Oppositional Defiant Disorder (ODD): Symptoms & Treatment (2023)


Oppositional Defiant Disorder (ODD): Symptoms & Treatment (1)

What is oppositional defiant disorder (ODD)?

Oppositional defiant disorder (ODD) is a behavior condition in which your child displays a continuing pattern of uncooperative, defiant and sometimes hostile behavior toward people in authority. This behavior often disrupts your child’s normal daily functioning, including relationships and activities within their family and at school.

It’s common for children — especially those two to three years old and in their early teens — to be oppositional or defiant of authority once in a while. They might express their defiance by arguing, disobeying or talking back to adults, including their parents or teachers. When this behavior lasts longer than six months and goes beyond what’s usual for your child’s age, it might suggest that they have ODD.

The majority of children and teens who have ODD also have at least one other mental health condition, including:

  • Attention-deficit hyperactivity/disorder (ADHD).
  • Anxiety disorders, including obsessive-compulsive disorder (OCD).
  • Learning differences.
  • Mood disorders, such as depression.
  • Impulse control disorders.

About 30% of children with ODD develop a more serious behavior condition called conduct disorder. ODD behaviors can continue into adulthood if ODD isn’t properly diagnosed and treated.

What is conduct disorder?

Conduct disorder (CD) is a condition in which your child or adolescent shows an ongoing pattern of aggression toward others. They also show serious violations of rules and social norms at home, in school and with peers.

These rule violations may involve breaking the law. Children with CD are more likely to get injured and may have difficulties getting along with peers.

Signs of conduct disorder include:

  • Frequently breaking serious rules, such as running away from home, staying out at night when told not to or skipping school.
  • Being aggressive in a way that causes harm, such as bullying, fighting or being cruel to animals.
  • Lying, stealing or damaging other people’s property on purpose.

What’s the difference between ODD and ADHD?

Approximately 40% of children with attention-deficit/hyperactivity disorder (ADHD) also have oppositional defiant disorder or a related conduct disorder. While these two conditions commonly occur together, they’re distinct conditions.

ODD is related to a child’s conduct and how they interact with their parents, siblings, teachers and friends. ADHD is a neurodevelopmental disorder that causes a person to be easily distracted, disorganized and excessively restless.

Who does oppositional defiant disorder affect?

ODD most commonly affects children and teenagers, but it can also affect adults. It most commonly begins by age 8.

(Video) What Is Oppositional Defiant Disorder?

Some children outgrow ODD or receive proper treatment for it, while others continue to have symptoms through adulthood.

Children assigned male at birth (AMAB) are more likely to have ODD in their younger years than children assigned female at birth (AFAB). But teenagers who were AMAB and AFAB are affected equally.

Your child is more likely to develop ODD if they have the following risk factors:

  • A history of child abuse or neglect.
  • A parent or caregiver who has a mood disorder or who has substance or alcohol use disorders.
  • Exposure to violence.
  • Inconsistent discipline and lack of adult supervision.
  • Instability in their family, such as divorce, moving to different houses often and changing schools frequently.
  • Financial problems in their family.
  • Parents who have or have had ODD, attention-deficit/hyperactivity disorder (ADHD) or behavioral problems.

How common is oppositional defiant disorder?

Researchers estimate that oppositional defiant disorder affects 2% to 11% of children. This range is so wide because some children may be misdiagnosed as having conduct disorder, and teenagers, as a population, are often underdiagnosed.

The prevalence of ODD declines with increasing age.

Symptoms and Causes

What are the signs and symptoms of oppositional defiant disorder (ODD)?

Signs and symptoms of oppositional defiant disorder usually begin by age 8. Symptoms usually remain stable between the ages of 5 and 10 and typically, but not always, decline afterward.

The symptoms are often apparent in multiple settings but may be more noticeable at home or school.

Signs and symptoms of ODD can be grouped into three categories:

  • Anger and irritability.
  • Argumentative and defiant behavior.
  • Vindictiveness.

In addition, many children with ODD are moody, easily frustrated and have low self-esteem. They also might misuse drugs and alcohol.

Anger and irritability

Signs of anger and irritability are part of the diagnosis of ODD. If your child has ODD, they may:

(Video) What is Oppositional Defiant Disorder?

  • Lose their temper easily.
  • Have frequent outbursts of anger and resentment.
  • Be touchy and/or easily annoyed by others.
  • Be frequently angry and/or disrespectful.

Argumentative and defiant behavior

Argumentative and defiant behavior is part of the diagnosis of ODD. If your child has ODD, they may:

  • Excessively argue with adults.
  • Actively refuse to comply with requests and rules.
  • Blame others for their own mistakes.
  • Deliberately try to annoy or upset others.


Signs of vindictiveness in ODD include:

  • Being spiteful and seeking revenge.
  • Saying mean and hateful things when angry or upset.

What causes oppositional defiant disorder (ODD)?

Researchers believe that the cause of oppositional defiant disorder is a complex combination of biological, genetic and environmental factors:

  • Genetic factors: Research suggests that genetics account for about 50% of the development of ODD. Many children and teens with ODD have close family members with mental health conditions, including mood disorders, anxiety disorders and personality disorders. Further, many children and teens with ODD also have other mental health conditions, such as ADHD, learning differences, or depression and anxiety disorder, which suggests a genetic link between the conditions.
  • Biological factors: Some studies suggest that changes to certain areas of your brain can lead to behavior disorders. In addition, ODD has been linked to issues with certain neurotransmitters, which help nerve cells in your brain communicate with each other. If these chemicals are out of balance or not working properly, messages might not make it through your brain correctly, leading to symptoms.
  • Environmental factors: Having a chaotic family life, childhood maltreatment and inconsistent parenting can all contribute to the development of ODD. In addition, peer rejection, deviant peer groups, poverty, neighborhood violence and other unstable social or economic factors may contribute to the development of ODD.

Diagnosis and Tests

How is oppositional defiant disorder diagnosed?

Mental health professionals diagnose oppositional defiant disorder (ODD) if your child meets four or more of the symptom criteria as described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) for at least six months. The DSM-5, published by the American Psychiatric Association, is the standard reference book for recognized mental illnesses. The symptoms must also be severe and disruptive to daily life.

Your child will likely need to see a child and adolescent psychologist or psychiatrist if they’re showing signs of ODD. These mental health professionals use specially designed interview and assessment tools to evaluate your child for a mental health condition.

Psychiatrists and psychologists often rely on reports from the child’s parents, siblings, friends and teachers to get a full understanding of their behavior.

Your child’s psychologist or psychiatrist will carefully assess your child. They must distinguish oppositional defiant disorder from the following conditions, which may cause similar symptoms:

  • Mild to moderate oppositional behaviors.
  • Untreated attention-deficit/hyperactivity disorder (ADHD).
  • Mood disorders.
  • Anxiety disorders and obsessive-compulsive disorder (OCD).

Management and Treatment

How is oppositional defiant disorder treated?

Treatment for ODD varies based on many factors, including:

  • Your child’s age.
  • The severity of their symptoms.
  • Your child’s ability to take part in and tolerate specific therapies.
  • If your child has other conditions, such as ADHD, learning differences and/or OCD.

Treatment of ODD should involve your child, your family and their school.

(Video) What is Oppositional Defiant Disorder?

Treatment usually consists of a combination of the following:

  • Parent management training (PMT).
  • Psychotherapy (talk therapy).
  • School-based interventions.

Parent management training for ODD

Parent management therapy (PMT) is the main treatment for oppositional behaviors. It teaches parents ways to change their child’s behavior in the home by using positive reinforcement to decrease unwanted behaviors and promote healthy behaviors.

There are different types of training programs, which usually involve multiple sessions over several weeks. During the sessions, parents learn to identify problem behaviors, as well as positive interactions, and to apply punishment or reinforcement as appropriate.

PMT has been shown to decrease conduct problems in multiple contexts and family backgrounds significantly.

Psychotherapy for ODD

Psychotherapy (talk therapy) is a term for a variety of treatment techniques that aim to help you identify and change troubling emotions, thoughts and behaviors. Working with a mental health professional, such as a psychologist or psychiatrist, can provide support, education and guidance to your child and your family.

Common types of psychotherapy that help treat ODD include:

  • Cognitive behavioral therapy (CBT): This is a structured, goal-oriented individual type of therapy. A therapist or psychologist helps your child take a close look at their thoughts and emotions. Your child will come to understand how their thoughts affect their actions. Through CBT, your child can unlearn negative thoughts and behaviors and learn to adopt healthier thinking patterns and habits. CBT-based anger management training is useful in treating anger problems in children with ODD. In older children, problem-solving skills training and perspective-taking are helpful therapy strategies.
  • Family-focused therapy: This therapy is for children with ODD and their caregivers. During this treatment, your child and family will join together in therapy sessions of psychoeducation regarding ODD, communication improvement and problem-solving skills. It can help identify factors in your home life that may contribute to or worsen aggressive behaviors.

School-based interventions for ODD

Supportive interventions to improve school performance, peer relationships and problem-solving skills are very useful in the treatment of ODD.

These interventions may include:

  • Education and tools for your child’s teacher(s) to improve classroom behavior.
  • Techniques to prevent oppositional behavior or the worsening of such behavior.
  • Other methods that help your child follow classroom rules and acceptable social interactions.

Medications for ODD

Although there isn’t medication formally approved to treat ODD, your child’s healthcare provider or psychiatrist might prescribe certain medications to treat other conditions they may have, such as ADHD, OCD or depression. If left untreated, these conditions can make the symptoms of ODD worse.


Can oppositional defiant disorder be prevented?

Although it might not be possible to prevent oppositional defiant disorder, recognizing and acting on symptoms when they first appear can minimize distress to your child and family. It can also help prevent many of the problems associated with the disorder. Family members can learn steps to take if signs and symptoms return, as well.

(Video) Tips for Managing Oppositional Defiant Disorder | Animated Video from Brain Balance

In addition, providing a nurturing, supportive and consistent home environment might help reduce symptoms and prevent episodes of defiant behavior.

Outlook / Prognosis

What is the prognosis (outlook) for oppositional defiant disorder (ODD)?

Children with ODD can experience significant issues in school, at home and in social relationships.

Mild to moderate forms of ODD often improve with age, but more severe forms can evolve into conduct disorder.

A lack of treatment and parental support often leads to a poor prognosis for oppositional defiant disorder, while adequate treatment of coexisting conditions (such as ADHD or OCD), individual and/or family therapy, and positive parenting are associated with a good prognosis.

Living With

How do I take care of my child with oppositional defiant disorder?

If your child has oppositional defiant disorder, aside from getting them professional care, you can help them and yourself in the following ways:

  • Build on the positives: Give your child praise and positive reinforcement when they show flexibility or cooperation.
  • Take a time-out or break when needed: If you’re about to make the conflict with your child worse instead of better, take a break and step away. This also sets a good example for your child. Support your child if they decide to take a break to prevent escalating a negative situation.
  • Be consistent: Set reasonable, age-appropriate limits with consequences for poor behavior that can be enforced consistently. Be consistent about rules as well.
  • Take care of yourself: Maintain interests and hobbies that you enjoy and practice self-care. Try to work with and gain support from the other adults who are interacting with your child.

When should my child see their healthcare provider about oppositional defiant disorder?

If your child has been diagnosed with oppositional defiant disorder, and their behavior becomes more severe or disrupts family or school life, talk to their mental health provider.

If your child displays behavior that harms or endangers others, such as other children or animals, it’s important to find them immediate care.

A note from Cleveland Clinic

Children and teens who are defiant or very disruptive can be very challenging for parents. While it’s normal for young children and teens to show defiant behavior from time to time, frequent and disruptive behavior may indicate oppositional defiant disorder (ODD).

(Video) Oppositional Defiant Disorder: Raising a Child with ODD and ADHD

Starting treatment early for ODD is important, and the first step to treatment is to talk with a healthcare provider or a mental health provider. Don’t be afraid to ask your healthcare provider questions. They’re available to help.


What is the best treatment for ODD? ›

The preferred ODD treatment is a combination of individual and family behavioral therapy. When therapy alone does not resolve symptoms, medication for ODD can sometimes help. In addition, lifestyle changes can help some people with mild symptoms to control their explosions.

What is ODD and its symptoms? ›

Overview. Even the best-behaved children can be difficult and challenging at times. But oppositional defiant disorder (ODD) includes a frequent and ongoing pattern of anger, irritability, arguing and defiance toward parents and other authority figures.

How do you discipline an ODD child? ›

Instead, follow these strategies for how to discipline a child with oppositional defiant disorder:
  1. Treat before you punish. ...
  2. Exercise away hostility. ...
  3. Know your child's patterns. ...
  4. Be clear about rules and consequences. ...
  5. Stay cool-headed and under control. ...
  6. Use a code word like 'bubble gum. ...
  7. Stay positive.
Sep 20, 2022

What is the main cause of ODD? ›

Oppositional Defiant Disorder (ODD) is thought to be caused by a combination of biological, psychological, and social factors. ODD tends to occur in families with a history of Attention Deficit Hyperactivity Disorder (ADHD), substance use disorders, or mood disorders such as depression or bipolar disorder.

Is ODD the parents fault? ›

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.

Do kids outgrow ODD? ›

Some children with ODD will eventually outgrow the disorder. Symptoms may disappear as they age. However, as much as 30 percent of children with ODD eventually develop a conduct disorder. About 10 percent of children with ODD may eventually develop a personality disorder, like antisocial personality disorder.

Is ODD a form of ADHD? ›

Oppositional defiant disorder (ODD) is one such condition. In fact, ODD is the most common comorbidity with ADHD. Experts believe that about four out of 10 kids with ADHD also have ODD.

What untreated ODD can cause? ›

If untreated, ODD may lead to anxiety, depression, or a more serious disorder called conduct disorder. A child or teen with conduct disorder may harm or threaten people or animals, damage property or engage in serious violations of rules.

Can ODD be treated with medication? ›

Medicines alone generally aren't used for ODD unless your child also has another mental health condition. If your child also has other conditions, such as ADHD , anxiety disorders or depression, medicines may help improve these symptoms. Treatment for ODD usually includes: Parenting skills training.

What age does oppositional defiant disorder start? ›

Oppositional Defiant Disorder

ODD usually starts before 8 years of age, but no later than by about 12 years of age. Children with ODD are more likely to act oppositional or defiant around people they know well, such as family members, a regular care provider, or a teacher.

Is ODD a chemical imbalance? ›

Like other mental health disorders, ODD can be caused by a combination of genetic, family and social factors. Children with ODD may inherit chemical imbalances in the brain that make them more prone to the disorder.

How 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.

How does a doctor diagnose ODD? ›

The doctor bases their diagnosis on reports of the child's symptoms and 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 do you deal with an ODD meltdown? ›

How should I treat my child's ODD?
  1. Always build on the positives, give the child praise and positive reinforcement when he shows flexibility or cooperation. ...
  2. Learn to control yourself. ...
  3. Pick your battles. ...
  4. Set up reasonable, age-appropriate limits with consequences that can be enforced consistently. ...
  5. Don't go it alone.

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.

What does oppositional defiant disorder 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.

Is ODD caused by abuse? ›

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.

Does ODD run in families? ›

ODD is genetic.

Oppositional defiant behavior tends to run in families. Studies show that the development of the condition is more heavily influenced by genes than it is by environmental factors. A child diagnosed with ODD quite frequently has a first-degree relative with ODD.

Is ODD worse than ADHD? ›

The key difference between ADHD and ODD is that children with ADHD are easily distracted and disorganized, while children with ODD are angry and defiant. For example, a child with ADHD may impulsively push another child and later regret it.

What happens to children with ODD as adults? ›

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.

Do kids with ODD hurt others? ›

Oppositional defiant disorder (ODD) is a type of behavior disorder. It is mostly diagnosed in childhood. 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.

Can ODD be reversed? ›

It is important to keep in perspective that most ODD teens turn out just fine in adulthood. It is impossible to resolve clinical levels of ODD without detaching emotionally and remaining detached while the the teen is in pain. (This is particularly difficult for mothers.)

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.

Do stimulants help ODD? ›

Pharmacologic Treatment

According to these studies, stimulants reduced the symptoms of both ADHD and oppositional defiant disorder symptoms.

Can ADHD meds help with ODD? ›

Medication is not usually effective in treating ODD alone, but when ODD co-occurs with ADHD, stimulants are still an effective ADHD treatment option. Looking for more?

How do you deal with ODD in school? ›

Be sensitive to self-esteem issues. Provide feedback to your student with ODD in private, and avoid asking the student to perform difficult tasks in front of classmates. It can be helpful to praise positive behaviors, such as staying seated, not calling out, taking turns, and being respectful.

Do ODD kids have empathy? ›

Empathy problems have been associated with oppositional defiant disorder (ODD) and conduct disorder (CD) [1]. 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].

Do mood stabilizers help with ODD? ›

Studies have shown that these medications also help with irritable, aggressive, and impulsive behavior. Lithium, another mood stabilizer, may also be useful for some children with ODD.

Is oppositional defiant disorder part of autism? ›

A large percentage of children with autism spectrum disorder (ASD) exhibit the symptoms of DSM-IV-defined oppositional defiant disorder (ODD), which is characterized by a pattern of hostile and defiant behavior directed toward adults.

What does ODD look like in girls? ›

The symptoms of ODD may look different in girls and boys, for whom the condition is more common. Boys with ODD tend to be more physically aggressive and have explosive anger while girls often lie, refuse to cooperate, and express symptoms in other indirect ways.

Does ODD affect memory? ›

Results showed that boys with ODD/CD showed impaired working memory under typical testing conditions, and impairments in working memory and sustained attention under stressful conditions.

Does ODD cause anxiety? ›

Although oppositional defiant disorder (ODD) and anxiety disorders (ADs) often co-occur, the literature is mixed regarding the effects of such co-occurrence. For example, there is evidence that AD symptoms may mitigate ODD symptoms (buffer hypothesis) or exacerbate ODD symptoms (multiple problem hypothesis).

Is ODD related to schizophrenia? ›

Oppositional Defiant Disorder Linked to Symptoms of Schizophrenia Spectrum Disorder. Many children with oppositional defiant disorder but not autism nevertheless exhibit elevated symptoms of autism spectrum disorder as well as schizophrenia spectrum disorder.

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.

How do you parent a defiant child? ›

How to Parent a Defiant Child
  1. Look for Underlying Issues. Defiance can stem from a number of circumstances. ...
  2. Take a Break before Assigning a Punishment. ...
  3. Be Consistent with Disciplinary Strategies. ...
  4. Celebrate Your Child's Accomplishments – Even the Small Ones. ...
  5. Prioritize Family Time.
Nov 13, 2020

Is there any treatment for ODD? ›

Some children might also benefit from: Social skills training to improve their peer relationships. Cognitive behavioral therapy (CBT) if they are struggling with anxiety or depression. Dialectical behavior therapy (DBT) if they are struggling with extreme emotions.

Does ODD in children go away? ›

Some children with ODD will eventually outgrow the disorder. Symptoms may disappear as they age. However, as much as 30 percent of children with ODD eventually develop a conduct disorder. About 10 percent of children with ODD may eventually develop a personality disorder, like antisocial personality disorder.

How can I help my child with ODD at home? ›

Use a calm voice when dealing with ODD in kids.

It is difficult for kids to argue when they have no one to argue with them! If you engage in a back-and-forth argument with a defiant child, you have given the child the power to control the exchange. Remember, the house rules apply to everyone in your home.

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.

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.

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.


1. ASK UNMC! How is oppositional defiant disorder in children treated?
2. Oppositional Defiant Disorder (ODD)
(Practical Behaviour Solutions)
3. What is ODD? ODD meaning and Oppositional Defiant Disorder DSM 5 diagnosis
(Smarter Parenting)
4. Disruptive, impulse control, and conduct disorders
(Osmosis from Elsevier)
5. What Is Oppositional Defiant Disorder? | Child Psychology
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