Oppositional defiant disorder (ODD) is a behavior disorder, usually diagnosed in childhood, that is characterized by uncooperative, defiant, negativistic and irritable behaviors toward parents, peers, teachers and other authority figures. Children and adolescents with ODD are more distressing or troubling to others than they are distressed or troubled themselves.

Whose Is Affected?

Behavior disorders, as a category, are, by far, the most common reason for referrals to mental health services for children and adolescents. Oppositional defiant disorder is reported to affect between 2-16% of children and adolescents in the general population. ODD is more common in boys than in girls.

There are two main theories as to what causes Oppositional Defiant Disorder (ODD):

• Developmental theory: This theory says that ODD can start when children are very young, like toddlers. It suggests that kids with ODD might have had a hard time learning to be independent from their parents or caregivers. The "bad attitudes" you see in ODD are thought to be a leftover from normal toddler problems that never really went away.
• Learning theory: This theory suggests that kids with ODD learn their negative behaviors from the adults around them. For example, if a child acts out and gets more attention from their parents — even if it's negative attention — they might learn to keep acting that way to get what they want. It’s like they’ve learned that being defiant is a good way to get their parents' attention.

Most symptoms seen in children and adolescents with oppositional defiant disorder also occur at times in children without this disorder, especially around the ages or 2 or 3 or during the teenage years. Many children, especially when they are tired, hungry or upset tend to disobey, argue with parents or defy authority. However, in children and adolescents with oppositional defiant disorder, these symptoms occur more frequently and interfere with learning, school adjustment and, sometimes, with the child's relationships with others.

Symptoms of oppositional defiant disorder may include:

• Frequent temper tantrums
• Excessive arguments with adults
• Refusal to comply with adult requests
• Always questioning rules or refusal to follow rules
• Behavior intended to annoy or upset others, including adults
• Blaming others for misbehaviors or mistakes
• Easily annoyed by others
• Frequently has an angry attitude
• Speaking harshly or unkindly
• Seeking revenge

The symptoms of ODD may resemble other medical conditions or behavior problems. Always consult your child's physician for a diagnosis.

Parents, teachers, and other authority figures in child and adolescent settings often identify the child or adolescent with ODD. However, a child psychiatrist or a qualified mental health professional usually diagnoses ODD in children and adolescents. A detailed history of the child's behavior from parents and teachers, clinical observations of the child's behavior, and, sometimes, psychological testing contribute to the diagnosis. Parents who note symptoms of ODD in their child or teen can help by seeking an evaluation and treatment early. Early treatment can often prevent future problems.

Further, oppositional defiant disorder often coexists with other mental health disorders, including mood disorders, anxiety disorders, conduct disorder and attention-deficit/hyperactivity disorder, increasing the need for early diagnosis and treatment. Consult your child's physician for more information.

Specific treatment for children with oppositional defiant disorder will be determined by your child's physician based on:

• Your child's age, overall health and medical history.
• Extent of your child's symptoms.
• Your child's tolerance for specific medications or therapies.
• Expectations for the course of the condition.
• Your opinion or preference.

Types of Treatment

• Individual psychotherapy: Individual psychotherapy for ODD often uses cognitive-behavioral approaches to improve problem solving skills, communication skills, impulse control and anger management skills.
• Family therapy: Family therapy is often focused on making changes within the family system, such as improving communication skills and family interactions. Parenting children with ODD can be very difficult and trying for parents. Parents need support and understanding as well as help in developing more effective parenting approaches.
• Peer group therapy: Peer group therapy is often focused on developing social skills and interpersonal skills.
• Medication: While not considered effective in treating ODD, medication may be used if other symptoms or disorders are present and responsive to medication.

Prevention

Some experts believe a child can develop ODD through a series of events. It might start with parents who struggle to raise their children effectively, which then leads to the child having problems with other adults and friends. As these negative experiences continue, the child's defiant behaviors become a habit.

How To Help

Catching these problems early is very important. By teaching the child and their parents better communication, anger management and problem-solving skills, it can stop the bad behaviors from getting worse. The goal is to help the child grow up healthy and improve their life.