Most kids are oppositional and defiant from time to time—arguably, these behaviors are signs of healthy development. But when a child has a frequent, repeated pattern of arguing, getting angry, defying their parents or other adults, and/or is malicious toward others, they may have a condition called oppositional defiant disorder (ODD).
ODD is one of a group of behavioral disorders called disruptive behavior disorders (DBD), so-called because children who have these disorders have a tendency to disrupt others. According to the American Academy of Child & Adolescent Psychiatry, evidence suggests that up to 16% of children and adolescents have ODD. Here’s what you need to know about this mental health condition.
Symptoms of ODD
Psychiatric providers use The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to help decide when a person has symptoms that meet the criteria to make a psychiatric diagnosis. In the case of ODD, the criteria include an angry and irritable mood, argumentative and defiant behavior, and vindictiveness that lasts at least six months.
An angry and irritable mood may include a child losing their temper often, and being touchy and easily annoyed by others. Argumentative could mean squabbling with adults or people in authority—often deliberately annoying or upsetting people—and blaming others for their mistakes or misbehavior. A patient meets the vindictiveness criteria if they are often spiteful or have shown spiteful or vindictive behavior at least twice in the past six months.
“ODD describes a pattern of pervasive negative mood and disruptive behavior occurring in children at least six years of age,” Maryland-based psychiatrist Margaret Seide, MD, tells Health. “Individuals can be observed to be irritable, impulsive and frequently angry without just cause. They can also exhibit vindictiveness, be argumentative and readily engage in rule-breaking, and seem to have little regard for others. They can seem to dismiss social norms and behave recklessly.”
As the name suggests, defiance or difficulty with authority is almost always present with ODD. “I would say this is the most common and the most detrimental symptom,” Dr. Seide says. “While you can have the talent or athleticism to succeed, you won’t get far in life without the ability to follow directions or adhere to rules.”
This makes life difficult for people with ODD. “So much of achievement is about emotional regulation in the face of laws and guidelines,” Dr. Seide says. “Being able to thrive and realize your full potential is about frustration tolerance and respect for the hierarchy. All the rules that other children abide by without even thinking about it will be a huge obstacle and struggle for a child with ODD.”
Children with ODD may sometimes bully other children; it's an attempt to force their way into play or socialization with peers. “A child with ODD who is rebellious and unwilling to abide by the unspoken rules of civility, sharing, and taking turns will be unable to do well among their peers,” Dr. Seide explains. “They will never feel that sense of belonging that is truly important to social development and social competence. They cannot gain acceptance among their peer group in an organic way.”
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Who develops ODD?
By definition, ODD is a disorder of childhood and has not been defined for adults.
“Typically, toddlers and young school-aged children qualify for an ODD diagnosis,” California-based psychiatrist and author Gayani DeSilva, MD, tells Health. “A thorough psychiatric evaluation is necessary to find out what is driving the oppositional and defiant behaviors. There may be child abuse, a sleep disorder that is not obvious, or even a learning disorder.”
The American Academy of Child & Adolescent Psychiatry states that ODD usually appears during the preschool or early elementary school years. In younger kids, it’s more common in boys than girls. However, in school-age kids and adolescents, there’s a pretty equal split between the sexes.
While ODD can occur in adults, it’s extremely rare. “The condition is more closely associated with childhood,” Dr. Seide says. “It may be diagnosed in adulthood when the person was diagnosed in childhood and continues to display symptoms in adulthood—in this case, the diagnosis is a carryover.”
Mental health professionals tend to err on the side of caution and say there’s no clear answer as to why some kids develop ODD. “It’s likely a mixture of brain chemistry, genetics, and home environment,” Dr. Seide says. “It has been observed that children with ODD are more likely to have been exposed to parental styles that are harsh or neglectful in the home environment, so it appears that there is a connection with that.”
How is ODD diagnosed?
When diagnosing ODD, Dr. Seide says it’s important to establish that the behaviors are occurring in multiple settings. For example, if a child is displaying ODD symptoms at home but is relatively well-behaved in school, this may indicate an issue in the home environment rather than in the child. “The clinician should also rule out other things that can mimic this disorder, such as attention deficit disorder (ADD), depression, or autism spectrum disorder,” Dr. Seide adds.
Dr. DeSilva believes an ODD diagnosis should be a last resort or a diagnosis used to describe a constellation of symptoms that are problematic until the underlying disorder or problem can be fully understood.
“In my experience with children who meet criteria for the diagnosis of ODD, there is most often another diagnosis to treat, such as major depression, anxiety disorder, attention deficit hyperactivity disorder (ADHD), post-traumatic stress disorder, neglect, physical or sexual abuse, or being bullied,” Dr. DeSilva says. “In my opinion, there is always another story to understand when a child has ODD. When the underlying issue is addressed and treated, the ODD will likely resolve on its own.”
A child with a diagnosis of ODD is at greater risk of having other behavioral disorders later in life—but not necessarily. “The next disorder in adolescence is conduct disorder, followed by antisocial personality disorder (ASPD) in adulthood,” Dr. DeSilva says. “But if ODD is identified in childhood, and the root cause of ODD symptoms are understood, intervention can make a significant difference—even changing the course altogether.”
If a doctor identifies symptoms associated with ODD in an adult, they will more than likely make a diagnosis of (ASPD).
“Many of the features of ODD are associated with ASPD, such as being dismissive of laws, lacking remorse, and having no regard for the feelings of others, when seen beyond the age of 18,” Dr. Seide says. “Therefore, if the person doesn’t have a history of ODD in childhood—and sometimes even if they do—they are significantly more likely to be diagnosed with ASPD.”
ASPD is characterized by a persistent and blatant disregard for the rights of others. “These adults may be charming, but only in order to manipulate others to meet their wants and needs,” Dr. DeSilva says. “They are not trustworthy, and frequently break the law.”
ASPD is not as easy to treat as ODD, partly because adults with ASPD typically have well-defined patterns of behavior and thought.
Treatment of ODD
There’s no cure for ODD, but certain management strategies can be successful. “Usually, multiple methods are used to address the condition,” Dr. Seide says. “Rewarding good behaviors, social skills training, family education, and, when appropriate, pharmacological interventions can be used. These methods can strengthen coping skills and diminish aggressive behaviors.”
If you think your child might have ODD or another behavior disorder, the first step is a discussion with your pediatrician. “Pediatricians are well aware of expected developmental progress and behaviors at different developmental stages,” Dr. DeSilva says. “They can also make referrals to a therapist and a child psychiatrist for further evaluation.”
Dr. DeSilva advises against seeking psychological or neuropsychological testing when you’re not sure of what’s happening with your child. “The testing is much more helpful when a clear clinical question has been formed by a treating provider, and then the results of the often long and tedious testing process can be useful to improve treatment,” she explains. “Therapists are also helpful to elucidate the cause of the behavioral concerns.”
Some behavioral concerns are due to developmental issues, like struggling with fine motor skills. In those cases, occupational therapy can be helpful. But in all cases, an initial evaluation by your pediatrician will help direct which steps—and with whom—would be most beneficial.
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