Oppositional Defiant Disorder

What is oppositional defiant disorder (ODD)?

ODD is a common childhood and teen problem. Children with ODD are repeatedly disobedient and hostile for 6 months or more. The problem behaviors are more frequent and worse than typical for the child's age and sex.

If a child's behavior has worsened (for example, dangerous anger or violence, destroying property, and stealing) for a year or more, the problem may be a more serious condition called conduct disorder.

What is the cause?

The exact causes of ODD are not fully understood. It tends to run in families, but home environment and parenting also have an effect. ODD may occur in children from any background, but it is more common in children with a parent who:

• has a history of ODD, conduct disorder, substance abuse problems, or mood problems like depression
• has marriage troubles
• uses harsh or inconsistent discipline
• pays little attention to his or her children

ODD usually starts in the late preschool years or the early teenage years. It may start at any age. Young children who are very irritable (for example, very colicky babies) often develop ODD. Children with attention deficit/hyperactivity disorder (ADHD), speech and language problems, or school problems are also at greater risk of having ODD.

In young children, ODD is more common in boys. It is equally common in teenage boys and girls. From 2% to 15% of children ages 3 to 18 develop ODD at some time in their childhood. Most have a mild form of the disorder.

What are the symptoms?

A child behaves this way for at least 6 months:

• defies rules and authority at home and at school far more than what is usual for their age and sex
• has an angry attitude
• often seeks to annoy adults and peers
• blames others for their misbehaviors and negative attitudes
• throws severe temper tantrums and talks back to adults

How is it diagnosed?

There are no medical tests for ODD. A therapist or healthcare provider will ask about your child's symptoms and how long your child has been behaving this way.

If behaviors like the ones listed are a reaction to a recent event such as child abuse or divorce, the diagnosis may be adjustment disorder with disturbance of conduct instead of ODD. If stealing, vandalism, or assault goes on for a year or more, the child may have conduct disorder.

How is it treated?

The best treatment is good child management by parents, teachers, and daycare providers. ODD children need very firm limits with clear rules, consistent results, and immediate rewards for good behavior.

Be calm during discipline. Since these children seek to annoy, if you become angry and yell, it may increase how often they misbehave. Severe punishments do not help the problem, but instead seem to make it worse.

Talking with a child therapist is helpful.

Medicines are not useful with simple ODD. Medicines do help when ODD exists with attention deficit/hyperactivity disorder (ADHD) or mood problems, such as childhood depression or bipolar disorder. Your healthcare provider or therapist will select the best treatment.

How long will the effects last?

With good child management by adults, many children grow out of ODD. The most common times for major improvements are before the teenage years or in young adulthood.

In some children the condition worsens into conduct disorder by late childhood or teenage years.

What can I do to help my child?

The main things to do are:

• Do not use anger or yell when you discipline your child.
• Tell your child what you expect.
• Notice your child's efforts to behave.
• Praise helping behaviors.
• Reward good behaviors.
• Help your child to handle conflicts.
• Teach your child to cooperate with others.
• Be consistent and set clear rules.
• Maintain a healthy diet.
• Eliminate caffeine.
• Encourage regular exercise.
• Seek professional help.

If severe behavior problems have lasted more than a few months, talk with your child's healthcare provider or a mental health therapist. They can help you learn if your child has ADHD, a mood problem, or some other childhood problem.