Reviewed by Psychology Today Staff
Oppositional defiant disorder (ODD) is a disruptive behavior disorder that emerges during childhood or adolescence and is characterized by persistent angry or irritable mood, unruly and argumentative behavior, and vindictiveness. It frequently manifests in hostility toward authority figures.
All children display defiant behavior at some point, especially when tired or stressed. Oppositional behavior is in fact normal in toddlers and in early adolescents. The behavior of a child with ODD is much more extreme and disruptive than normal, however, and occurs much more frequently than the type of childhood stubbornness and rebellion that children may display over the course of development. The oppositional behavior of ODD is not only persistent but occurs across a wide array of situations and interferes with children’s social, family, and educational life.
The condition affects about 3 percent of children and occurs more frequently in boys than girls before adolescence, but not after, according to the DSM-5. It often co-occurs with attention deficit hyperactivity disorder (ADHD), conduct disorder, and with anxiety and mood disorders.
ODD is diagnosed when, on some to most days for a period lasting at least six months, a child or teenager behaves in extremely negative, hostile, and defiant ways that disrupt their home, school, and social lives. Symptoms can appear as early as three years of age. Children with ODD usually display an angry or irritable mood. Children often lose their temper, become easily annoyed, angry and resentful, and the behavior is directed at a person or persons who are not a sibling. They engage in argumentative behavior with parents, teachers, or other authority figures; deliberately annoy others; and often blame others for their misbehavior. They are spiteful and vindictive.
Children with ODD may also have problems with their peers, although, in relatively mild cases, symptoms may be confined to only one setting, typically the home. In more severe cases, the uncooperative, vindictive, and disruptive behavior occurs in multiple settings across multiple relationships. Children with the disorder often do not see themselves as angry and defiant but consider their behavior justified by the unreasonable demands of others. The irritability that ODD children display may also be associated with anxiety.
How common is ODD?
Oppositional defiant disorder is the most frequent behavioral disorder in preschoolers. The prevalence of ODD is reported to be between 1 percent and 11 percent in community samples. Some studies report 10 percent occurrence rate in the United States and 7 percent in other countries, such as Spain.
How is ODD diagnosed?
There is no one test for ODD and because the disorder often occurs with other conditions, a definitive diagnosis can be difficult to establish. The diagnosis of ODD is made after a comprehensive psychological evaluation that probes many facets of a child’s behavior to identify patterns typical of the disorder as well as to gauge the presence or absence of related conditions such as ADHD and anxiety.
Typically, clinicians use a variety of well-validated screening tools in addition to their own experienced observations of a child’s behavior and interaction patterns. Screening tools include child behavior checklists to identify behavioral, cognitive, and emotional problems and parental questionnaires and observations of a child’s behavior. Important factors include the frequency and intensity of problem behaviors, the types of settings problem behaviors occur in, the nature of family interactions, and the co-existence of other difficulties.
ODD is a serious diagnosis and is not rendered lightly. Some experts believe that diagnosis is itself harmful in that it implies that the problem resides in the child and doesn’t tell parents more than they already know—that dealing with their child is difficult. Further, it doesn’t direct attention to why a child is behaving in a disruptive manner. “Defiant” is not merely a stigmatizing label but also carries implications of willfulness that affect parental attitudes toward a child, their willingness to focus on the problems underlying disruptive behavior, and their own receptivity to change.
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The cause of ODD is unclear but a mix of biological, social, and psychological factors appears to put children at risk. These factors can include poverty (although ODD can occur in families of any economic status), experiencing a traumatic transition, having a parent with a mood, addictive, or behavioral disorder, having a bad relationship with a parent, having a neglectful or abusive parent, or a parent who is an overly harsh disciplinarian, or other family instabilities. At least one study has reported that ODD symptoms are worse in children who struggle with peer acceptance in addition to family issues. Several studies link ODD to harsh, inconsistent, or neglectful parenting practices.
Many children with ODD have coexisting conditions, most notably mood or anxiety disorders and ADHD, but also learning disorders or language disorders. Such conditions, if present, require specific treatment in addition to treating the behavioral disorder. It is necessary to determine whether a child’s poor behavior is occurring in response to a temporary situation or, as in ADHD, is limited to situations that demand sustained effort, attention, or sitting still.
What is the main cause of ODD?
Disruptive disorders of childhood are not well understood. Children do not set out to be difficult. Childhood misbehavior is a nonspecific response to many internal and external disturbances, and defiance is even appropriate at some stages of development. No single cause of ODD has been identified, and while the condition tends to run in families, no genetic patterns have been identified. Biological, social, and childrearing factors all seem to play a role in ODD.
Some research identifies two different types of ODD that may have different roots. One, more reactive, is marked by irritability, associated with internalizing conditions such as anxiety, and fueled by poor frustration tolerance and problems of emotion regulation. The other, more proactive, is most marked by argumentativeness and vindictiveness, associated with externalizing conditions such as conduct disorder, and is linked to neurobiological makeup including low heart rate and low stress reactivity, both signs of underarousal of the autonomic nervous system.
Do parenting practices play a role in ODD?
It may be most accurate to think of ODD as a consequence of the interaction of several factors. In this view, individual characteristics such as a high emotional reactivity, low emotion regulation, or difficulties in social learning collide with environmental adversities such as dysfunctional parenting style, parental psychopathology, socioeconomic difficulties, or high levels of family conflict.
Several studies identify complex behavioral patterns in which coercive interactions between young children and their caregivers amplify children’s noncompliance. Patterns of relating within the family are thought to carry over into other settings.
How can I help a child who is diagnosed with ODD?
There’s no invariable outcome for ODD, but when tackled early, conduct problems that develop early in childhood can be mitigated. ODD is a largely treatable condition. According to the American Academy of Child and Adolescent Psychiatry, the signs and symptoms of ODD resolve within three years in approximately 67 percent of children diagnosed with the disorder.
In the absence of treatment, the disruptive behavior of ODD is linked to later behavior problems in school and adjustment difficulties in adulthood. ODD carries a risk for the development of anxiety and depression in adulthood. A small portion of children with ODD, notably those who display defiance, argumentativeness, and vindictiveness, may go on to develop frank Conduct Disorder, a more serious condition marked by aggression toward people and animals, property destruction, and deceitfulness or theft.
It is generally up to the parent to seek treatment, since the child is unlikely to understand that there is a problem. Referrals for psychological evaluation and treatment often come from a medical doctor who has performed an examination and ruled out a physical cause.
Once the diagnosis of ODD is established, a combination of therapies is generally prescribed. It typically includes behavioral and family therapies, parental training. sometimes medication. One goal of therapy is to rebuild the parent-child relationship. Another is to teach parents new techniques for dealing with the child’s behavior. The earlier treatment begins, the greater the chances of preventing ODD from developing into a more serious conduct disorder, mental health disorder, or criminal behavior.
Are there any medications for treating ODD?
There is no medication for treatment of ODD, and medication is not recommended as an approach to treating the behavioral disorder. However, medication may be warranted for treating co-existing problems such as ADHD, anxiety, and depression, and drug treatment of those disorders, such as stimulants for ADHD or antidepressants for mood disorders, can improve symptoms of ODD. The most important treatment for ODD is psychotherapy involving parents as well as children.
What treatments work best for ODD?
The first-line treatments for ODD are psychosocial, and, while they take time, they can be highly effective. Therapy is aimed at both children and their parents. Children of school age engage in individual therapy to learn and practice skills and strategies of emotion and behavior regulation and impulse control. Therapy for parents of both preschoolers and school-age children includes learning effective parental management strategies.
In addition, family therapy is often helpful in undoing the damage done by repeated negative interactions and in supporting the establishment of new, more rewarding behavioral dynamics. Peer group therapy may be needed to address deficits in social skills. Teachers may be enlisted in some therapeutic settings.
A form of Cognitive and Behavioral Therapy (CBT) has been specifically developed for treating children with disruptive behavior. Called Collaborative and Proactive Solutions (CPS), it helps both parents and teachers engage with children in nonpunitive ways to identify and solve the problems that give rise to difficult behavior.
American Psychiatric Association. Understanding Mental Disorders: Your Guide to DSM-5. 2015. American Psychiatric Publishing.
ODD A Guide for Families by the American Academy of Child and Adolescent Psychiatry (AACP). 2009 AACAP Practice Parameter for the Assessment and Treatment of Children and Adolescents with Oppositional Defiant Disorder.
Tung I and Lee SS. Negative parenting behavior and childhood oppositional defiant disorder: Differential moderation by positive and negative peer regard. Aggressive Behavior. January 2014;40(1):79-90. First published online 5 August 2013.
Greene RW, Biederman J, Zerwas S, et al. Psychiatric comorbidity, family dysfunction, and social impairment in referred youth with oppositional defiant disorder. The American Journal of Psychiatry. July 2002;159(7):1214-1224.
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Last updated: 01/17/2022
Are kids with ODD remorseful? ›
Children with ODD may refuse to follow commands or requests made by parents, teachers or other adults. They may also overreact to life events. They frequently fail to take responsibility for their actions, and at times show little remorse.Do you ever grow out of ODD? ›
ODD most commonly affects children and teenagers, but it can also affect adults. It most commonly begins by age 8. Some children outgrow ODD or receive proper treatment for it, while others continue to have symptoms through adulthood.At what age does ODD go away? ›
Symptoms of ODD can appear as early as 2 or 3 years old. However, it's more likely they'll show up between ages 6 and 8. If ODD is not addressed and treated in childhood, the child may develop long-term, chronic problems. These issues can last through their teenage years and into adulthood.Can ODD be misdiagnosed? ›
A lot of kids with behavior problems are diagnosed with oppositional defiant disorder (ODD). But sometimes kids who seem to have ODD are actually struggling with anxiety, OCD or a learning disorder.What kind of trauma causes ODD? ›
Factors such as a chaotic home life, inconsistent discipline by parents, and being exposed to abuse, neglect, or trauma at an early age can all lead to the onset of ODD symptoms. Risk Factors: Family history of mental illness. Witnessing violent or aggressive behaviors.What triggers ODD in a child? ›
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.
One of the most important things to know about ODD is that it's not the parent's fault. There are many reasons a child may have ODD. Trauma, such as divorce and death, is a common cause, and it was the reason for my daughter's ODD.How do you discipline ODD? ›
- Treat before you punish. ...
- Exercise away hostility. ...
- Know your child's patterns. ...
- Be clear about rules and consequences. ...
- Stay cool-headed and under control. ...
- Use a code word like 'bubble gum. ...
- Stay positive. ...
- Call in the professionals.
- 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.
The condition may persist for a lifetime just as often as it spontaneously disappears. In about 40 percent of cases, adults with ODD become progressively worse and end up developing antisocial personality disorder.
Can a child with ODD behave at school? ›
ODD may occur only in certain settings.
More recently, medical professionals have recongized that certain children with ODD may behave well at school, and only show symptoms at home. In addition, a child may be oppositional with only one parent, though this occurs less frequently.
Some children with ODD outgrow the condition by age eight or nine. But about half of them continue to experience symptoms of ODD through adulthood. People with ODD report feeling angry all of the time, and about 40 percent of them become progressively worse and develop antisocial personality disorder.What is a similar diagnosis to ODD? ›
Disruptive behavior disorders include two similar disorders: oppositional defiant disorder (ODD) and conduct disorder (CD). Common symptoms occurring in children with these disorders include: defiance of authority figures, angry outbursts, and other antisocial behaviors such as lying and stealing.Is ODD genetic or learned? ›
Genetic: It has been shown that ODD is likely a hereditary condition and that if an individual has a close relative with this mental illness, they have a predisposition to the development of oppositional defiant disorder.What is the main cause of ODD? ›
Genetic and biological factors
Children with a family history of depression or ADHD also have a higher chance of developing ODD. Some brain imaging research from 2016 also points to differences in some parts of the brain. These parts help regulate impulse control, problem solving, social behavior, and empathy.
Empathy problems have been associated with oppositional defiant disorder (ODD) and conduct disorder (CD) . Children with ODD/CD constitute a heterogeneous group, however, and research suggests that there are individual differences in the mechanisms underlying empathy deficits in children with ODD/CD [1, 2].What medication helps with ODD? ›
No medications are FDA-approved for the treatment of ODD in the U.S. Nonetheless, clinical experience has shown that the majority of children and adolescents with ODD do show signs of improvement with a low dose of atypical neuroleptics – arippirazole (Abilify) and risperidone (Risperidal), for example.What is an ODD meltdown? ›
ODD is a pattern of disobedient, hostile, and defiant behaviour directed towards authority figures. Children with ODD rebel, are stubborn, argue with adults, and refuse to obey. They have anger outbursts and a hard time controlling their temper.What behaviors do students with ODD have? ›
Students with ODD can be so uncooperative and combative that their behavior affects their ability to learn and get along with classmates and teachers. It can lead to poor school performance, anti-social behaviors, and poor impulse control. ODD is more common in boys than girls.Can a child be medicated for ODD? ›
Studies have not found medication to be an effective treatment for ODD. However, if your child has been diagnosed with ODD and ADHD, then your doctor or psychiatrist might prescribe stimulant medication to help manage this unique combination of difficulties.
Do kids with ODD hurt others? ›
Children with ODD are uncooperative, defiant, and hostile toward peers, parents, teachers, and other authority figures. They are more troubling to others than they are to themselves.Does ODD become antisocial? ›
ODD and CD are diagnosed more often in boys than in girls. If not managed promptly, ODD can progress to CD, which can then transition to antisocial personality disorder.Does ODD affect the brain? ›
Research shows that children with ODD have trouble controlling impulses and emotional behavior. Scientists believe that these children may have underdeveloped prefrontal cortexes—or, the part of the brain that is in charge of executive functioning and managing impulsive behavior.What helps kids with ODD? ›
- Parenting skills training. ...
- Parent-child interaction therapy (PCIT). ...
- Individual and family therapy. ...
- Problem-solving training. ...
- Social skills training.
Use a calm voice when dealing with ODD in kids.
Explain in as few words as possible your position or parental requirement then do not continue to discuss the issue. It is difficult for kids to argue when they have no one to argue with them!
- Always build on the positives, give the child praise and positive reinforcement when he shows flexibility or cooperation. ...
- Learn to control yourself. ...
- Pick your battles. ...
- Set up reasonable, age-appropriate limits with consequences that can be enforced consistently. ...
- Don't go it alone.
The typology consists of three types: Stimulus Dependent ODD, Cognitive Overload ODD and Fearful ODD.What does ODD look like in the classroom? ›
These students can appear defiant, disobedient, angry and irritable. They might argue with parents, teachers and other students. They may find it hard to follow teachers' instructions. They may lose their temper if they feel like something isn't going their way.Is ODD linked with ADHD? ›
Attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) are often closely linked, with many people experiencing both disorders at the same time. Doctors usually diagnose these disorders in children. According to a 2017 study, more than half of people with ADHD also have ODD.How rare is ODD? ›
ODD is a fairly common problem faced by children and teens. At any given point in time, about 1% to 16% of children and teens are struggling with this behavior problem. Boys are much more likely to have ODD than girls.
Does ODD run in families? ›
It may result from a combination of factors. The child's general attitude and how the family reacts to his or her behavior may play a role in it. ODD may run in families. Other causes may be related to the nervous system or to brain chemicals that are out of balance.Is ODD considered intellectual disability? ›
Oppositional defiant disorder (ODD) is one of the most frequently diagnosed disorders in children with intellectual disabilities (ID).What is the prognosis for ODD? ›
Children with ODD often do well with early treatment. In fact, the earlier the condition is managed, the better the prognosis. Many children are free of the behavioral patterns within three years of treatment.What is ODD called now? ›
Oppositional defiant disorder (ODD) is listed in the DSM-5 under Disruptive, impulse-control, and conduct disorders and defined as "a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness".Can ODD start suddenly? ›
Childhood-onset ODD: Present from an early age, and requires early intervention and treatment to prevent it from progressing into a more serious conduct disorder. Adolescent-onset ODD: Begins suddenly in the middle- and high-school years, causing conflict at home and in school.How does ODD affect emotional development? ›
Children suffering from ODD and CD are at risk for numerous negative outcomes, such as delinquency, unemployment, depression, anxiety and other psychiatric problems . Identifying risk factors for antisocial and aggressive behavior that can be targets for potential change is therefore important.How does a child with ODD act? ›
About oppositional defiant disorder
Children with ODD are prone to persistent angry outbursts, arguments and disobedience and usually direct their behavior at authority figures, like parents and teachers. They may also target their behavior at siblings, classmates and other children.
Therapy can help children and adults with ODD better manage their emotions and control their behavior. This can improve their relationships, help them succeed at school, and decrease the likelihood they will have serious mental health issues in adulthood.What is the long term effects of ODD? ›
Children who do not receive treatment for their symptoms of ODD may end up suffering from long-term effects that follow them into adulthood. Some examples of these effects may include: Social isolation. Difficulty or an inability to develop and maintain meaningful relationships.What can ODD turn into? ›
If not managed promptly, ODD can progress to CD, which could then transition to antisocial personality disorder. Disruptive behavior disorders are psychiatric conditions that are characterized by significant impairments in behavior.