Boy at his desk with his head resting on his hands, looking angryOppositional defiant disorder (ODD) is a diagnosis that applies to some people who are excessively aggressive, angry, or defiant. Though it’s most commonly diagnosed in children, adults can have ODD. Oppositional defiant behavior goes beyond what is developmentally normal or a clear reaction to challenging circumstances. For example, neither a toddler throwing tantrums nor a teenager reacting with anger to abuse warrant a diagnosis of ODD.

ODD can feel overwhelming. Kids and teens may feel out of control and angry. This can affect their relationships with peers and family, and undermine their ability to succeed at school. ODD often affects an entire family. Parents may feel frustrated, angry, and anxious. Siblings may be afraid of another child with ODD. It’s common for families to disagree about how to manage ODD. Spouses may find themselves frequently fighting about the child.

Therapy can help children with ODD and their families manage the many challenges they face. Individual counseling can help kids better control their emotions, while family counseling can help families support a child struggling with ODD and find better strategies for communicating with one another. If you suspect the condition may be at play, find a therapist who specializes in ODD.

Understanding ODD

At certain ages, children may be naturally rebellious. Adolescence, for example, may be characterized by frequent bouts of anger and misbehavior. Toddlers may express their individuality by refusing to follow rules and exhibiting contrary behavior. These types of rebellious behavior are often part of a normal individuation process. They are not diagnosable behavioral conditions, although they may be frustrating and often require some parental skills with boundaries, patience, discipline, and good communication.

Some children, however, may seem unwilling or unable to follow rules, cooperate with adults, or accept any sort of discipline or structure. They may challenge their parents frequently and resist attempts to manage their behavior, appearing to be triggered by insignificant things or by nothing at all. When this type of vindictive, argumentative, defiant behavior persists, often to the point of disrupting normal functioning, ODD may be the culprit. According to the American Psychiatric Association's Diagnostic and Statistical Manual (DSM), diagnosis requires that incidences of defiant behavior occur on most days for at least six months in children under 5, or at least once a week for six months in children older than 5.

ODD Symptoms

ODD is characterized by a pattern of aggressive and defiant behavior. Because children spend more of their lives than adults under the control of others, ODD is more frequently diagnosed in children. The DSM-5 puts no age limit on ODD diagnoses, though, so it’s possible for adults to have symptoms. Most adults with ODD are diagnosed or show symptoms in childhood.

According to the DSM, a child must exhibit a pattern of angry, defiant, and vindictive behavior for at least six months to be diagnosed. A diagnosis requires four or more symptoms from any of these categories:

Angry or irritable mood

  • Often loses temper. The loss of temper must be developmentally inappropriate. For instance, a 2-year-old who throws things in anger may not have ODD, but a teenager who does so might.
  • Easily annoyed or touchy. People with ODD are quickly irritated by experiences others find innocuous or only mildly annoying. For instance, a child might quickly lose their temper with a sibling or be annoyed by extraneous noise.
  • Angry and resentful. People with ODD show a pattern of resentful or angry behavior. Children may behave aggressively toward siblings or parents, or display anger that seems disproportionate. For instance, a child might break a sibling’s toys because the sibling looked at them the wrong way.

Argumentative and defiant behavior

  • Frequent arguments with adults or authority figures. Everyone experiences occasional frustration with authority, and not all authority figures behave reasonably. ODD is characterized by more than mere frustration, and does not include reasonable anger at unreasonable parents or other authority figures. Instead, people with ODD seem to defy authority merely for the sake of doing so.
  • Defies or refuses to comply with requests from authority figures. No one follows the rules all the time. People with ODD, however, defy the rules for no apparent reason. They may seem angry about the existence of rules.
  • Deliberately annoys others. People with ODD don’t just ignore the feelings of others. They deliberately annoy people. A child might provoke siblings or harass parents.
  • Blames others for mistakes or problem behavior. Even people without ODD can struggle to take responsibility for their own behavior. In ODD, this pattern is chronic and pronounced.

Vindictiveness

  • Has behaved spitefully or vindictively at least twice within the past six months. For instance, a child might expend significant energy to get revenge for a bad grade. An adult might hatch a complicated plan to punish a boss for perceived wrongdoing.

ODD diagnosis is inappropriate when symptoms are due to something else, such as a phobia, anxiety, substance abuse, intellectual disability, or trauma. Numerous environmental issues—family abuse, an unstable home environment, a sudden change in family structure—can trigger defiant behavior in children. So before diagnosing ODD, it is important to investigate alternative causes.

Causes of ODD

Like many mental health diagnoses, researchers have not identified a single cause that inevitably leads to ODD. Instead, ODD is the result of genetic, psychological, social, and environmental factors, as well as the interaction between these factors. For instance, a child who has a family history of ODD might be more likely to develop ODD in a chaotic environment.

Research on the specific causes of ODD is in its infancy, but some highlights include:

  • A link between ODD and other mental health conditions. Children with other mental health conditions may be more likely to develop ODD. This could be because of genetic or biological factors. It could also be because of a complex interaction between the environment and the child’s biology.
  • Brain studies suggest ODD is characterized by problems with judgment, reasoning, and impulse control. Regions of the brain that play a role in these behaviors look different on brain scans in people with ODD.
  • Social challenges. Some research suggests aggressive children have more trouble reading their peers’ social cues. They also struggle to develop solutions to complex social challenges. ODD treatment often focuses on overcoming these difficulties.

Some people mistakenly blame parents for a child’s ODD. This stigma can deter treatment and needlessly shame families. Some research, however, suggests that certain parenting shortcomings increase the risk of ODD. Those include inconsistent discipline strategies, excessively harsh discipline, and exposure to abuse or violence.

ODD vs. Conduct Disorder

Oppositional defiant disorder and conduct disorder are superficially similar. Both can cause behavior problems that make it difficult to get along with adults and peers. Both often cause children to break the rules. But while ODD is characterized by defiance of authority, conduct disorder is characterized by a desire to violate the rights of others.

In ODD, hurting others is generally incidental. A child might yell at their mother because they don’t want to follow the rules, or hit a teacher who tries to make the child do something they don’t want to do. With conduct disorders, a desire to hurt and harm others is central. Symptoms of a conduct disorder in the DSM-5 include:

  • Aggression to people or animals. This may include physical or psychological cruelty to people or animals, bullying, sexual abuse, and fighting.
  • Property destruction. Deliberately destroying things that belong to others, such as by setting fires.
  • Dishonesty or theft. A person might lie to get things from others, deceive someone to take their property, or steal.
  • Serious rule violations. A person with conduct disorder continually violates societal and interpersonal norms beyond what is age-appropriate. For example, a 10-year-old might sneak out to smoke with friends.

ODD is often a precursor to a conduct disorder, though not all children with ODD develop a conduct disorder.

ADHD Signs and Oppositional Defiant Disorder

Attention-deficit hyperactivity disorder (ADHD) is a condition that causes inattention, impulsivity, and hyperactive behavior. ADHD is the most common diagnosis to co-occur with ODD. Both ODD and ADHD can cause impulsive or aggressive behavior. One condition may be mistaken for the other. This can lead to misdiagnosis and inappropriate treatment.

ADHD signs include:

  • Trouble paying attention.
  • Constantly being in motion.
  • Easy distraction.
  • Excessive talking, or difficulty listening to others.
  • Difficulties at school.

Attention and focus problems are not a characteristic of ODD. So when a child also struggles with attention, the problem might be due to ADHD, or ADHD co-occurring with ODD.

ODD in Children

ODD in children can disrupt families and schools. When parents and teachers spend an inordinate amount of time managing a child’s behavior, a child may get less attention and affection. Other children may feel frustrated by the distraction of a child’s problem behavior, or even fear for their safety.

ODD can begin as early as the toddler years, and many children with ODD develop symptoms well before they begin school. Some children with ODD have symptoms only in specific contexts. Clinicians rate the severity of ODD based on where it occurs. ODD that occurs in only one setting, such as at home or in school, is mild. ODD in two settings is moderate, while ODD that appears in three or more settings is severe.

ODD in Adults

Oppositional defiant disorder in adults is poorly understood, primarily because the diagnosis is almost always diagnosed in children. Oppositional behavior in adults puts them at risk of relationship, work, and family problems. Behavior associated with ODD can lead to arrests, job loss, divorce, and family estrangements.

ODD treatment can help people with ODD nurture happy relationships, get along with peers, and excel at work and school. A skilled therapist can help a person with ODD understand and manage feelings of defiance and opposition. The right therapeutic alliance can support a person to set goals, make positive changes, and overcome intense emotions. A therapist can also work with families, spouses or partners, and friends to manage communication issues, understand the challenges of ODD, and restore harmony to the relationship.

References:

  1. Del Valle, P., Kelley, S. L., & Seoanes, J. E. (2001). The 'oppositional defiant' and 'conduct disorder' child: A brief review of etiology, assessment, and treatment. Behavioral Development Bulletin, 10(1), 36-41. Retrieved from http://psycnet.apa.org/fulltext/2014-55587-008.html
  2. Diagnostic criteria for 313.81 oppositional defiant disorder. (n.d.). Retrieved from https://behavenet.com/diagnostic-criteria-31381-oppositional-defiant-disorder
  3. Frequently asked questions. (n.d.). Retrieved from https://www.aacap.org/aacap/Families_and_Youth/Resource_Centers/Oppositional_Defiant_Disorder_Resource_Center/FAQ.aspx
  4. Reynolds, C. R., & Kamphaus, R. W. (2013). Conduct disorder [PDF]. Pearson. Retrieved from http://images.pearsonclinical.com/images/assets/basc-3/basc3resources/DSM5_DiagnosticCriteria_ConductDisorder.pdf
  5. Reynolds, C. R., & Kamphaus, R. W. (2013). Oppositional defiant disorder [PDF]. Pearson. Retrieved from https://images.pearsonclinical.com/images/assets/basc-3/basc3resources/DSM5_DiagnosticCriteria_OppositionalDefiantDisorder.pdf