Oppositional Defiant Disorder

ODD is a behavior disorder involving one or more of these three features:

• Angry or irritable mood
• Argumentative or defiant behavior
• Vindictiveness 

Examples of these symptoms are:

• Having frequent temper tantrums
• Arguing with adults
• Questioning rules
• Refusing to follow or not following requests from adults
• Attempting to annoy or upset people
• Blaming others for mistakes or misbehavior
• Becoming easily annoyed by others
• Frequent anger and resentment
• Saying mean things when upset
• Spiteful attitude or looking for revenge

A pattern of these behaviors is essential to a diagnosis—a child or adolescent who only occasionally gets angry or disobeys probably does not have ODD. A diagnosis isn’t made unless the behavior patterns have been a problem for at least six months.

Estimates of how many children have ODD vary, but one study concluded that about 3.3% of children have the disorder. In many cases, a child may show symptoms in only one setting. For instance, the child might be a model student in school but might have frequent outbursts at home.

It is believed that both biology and psychology have a role in the disorder. Some research has linked parents’ smoking and prenatal nutritional deficiency to high risk of ODD. Parents who aren’t prepared or confident in their parenting skills might also play a role. But again, no one factor is the certain cause for the problems your family is experiencing.

Those who have had ODD in their youth are more likely to be diagnosed with another behavioral health condition as an adult, and are at higher risk for suicide. This is why it’s so important to get help for your child early on. 

Diagnosis and treatment could prevent development of substance use problems and other challenges that can do lifelong damage.

ODD is most often diagnosed in preschool or early school-age children, but it also can emerge in teenagers. It’s believed that ODD occurs more often in boys than girls, but this is unclear because girls’ aggressive or defiant behavior may be less direct than boys’. Also, by adolescence, a relatively equal number of boys and girls are diagnosed with ODD.

Some research found that ODD is seen more frequently in lower-income groups, but it can happen in any family.

Children and adolescents with other behavioral health disorders are more likely to have ODD. One of the most common conditions that is seen together with ODD is attention-deficit/hyperactivity disorder (ADHD). ADHD is seen in an estimated 14% to 40% of children with ODD, and the symptoms of ADHD often appear first. Anxiety and depression also are often seen in children with ODD.

While both behavioral therapies and medications can have an important role in treating ODD, behavioral therapies are considered the best first option. It is important to remember that the most effective treatment will involve both you and your child, not just one of you alone.

We may recommend two separate therapeutic approaches for you and your child, or possibly a collaborative strategy where you work together. A common approach with the parent is called “parent management therapy.” This type of therapy helps you build skills so you’re not reinforcing your child’s negative behaviors, but instead, you’re helping your child understand the consequences of their disruptive acts. 

You are not to blame for your child’s difficulties, but we can help you manage your reactions to their behaviors and be more consistent in your responses.

The therapeutic strategy for the child depends on a number of factors, including the child’s age. Individual therapy for the child is more effective if your child is a teen or tween. But even at that stage, including the parent in therapy works better than working with the child alone.

Medications such as stimulants or antidepressants can be effective when used with therapy, particularly for children who also have ADHD or depression along with ODD. But researchers believe that medication by itself probably will not help a child with ODD.

ODD is unpredictable. But usually, its symptoms resolve by the end of adolescence. Research has shown that 7 of every 10 children with ODD have no more symptoms by the age of 18. Also, around two-thirds of children will no longer have the diagnosis of ODD within three years of first being diagnosed.

Still, the treatment process isn’t easy. It will take time for you and your child to build a working relationship to heal your family. 

Rather than putting an exact time frame on treatment, figure that several months of treatment and at-home reinforcement will be needed. Remember, your child probably doesn’t think his or her behaviors are a problem.

The length of treatment also may depend on how young your child is when symptoms first emerge and how quickly treatment begins after these problems surface. As with many behavioral health conditions, early diagnosis and treatment can make a big difference.

If your child loses their temper or breaks the rules sometimes, this is probably just a normal part of growing up. No child is going to be happy or obedient all the time. 

But if a pattern of angry outbursts and refusing to follow the rules has been there for at least six months, and it’s leading to negative consequences at home, school or both, treatment may be needed to put your family on a better path.

A pattern of behavior that has affected your family for months probably isn’t “just a phase” your child will grow out of. We can help you and your child find more productive solutions, without assigning blame or shame. ODD affects many families, and it’s very treatable.

At Eappen Clinic, we will work with both you and your child on a treatment plan that meets your family’s needs. Your first appointment with us is a detailed evaluation. At the end of the evaluation, you’ll know the next steps.

Let’s work together to restore your family’s peace, health and well-being.