What is oppositional defiant disorder?

Oppositional defiant disorder (ODD) is a condition in which the person's behaviour is consistently angry, argumentative and defiant, particularly towards figures of authority. While it generally arises in early childhood, it can affect a person for their entire life.

There is quite a wide range of estimates of how common ODD is in the community. According to the Diagnostic and Statistical Manual of Mental Disorders, the estimate is that around 3.3% of the population have ODD. [1]

1. American Psychiatric Association. (2013) Diagnostic and Statistical Manual of Mental Disorders (5th edition). Washington D.C: American Psychiatric Publishing.

Causes

No single cause has been identified for the development of ODD.

1. American Psychiatric Association. (2013) Diagnostic and Statistical Manual of Mental Disorders (5th edition). Washington D.C: American Psychiatric Publishing.

Risk factors

In childhood, ODD appears to be more common in boys than in girls, although in adolescents and adults, this does not appear to be the case.

Factors that may contribute to the development of the disorder include:

  • A child's temperament. Children who have problems controlling their emotions (for example, who have extreme emotional reactions or do not tolerate frustration well) may be more likely to develop ODD, and;
  • A child's environment. Children who experience harsh, inconsistent or neglectful parenting practices, or a traumatic family life (domestic violence, abuse, poverty) may be more likely to develop ODD.

It is not currently clear what role genetics may play in developing ODD.

1. American Psychiatric Association. (2013) Diagnostic and Statistical Manual of Mental Disorders (5th edition). Washington D.C: American Psychiatric Publishing.

Types

It is thought that there may be two different pathways to developing ODD:

  • An early pathway in which children develop symptoms in the years before they go to school. These symptoms can continue into adolescence, and;
  • A later pathway in which children do not show signs of these behaviours until adolescence. This is often associated with family problems or disruption, such as divorce.

Children who develop ODD later may tend to have a better prognosis, because they have had more of an opportunity to develop social skills and relationships with others in their early childhood.

ODD in adults

Children who are diagnosed with ODD may have some symptoms and mental health problems that carry on into adulthood and require treatment and management. Other people may not be diagnosed until they are adults, but will generally have had symptoms from childhood.

Symptoms of ODD in adults are similar to those displayed by children, although they may become more severe and cause different difficulties in adult life.

1. American Psychiatric Association. (2013) Diagnostic and Statistical Manual of Mental Disorders (5th edition). Washington D.C: American Psychiatric Publishing.

Signs and symptoms

One of the challenges of diagnosing ODD is that all children show some of the behaviours described as symptoms of ODD, some of the time, as part of their normal development. 

However, for children with ODD, these behaviours occur more frequently, more severely and persist over time. They have a disruptive effect on many aspects of a child's life, including family relationships, their education and how they play and interact with other children.

There are three main symptoms of ODD:

  • An angry or irritable mood. This can include the child losing their temper frequently, being easily annoyed or angered and being resentful of other people;
  • Argumentative and defiant behaviour. This can include the child persistently arguing with authority figures and defying their requests, going out of their way to annoy other people and blaming other people for their mistakes, and;
  • Vindictive or spiteful behaviour.

Symptoms of ODD usually first appear in early childhood and, less commonly, develop after a person passes the early years of their adolescence.

Parent comforting troubled boy with an oppositional defiant disorder.In children, oppositional defiant disorder can result in behaviour that is consistently angry, argumentative and spiteful. 

1. American Psychiatric Association. (2013) Diagnostic and Statistical Manual of Mental Disorders (5th edition). Washington D.C: American Psychiatric Publishing.

Methods for diagnosis

Assessment and diagnosis of ODD are performed by a specialist health professional, such as a paediatrician, child psychologist or child psychiatrist. Your general practitioner can make an initial assessment, however, they will usually refer your child for further assessment if they suspect ODD.

For a child to be diagnosed with ODD, symptoms and behaviours need to occur on a long-term basis (a minimum of six months). They must also behave in this way with at least one person who is not a sibling, although some children will only display these behaviours at home.

Assessment for ODD is complex and can include:

  • A medical examination to rule out any underlying medical conditions;
  • A mental health assessment;
  • A developmental assessment to understand your child's overall development compared to milestones expected for their age;
  • Assessment of your child's situation and needs including family, culture and education, and;
  • Assessment of your child's behaviour.

In order for this assessment to be comprehensive, your specialist may ask to talk to other family members and teachers about your child's behaviour. They may also ask to review information, such as school reports, or for your child to be observed at home or school.

In Australia, guidelines and approaches to diagnosing ODD are evolving. Particularly with children who have mild symptoms, there can be different approaches to diagnosing the condition. If you have any concerns or questions about how ODD is diagnosed or your child's diagnosis, you can discuss them with your specialist.

Diagnosis of adults

As with children, while a general practitioner can make an initial assessment, most adults will be referred to a specialist, usually a psychiatrist, for a full assessment and diagnosis.

A full medical assessment helps to determine whether there are any underlying medical conditions that may be contributing to your symptoms. Your specialist will ask you about your symptoms and may also ask to speak with your partner or other family members.

ODD is only diagnosed if the symptoms create a serious disruption to your life.

Child psychiatrist

A doctor who specialises in diagnosing and treating mental health conditions in children and infants.

Child psychologist

A health professional who specialises in providing testing and counselling to children with mental health conditions.

Paediatrician

A doctor who specialises in the diagnosis and treatment of health conditions in children and babies.

1. American Psychiatric Association. (2013) Diagnostic and Statistical Manual of Mental Disorders (5th edition). Washington D.C: American Psychiatric Publishing.

Types of treatment

ODD cannot be cured, but the goal of treatment is to:

  • Reduce and manage disruptive behaviours so that they have less impact on the child's wellbeing and development, and;
  • Support parents, carers and other family members.

It is helpful for children with ODD if everyone who cares for them (for example, teachers, child-care workers, grandparents and other family members, as well as parents or primary carers) are consistent in the way they deal with them. So, a management plan for ODD may involve family, school and other people who care for the child.

Family education and support

It can be very challenging to care for a child with ODD. Disruptive behaviours can cause stress for parents and other family members.

The main form of management for ODD is to help parents and carers understand ODD and learn techniques to reduce and better manage disruptive behaviour. Information and counselling are available. Support groups with other families of children with ODD may also help.

Psychological management

Family counselling that helps family members communicate and solve problems more effectively may be helpful.

Mental health practitioner talking with a young girl with oppositional Defiant Disorder and her mother.Councelling can help with understanding and managing oppositional defiant disorder. 

Medication

There are currently no medications recommended for the treatment of ODD. However, many children with ODD are also diagnosed with attention deficit hyperactivity disorder (ADHD). Medications for ADHD, such as methylphenidate and dexamphetamine sulphate, may help to improve behaviour in children who have both disorders.

Treatment of adults

Following diagnosis, you can discuss options with your specialist for psychological management of your symptoms.

1. American Psychiatric Association. (2013) Diagnostic and Statistical Manual of Mental Disorders (5th edition). Washington D.C: American Psychiatric Publishing.

Potential complications

ODD and other developmental and mental disorders

There is a wide range of behaviour and mental health disorders that can cause similar symptoms to ODD. Part of the assessment procedure is to identify the pattern of symptoms and provide an accurate diagnosis, so that the most effective management can be recommended.

In some cases, a person with ODD may also be diagnosed with another disorder:

  • Children with ODD are frequently also diagnosed with attention deficit hyperactivity disorder (ADHD);
  • Both children and adults with ODD are at increased risk of anxiety and depression, and;
  • Adults and adolescents with ODD are at increased risk of substance abuse.

Conduct disorder

Conduct disorder is a more severe behaviour disorder than ODD. Conduct disorder involves a persistent pattern of behaviour that includes:

  • Bullying, threatening and committing violence against people or animals;
  • Deliberately destroying property;
  • Theft, lying to or deceiving others, and;
  • Disobeying essential rules (such as school attendance or night curfews).

Children with ODD can go on to develop conduct disorder.

1. American Psychiatric Association. (2013) Diagnostic and Statistical Manual of Mental Disorders (5th edition). Washington D.C: American Psychiatric Publishing.

Prognosis

Early intervention and management involving both the family and the child has been shown to help prevent the development of more serious behaviour disorders and mental health issues. ODD is a relatively new diagnosis, so research into therapies and ways to manage the condition are ongoing.

1. American Psychiatric Association. (2013) Diagnostic and Statistical Manual of Mental Disorders (5th edition). Washington D.C: American Psychiatric Publishing.

Prevention

Dealing with family difficulties and developing positive parenting practices may help to reduce a child's risk of developing ODD. 

1. American Psychiatric Association. (2013) Diagnostic and Statistical Manual of Mental Disorders (5th edition). Washington D.C: American Psychiatric Publishing.