What is Oppositional Defiant Disorder?
Oppositional Defiant Disorder (ODD) is a condition seen in children where there are ongoing issues with managing emotions and behavior. It falls under the category of disorders that cause disruptive behavior in kids. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) explains that the main signs of ODD are a constant pattern of either an angry or short tempered mood, defiant or argumentative behavior, or being purposely hurtful or revengeful towards others.
What Causes Oppositional Defiant Disorder?
Oppositional Defiant Disorder (ODD) is a complex condition that usually comes about due to a mix of genetic factors, environmental circumstances, and psychological influences.
Genes play a sizeable role in the onset of ODD, contributing to about half its occurrence. ODD shares a fair amount of common genetic traits with Conduct Disorder, Attention Deficit Hyperactivity Disorder (ADHD) and depression. There are interactions between genes and environment which come into play too; in one study, people who had a certain gene that affects neurotransmitter breakdown, and who were also victim to child abuse, were found to have a higher risk of showing conduct problems and aggressive behavior. Levels of cortisol (a hormone linked to stress), and changes in certain areas of the brain have also been found to be involved in the onset of ODD.
The child’s environment is another significant factor. Children with ODD often grow up in environments characterized by abuse, harsh or inconsistent parenting.
Lastly, certain personality traits and psychosocial issues relate to ODD. These include irritability, impulsivity, low tolerance to frustration, and high emotional sensitivity. Peer rejection, association with deviant peer groups, living in poverty or violent neighborhoods, and other unstable social or economic conditions can impact a child’s behavior negatively and contribute to the development of ODD. Furthermore, though not a trait observed in all children with ODD, some display callous and unemotional traits which are highly inherited and may be seen in children with more severe disruptive behaviors.
Risk Factors and Frequency for Oppositional Defiant Disorder
The number of people diagnosed with oppositional defiant disorder (ODD) changes quite a bit. It could be as low as 2% or as high as 11%. The different numbers can be because of reports from parents, kids, or teachers, when the diagnosis is made, or if kids are also diagnosed with something called conduct disorder. ODD is not typically diagnosed in older kids and teens, as their fighting with parents can be seen as normal.
ODD is more common in boys before they hit puberty than in girls (for every 1.4 boys, there’s 1 girl with ODD). However, this pattern doesn’t hold in teenagers and adults. The symptoms stay about the same between the ages of 5 and 10 and are thought to decrease after that. As people get older, the number of people with ODD gets smaller.
- Oppositional defiant disorder (ODD) prevalence is anywhere from 2% to 11%.
- The variation is due to different factors like who reports the symptoms, timing of diagnosis, and if children are also diagnosed with conduct disorder.
- ODD is rarely diagnosed in older children and teenagers due to confusion with normal disagreements with parents.
- Boys before puberty are more commonly diagnosed with ODD than girls with a ratio of 1.4:1. This difference is not seen in teenagers or adults.
- The symptoms stay roughly the same between the ages of 5 and 10 and then start to decline.
- The number of people with ODD gets smaller as age increases.
Signs and Symptoms of Oppositional Defiant Disorder
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the diagnostic criteria for a certain mental health disorder requires a person to have experienced at least four of the following symptoms for most days over a six-month period. The symptoms include being angry or quick to lose temper, often feeling annoyed or resentful, arguing frequently with authority figures, defiantly refusing to follow rules or requests, deliberately annoying others, blaming others for personal mistakes and misbehavior. Furthermore, the person might have shown spiteful or vindictive behavior at least twice in the past six months.
- Often loses temper
- Often touchy or easily annoyed
- Often angry and resentful
- Often argues with authority figures or adults (for children and adolescents)
- Often defiantly refuses to comply with requests or rules
- Often deliberately annoys others
- Often blames others for personal mistakes or misbehavior
- Shown spiteful or vindictive behavior at least twice in the past six months
The behaviors should result in some sort of impairment, such as distress in the individual or their family, or negative impacts on social, educational, or occupational functioning. These symptoms shouldn’t be a result of substance use or occur only during an episode of a psychotic, depressive, or bipolar disorder.
The severity of this disorder is classified as mild if symptoms are only present in one setting (home, school, work), moderate if symptoms are present in two settings, and severe if symptoms are present in three or more settings.
Testing for Oppositional Defiant Disorder
If it’s believed a child or teenager is displaying behaviors associated with oppositional defiant disorder, or ODD, comprehensive evaluations are necessary. These behaviors could start being noticeable in a child as early as age five, but they usually become more apparent when the child is school-aged.
These evaluations should involve conversations with multiple key people in the child’s life, including parents, siblings, friends, and teachers, and if possible, should be conducted in various environments. In addition, the child should undergo a full academic assessment and IQ test to check for any learning difficulties or intellectual issues. It’s also important to identify any adjustable risk factors—like bullying or poor performance in school—that could be contributing to the defiant behaviors.
ODD often occurs alongside attention-deficit/hyperactivity disorder (ADHD) and anxiety disorders, including obsessive-compulsive disorder (OCD). Thus, the medical professional assessing the child should also diagnose and provide treatment for these disorders, if present.
There are various tools that doctors can use to identify ODD, such as:
- The Child Behaviour Checklist
- Conners Child Behaviour Checklist
- The Behaviour Assessment for Children (BASC – 2)
- Strength and Difficulties Questionnaire (SDQ)
- The Child and Adolescent Psychiatric Assessment
- The Development and Well-Being Assessment (DAWBA)
- The Disruptive Behaviour Diagnostic Observation Schedule
Treatment Options for Oppositional Defiant Disorder
The treatment for oppositional defiant disorder (ODD) – a type of behavior disorder – involves a team approach, involving you, your family, schools and the community. It’s important to address other health issues that may accompany ODD, such as ADHD, depression, and anxiety, as well as other challenges like bullying and learning difficulties.
Treatment largely consists of parent management training (teaching parents strategies to manage behavior), school interventions (support to help children in educational settings), individual therapy for the child, and family therapy. It could also involve addressing any issues in parent-child relationships and any particular beliefs parents have about raising their children.
It’s crucial to identify any additional mental disorders you may have along with ODD because they can make the symptoms of ODD worse and should also be treated. Historically, ODD has been noted to be a part of the development of several mental disorders in young adulthood and can predict depression and anxiety later in life.
Parent management training is largely based on social learning theory, which involves changing behaviors through positive reinforcement (rewards for good behavior). Parents are taught to identify problem behaviors, promote positive behaviors and apply suitable responses accordingly. In certain cases, additional family therapy might help identify things at home that could be making aggressive behaviors worse.
Two well-known parent management training programs are “Incredible Years” and the “Triple P program”. The first involves weekly sessions where parents are shown examples of good and bad ways to manage child behavior, while the second involves advice and training programs for both parent and child. Both of these programs have been shown to effectively reduce conduct problems.
School-Based interventions target improvements in school performance, friendships with peers, and problem-solving skills. This might include providing teachers with tools to manage classroom behavior and prevent and de-escalate oppositional behavior, as well as techniques that encourage adherence to classroom rules and social norms.
For an individual child, cognitive-behavioral therapy, a type of talk therapy, can be useful, particularly for managing anger. Older children could benefit from learning problem-solving and perspective-taking skills. The Coping Power program is one example of anger management.
For medication, it’s usually reserved for cases where aggressive and problematic behavior continues despite the other treatments. Any other co-existing mental health challenges should be addressed first. Medications such as antipsychotics may be used in severe cases, but side-effects have to be weighed heavily against potential benefits. If aggression is not managed, mood-stabilizing medications could be an option after thorough assessment.
If ADHD is present along with ODD, stimulant medications might help. On the other hand, non-stimulant medications such as atomoxetine, guanfacine, and clonidine have also shown beneficial effects. Clear goals for treatment should be identified before starting any medication. Potential side effects should be discussed and further assessed in follow-ups.
What else can Oppositional Defiant Disorder be?
Behaviors that are oppositional and defiant can be indicators of many different conditions. To identify Oppositional Defiant Disorder (ODD), healthcare providers must distinguish it from other disorders that might show similar habits. Besides the conditions that will be mentioned, disorders like Obsessive Compulsive Disorder (OCD) and Autism should also be explored, as they may cause resistant behaviors when routines or rituals are changed or interrupted.
- Conduct Disorder (CD): Both CD and ODD involve conflicts with figures of authority, but are represented by somewhat different behaviors. ODD typically involves less severe actions like angry or argumentative behavior or intentionally annoying actions while CD often has more severe issues with physical aggression, fire-setting, cruelty towards animals, staying away from school, property damage, or stealing. A child diagnosed with ODD might later be diagnosed with CD, but not all individuals with CD previously had ODD.
- Attention-deficit/Hyperactivity Disorder (ADHD): Well-studied associations exist between ODD and ADHD, a common childhood behavioral disorder. Symptoms of ADHD include restless or fidgety behavior, trouble focusing on tasks or waiting turns, and difficulty following rules in many settings. ADHD and ODD often occur together, and healthcare providers must evaluate ADHD as a potential primary cause of oppositional/defiant behaviors.
- Mood Disorders: Mood disorders such as depression and bipolar disorders often come with emotional instability, negative emotions, and irritability. These can be common in individuals with ODD, as they often show problems with emotional regulation and might have a moody or irritable affect. ODD could be a precursor to mood disorders that develop later in life, given the shared risk factors.
- Disruptive Mood Dysregulation Disorder (DMDD): DMDD is a childhood disorder that involves frequent temper tantrums as well as a chronically irritable mood in between outbursts. These symptoms should be present for at least 12 months, in multiple settings, and should start before the age of 10. While ODD and DMDD share certain behaviors, DMDD is distinguished by persistent irritability between outbursts and more severe tantrums.
Importantly, a diagnosis of ODD should not be made if symptoms are exclusively present during a mood disorder.
What to expect with Oppositional Defiant Disorder
People who have oppositional defiant disorder (ODD) – a condition where an individual often behaves rudely and argues excessively – can face significant challenges in terms of their social life, academic performance, and work life. Often, they also struggle with conflicts with parents, teachers, and friends. These disruptive behaviors can result in increased expenses for society and may lead to poor emotional and social development as adults.
It’s important to note that mild to moderate forms of ODD often get better as the individual grows older. However, more severe cases can develop into conduct disorder – a more serious behavioral issue – in some people. Individuals who have lower intellectual abilities and don’t receive proper supervision generally have a poorer outlook.
On a positive note, effective treatment of coexisting conditions like attention-deficit hyperactivity disorder (ADHD) or mood disorders, coupled with therapy for the individual or family and positive parenting practices, can help improve the outlook for those with ODD.
Possible Complications When Diagnosed with Oppositional Defiant Disorder
Milder forms of the behavior-related condition called oppositional defiant disorder often improve as individuals grow older. However, severe forms of this condition can worsen, potentially developing into a more serious issue known as conduct disorder.
