Oppositional Defiant Disorder (ODD)

Oppositional defiant disorder (ODD) is a behavior disorder characterized by uncooperative, defiant, negativistic, irritable and annoying 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.

While the cause of ODD is not known, there are two primary theories offered to explain the development of ODD:

• A developmental theory, which suggests that the problems begin when children are toddlers. Children and adolescents who develop ODD may have had a difficult time learning to separate and become autonomous from the primary person to whom they were emotionally attached. The "bad attitude" characteristic of ODD are viewed as a continuation of the normal developmental issues that were not adequately resolved during the toddler years.
• Learning theory suggests that the negativistic characteristics of ODD are learned attitudes, reflecting the effects of negative reinforcement techniques used by parents and authority figures. The use of negative reinforcement by parents is viewed as increasing the rate and intensity of oppositional behaviors in the child as it achieves the desired attention, time, concern and interaction with parents or authority figures.

Oppositional defiant disorder affects between 1 percent to 16 percent of the school-age population. ODD is more common in boys than in girls.

Oppositional defiant disorder symptoms

It's common for children and adolescents to disobey their parents, argue or defy authority, especially when they are tired, hungry or upset.

In children and adolescents with oppositional defiant disorder, these symptoms occur more frequently and interfere with learning, school adjustment and 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; refusal to follow rules

• Behavior intended to annoy or upset others, including adults

• Blaming others for one's own mistakes

• Easily annoyed by others

• Frequently having an angry attitude

• Speaking harshly, or unkindly

• Seeking revenge

The presence of oppositional defiant disorder symptoms does not necessarily mean your child has the disorder, particularly around the ages of two or three, or during teenage years.

Diagnosis and treatment

Although parents, teachers and other authority figures will often identify a child or adolescent with ODD, a diagnosis is made by a child psychiatrist after a thorough examination and history of the child's behavior.

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.

• 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. 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 of oppositional defiant disorder in childhood

Some experts believe that a developmental sequence of experiences occurs in the development of oppositional defiant disorder.

This sequence may start with ineffective parenting practices, followed by difficulty with other authority figures and poor peer interactions. As these experiences compound and continue, oppositional and defiant behaviors develop into a pattern of behavior.

Early detection and intervention with more effective communication skills, parenting skills, conflict resolution skills, and anger management skills can disrupt the pattern of negative behaviors and decrease the interference of oppositional and defiant behaviors in interpersonal relationships with adults and peers, and school and social adjustment.