulses and anger.

• Family therapy. This therapy helps make changes in the family. It improves communication skills and family interactions. Having a child with ODD can be very hard for parents. It can also cause problems for siblings. Parents and siblings need support and understanding.

• Peer group therapy. A child learns better social skills.

• Medicines. These are not often used to treat ODD. But a child may need them for other symptoms or disorders, such as ADHD or anxiety disorders.

How can I help prevent ODD in my child?

Experts don’t know what causes ODD. But certain approaches can help prevent the disorder. Young children may be helped by early intervention programs. These can teach them social skills and how to deal with anger. For teens, having talk therapy (psychotherapy), learning social skills, and getting help with schoolwork can all help reduce problem behaviors. School-based programs can also help to stop bullying and improve relationships among teens.

Parent-management training programs are also important. These programs teach parents how to manage their child’s behavior. Parents learn positive reinforcement methods and also how to discipline their child.

How can I help my child live with ODD?

Early treatment for your child can often prevent future problems. Here are things you can do to help:

• Keep all appointments with your child’s healthcare provider and educational team.

• Take part in family therapy as needed.

• Talk with your child’s healthcare provider about other providers who could be included in your child’s care. Your child may get care from a team that may include counselors, therapists, social workers, psychologists, school psychologists, school counselors, and psychiatrists. Your child’s care team will depend on what your child needs and how serious the disorder is.

• Tell others who need to know about your child’s conduct disorder. Work with your child’s healthcare provider and school to create a treatment plan.

• If ODD greatly interferes with your child’s ability to succeed in school, they may be eligible for certain protections and reasonable accommodations under the Americans with Disabilities Act or Section 504 of the Civil Rights Act. Talk with your child’s teacher and school principal about how to get more information.

• Reach out for support. Being in touch with other parents who have a child with ODD may be helpful. If you or other family members feel overwhelmed or stressed out, talk with your child’s healthcare provider. They may direct you to a support group for caregivers and families of children with ODD.

When should I call my child’s healthcare provider?

Call your child’s healthcare provider right away if your child:

• Feels extreme depression, fear, anxiety, or anger

• Expresses thoughts of self-harm or harming others

• Feels out of control

• Hears voices that others don’t hear

• Sees things that others don’t see

• Can’t sleep or eat for 3 days in a row

• Shows behavior that concerns friends, family, or teachers, and others express concern about this behavior and ask you to seek help

Key points about ODD in children

• Oppositional defiant disorder (ODD) is a type of behavior disorder. Children with ODD are uncooperative, defiant, and hostile toward peers, parents, teachers, and other authority figures.

• Developmental problems may cause ODD. Or the behaviors may be learned.

• A child with ODD may argue a lot with adults or refuse to do what they ask. They may also be unkind to others.

• A mental health expert often diagnoses ODD.

• Therapy that helps the child get along better with others is the main treatment. Medicines may be needed for other problems, such as ADHD.

• Family therapy and community and school support resources can also be helpful to both parents and siblings.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.

• Before your visit, write down questions you want answered.

• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.

• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.

• Ask if your child’s condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if your child does not take the medicine or have the test or procedure.

• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your child’s healthcare provider after office hours. This is important if your child becomes ill and you have questions or need advice.