Oppositional Defiant Disorder in Children

Oppositional behavior is normal during certain periods of development. Children and adolescents go through developmental stages that include opposition to adult requests and expectations. 

Transient oppositional behavior can result from a desire for differentiation from parents and family members and can be seen as an attempt to assert independence. Conversely, chronic oppositional behavior, characterized by anger, irritability, arguing, defiance or vindictiveness towards parents and other authority figures is not part of typical development and may be an indicator of Oppositional Defiant Disorder (ODD).  

Individuals with ODD often have other co-occurring diagnoses, including attention-deficit hyperactivity disorder (ADHD), learning disabilities (LD), mood disorders (depression, bipolar disorder) and anxiety disorders.

Children with untreated ODD are at a higher risk for developing conduct disorder or a substance use disorder later in life.

Key facts

  • ODD is present in approximately 3% of the population

  • Symptoms of ODD are usually present before age 8

  • Effective treatment of ODD includes parent skills training, family therapy, behavior therapy, and sometimes medication

  • Children with a diagnosis of ADHD or a history of abuse are at higher risk for ODD

Oppositional Defiant Disorder criteria (DSM-V)

A.  A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months as evidenced by at least four symptoms from any of the following categories, and exhibited during interaction with at least one individual who is not a sibling.

Angry/Irritable Mood

  • Often loses temper.

  • Often touchy or easily annoyed.

  • Often angry and resentful.

Argumentative/Defiant Behavior

  • Often argues with authority figures or, for children and adolescents, with adults.

  • Often actively defies or refuses to comply with requests from authority figures or with rules.

  • Often deliberately annoys others.

  • Often blames others for his or her mistakes or misbehavior.

Vindictiveness

  • Has been spiteful or vindictive at least twice within the past 6 months.

B.   The disturbance in behavior is associated with distress in the individual or others in his or her immediate social context (e.g., family, peer group, work colleagues), or it impacts negatively on social, educational, occupational, or other important areas of functioning.

C.  The behaviors do not occur exclusively during the course of a psychotic, substance use, depressive, or bipolar disorder. Also, the criteria are not met for disruptive mood dysregulation disorder.

Severity:

  • Mild: Symptoms are confined to only one setting (e.g. at home, at school, at work, with peers).

  • Moderate: Some symptoms are present in at least two settings.

  • Severe: Some symptoms are present in three or more settings.

Factors that influence ODD

ODD likely results from a combination of genetics and environment. Children who demonstrate poor emotional regulation, and who experience highly punitive or neglectful parenting are at a much higher risk for developing ODD than the general population. Additionally, children with a diagnosis of ADHD are more likely to develop ODD than their peers. Having a parent with a mental health disorder or a substance use disorder is also a risk factor.

Assessment and treatment of ODD

Given the high incidence of ADHD, learning disorders, and ODD occurring together it is important for children to receive a comprehensive psychological assessment.

Treatment for ODD may include behavioral interventions, social skills training, parent skills training, and family therapy. When an individual also has a diagnosis of ADHD medication may be helpful in addressing behaviors that are related to deficits in attention.

ODD can be successfully managed when symptoms are identified before adolescence and parents and family members are involved in treatment. 

Next steps

If you are concerned about your child's mental health, contact us to learn how we can help with individual therapy and parent coaching.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders(5th ed.). Arlington, VA: American Psychiatric Publishing.