Oppositional Defiant Disorder
It's not unusual for children -- especially those in their "terrible twos"
and early teens -- to defy authority every now and then. They may express their
defiance by arguing, disobeying, or talking back to their parents, teachers, or
other adults. When this behavior lasts longer than six months and is excessive
compared to what is usual for the child's age, it may mean that the child has a
type of behavior disorder called oppositional defiant disorder (ODD).
ODD is a condition in which a child displays an ongoing pattern of
uncooperative, defiant, hostile, and annoying behavior toward people in
authority. The child's behavior often disrupts the child's normal daily
activities, including activities within the family and at school.
Many children and teens with ODD also have other behavioral problems, such
attention-deficit/hyperactivity disorder, learning disabilities, mood
disorders (such as depression), and
anxiety disorders. Some children with ODD go on to develop a more serious
behavior disorder called
What Are the Symptoms of Oppositional Defiant Disorder?
Symptoms of ODD may include:
- Throwing repeated temper tantrums
- Excessively arguing with adults
- Actively refusing to comply with requests and rules
- Deliberately trying to annoy or upset others, or being easily annoyed by
- Blaming others for your mistakes
- Having frequent outbursts of anger and resentment
- Being spiteful and seeking revenge
- Swearing or using obscene language
- Saying mean and hateful things when upset
In addition, many children with ODD are moody, easily frustrated, and have a
low self-esteem. They also may abuse drugs and alcohol.
What Causes Oppositional Defiant Disorder?
The exact cause of ODD is not known, but it is believed that a combination
of biological, genetic, and environmental factors may contribute to the
Biological: Some studies suggest that defects in or
injuries to certain areas of the brain can lead to serious behavioral problems
in children. In addition, ODD has been linked to abnormal amounts of special
chemicals in the brain called neurotransmitters. Neurotransmitters help nerve
cells in the brain communicate with each other. If these chemicals are out of
balance or not working properly, messages may not make it through the brain
correctly, leading to symptoms of ODD, and other mental illnesses. Further,
many children and teens with ODD also have other mental illnesses, such as ADHD, learning disorders,
depression, or an anxiety disorder, which may contribute to their behavior
Genetics: Many children and teens with ODD have close
family members with mental illnesses, including mood disorders, anxiety
disorders, and personality disorders. This suggests that a vulnerability to
develop ODD may be inherited.
Environmental: Factors such as a dysfunctional family
life, a family history of mental illnesses and/or substance abuse, and inconsistent discipline by parents
may contribute to the development of behavior disorders.
How Common Is Oppositional Defiant Disorder?
Estimates suggest that 2%-16% of children and teens have ODD. In younger
children, ODD is more common in boys. In older children, it occurs about
equally in boys and in girls. It typically begins by age 8.
How Is Oppositional Defiant Disorder Diagnosed?
As with adults, mental illnesses in children are diagnosed based on signs
and symptoms that suggest a particular illness like ODD. If symptoms are
present, the doctor will begin an evaluation by performing a complete medical
history and physical exam. Although there are no lab tests to specifically
diagnose ODD, the doctor may use various tests -- such as X-rays and blood
tests -- to rule out physical illness or medication side effects as the cause
of the symptoms. The doctor also will look for signs of other conditions that
often occur along with ODD, such as ADHD and depression.
If the doctor cannot find a physical cause for the symptoms, he or she may
refer the child to a child and adolescent psychiatrist or psychologist, mental
health professionals who are specially trained to diagnose and treat mental
illnesses in children and teens. Psychiatrists and psychologists use specially
designed interview and assessment tools to evaluate a child for a mental
illness. The doctor bases his or her diagnosis on reports of the child's
symptoms and his or her observation of the child's attitude and behavior. The
doctor often must rely on reports from the child's parents, teachers, and other
adults because children often have trouble explaining their problems or
understanding their symptoms.
How Is Oppositional Defiant Disorder Treated?
Treatment for ODD is determined based on many factors, including the child's
age, the severity of symptoms, and the child's ability to participate in and
tolerate specific therapies. Treatment usually consists of a combination of the
: Psychotherapy (a type of counseling) is aimed at
helping the child develop more effective ways to express and control anger. A
type of therapy called cognitive-behavioral therapy aims to reshape the child's
thinking (cognition) to improve behavior. Family therapy may be used to help
improve family interactions and communication among family members. A
specialized therapy technique called parent management training (PMT) teaches
parents ways to positively alter their child's behavior.
: While there is no medication formally approved to treat
ODD, various drugs may be used to treat some of its distressing symptoms, as
well as any other mental illnesses that may be present, such as ADHD or
What Is the Outlook for Children With Oppositional Defiant Disorder?
If your child is showing signs of ODD, it is very important that you seek
care from a qualified doctor immediately. Without treatment, children with ODD
may experience rejection by classmates and other peers because of their poor
social skills and aggressive and annoying behavior. In addition, a child with
ODD has a greater chance of developing a more serious behavioral disorder
called conduct disorder. When started early, treatment is usually very
Can Oppositional Defiant Disorder Be Prevented?
Although it may not be possible to prevent ODD, recognizing and acting on
symptoms when they first appear can minimize distress to the child and family,
and prevent many of the problems associated with the illness. Family members
also can learn steps to take if signs of relapse (return of symptoms) appear.
In addition, providing a nurturing, supportive, and consistent home environment
with a balance of love and discipline may help reduce symptoms and prevent
episodes of defiant behavior.