Condition Center: Oppositional Defiant Disorder
This informational guide, part of POPSUGAR’s Condition Center, lays out the realities of this health concern: what it is, what it can look like, and strategies that medical experts say are proven to help. You should always consult your doctor regarding matters pertaining to your health and before starting any course of medical treatment.
It’s not unusual for kids to misbehave from time to time. “Most children have moments of challenging behavior, pushing back against a parent’s instructions or expectations,” says Alison R. Zisser, PhD, a psychologist in the Department of Child and Adolescent Psychiatry and Behavioral Sciences at Children’s Hospital of Philadelphia. But if a child is showing a pattern of defiance and angry behavior toward authority figures, they may be dealing with oppositional defiant disorder.
“When a child is showing symptoms of oppositional defiant disorder, there is a frequent occurrence of irritability, defiance, and heightened anger, over and above a frequency that is developmentally typical of a child at that age,” Dr. Zisser explains.
Symptoms of oppositional defiant disorder can continue into adulthood if the condition isn’t properly treated, the Cleveland Clinic says. And if left unaddressed it can lead to conduct disorder or antisocial personality disorder, says Natalie Jones, PsyD, licensed psychotherapist and advisory board member for POPSUGAR’s Condition Center – making it important for parents and caregivers to be aware that the condition exists.
Understanding Oppositional Defiant Disorder
Oppositional defiant disorder (ODD) is a condition that can impact anywhere from 2% to 11% of children, and it’s often underdiagnosed, research has shown. The behavior disorder involves a frequent and ongoing pattern of anger, irritability, arguing, and defiance toward parents and other authority figures and toward other children, according to the Mayo Clinic. Children with ODD may also act spiteful and seek revenge.
What’s more, ODD is disproportionately diagnosed in Black, Latino, and Hispanic children, a diagnostic disparity that can be attributed in part to the unconscious racial bias within the healthcare system. “In fact, clinicians often over-pathologize behaviors of ethnic and racial minorities as more dangerous and disobedient, and can hold personal and inadvertent biases of criminal behavior, aggression, violence, and hostility toward certain minority groups,” according to a 2019 study out of “Academic Psychiatry”. Research also shows that children from racial and ethnic minority groups are more likely to receive a diagnosis of a behavioral disruptive disorder like ODD and less likely to receive a diagnosis of ADHD.
It can be difficult to tell signs of oppositional defiant disorder from a strong-willed child, the Mayo Clinic says. “The key to diagnosing ODD is the longevity of the behaviors,” says psychologist John Mayer, PhD, author of Family Fit: Find Your Balance in Life. Four or more of the characteristic symptoms must occur with at least one person who is not a sibling to warrant a diagnosis, explains Dr. Jones. And symptoms usually start during the preschool years and generally last at least six months, per Mayo clinic. It most commonly begins by age 8, the Cleveland Clinic reports. ODD symptoms can present as the following, per the Mayo Clinic:
- An angry and irritable mood. Children with ODD will often lose their temper, are typically angry and resentful, and are easily annoyed by others.
- Argumentative behavior. ODD patients often argue with adults or authority figures, openly defy or refuse an adult’s request or rules, or annoy or upset people on purpose. They also tend to blame others for their behavior, says Dr. Jones.
- Revengeful behavior. Children with oppositional defiant disorder may say mean and hateful things when they’re upset, deliberately try to hurt someone else’s feelings, and seek revenge on others at least twice in the past six months.
“Compared to peers, their behaviors may be developmentally inappropriate and negatively impacting their quality of life at home, in school, or socially,” says Hillary Ammon, PsyD, a clinical psychologist at the Center for Anxiety & Women’s Emotional Wellness.
The majority of children and teens with ODD have at least one other mental health condition, including ADHD, anxiety disorders, learning differences, mood disorders like depression, and impulse control disorders, according to the Cleveland Clinic.
ODD symptoms in adults are similar to that of children. “Adults with oppositional defiant disorder (ODD) display a pattern of negative, hostile, and defiant behavior that lasts at least six months and includes four (or more) of the following symptoms,” according to ADDitude Magazine:
- Often loses temper
- Often argues with family and coworkers
- Actively defies or refuses to comply with rules and laws
- Deliberately annoys people
- Blames others for his or her mistakes or misbehavior
- Easily annoyed by others
- Angry and resentful
- Spiteful or vindictive
Causes of Oppositional Defiant Disorder
The exact cause of ODD isn’t known, Dr. Zisser says. However, there are a few genetic and environmental factors that can contribute to a person developing oppositional defiant disorder.
- Parenting style or upbringing: “Parents of children with ODD may provide inconsistent or harsh discipline or consistently positively reinforce negative behaviors, e.g. giving a child what is desired only after the child yells or screams,” says Dr. Ammon.
- Exposure to negative behaviors at home: Other environmental factors including exposure to substance use in the home or repeated exposure to violence can also contribute to the development of ODD, Dr. Ammon says.
- Instability in the home: Major and unexpected changes to a child’s life including divorce, moving homes frequently, or changing schools often, along with financial problems, may contribute to ODD, the Cleveland Clinic says.
- Genetics: “Children with ODD often have parents that have psychological disorders, including anxiety and mood disorders,” Dr. Ammon says.
The Most Effective Treatment For Oppositional Defiant Disorder
Treatment for ODD involves several elements. “Research-supported treatment for oppositional defiant disorder actively involves the caregivers of the child,” Dr. Zisser says. “Caregivers are taught to recognize the factors in the child’s environment that are contributing to and potentially exacerbating the child’s challenging behavior.”
A therapist then works with the caregiver to teach alternative strategies to managing the child’s challenging behavior, she explains. “Therapy might include the clinician coaching the caregiver through a ‘bug in the ear’ in strategies to effectively communicate and connect with the child,” Zisser says. “Individual therapy may also be implemented with the child to facilitate development of emotion-regulation skills and more effective problem-solving of challenging situations.”
For adults, managing and treating ODD also involves the help of a mental health professional via therapy to work through that pattern of hostile and defiant behavior.
Parents or caregivers who suspect their child has ODD should talk to their pediatrician, Dr. Zisser says. “The pediatrician can help determine if a child’s behavior is falling outside of developmental norms and offer initial suggestions for shifting patterns of behavior.” And if you think you may be dealing with ODD, talk to your primary care doctor. If that doesn’t help, it’s often best to talk to a specialist with expertise in treatment of disruptive behavior disorders.