Oppositional Defiant Disorder: Causes, Symptoms, and Treatment
Key takeaways:
Oppositional defiant disorder (ODD) is a common mental health condition.
ODD causes frequent outbursts of anger and aggression that are difficult to control.
ODD is treated with therapy, and caregivers play an important role in the success of therapy.
Oppositional defiant disorder, or ODD, is a condition that causes people to have uncontrollable outbursts of anger and defiance. ODD can start at any age, even as early as 2 years old, but kids usually start to have outbursts around 6 years old. ODD is common and affects about 10% of people. People with ODD face challenges in social situations and relationships.
If your child has symptoms of ODD, you may be wondering how you can help them learn to manage their emotions in a positive way. Let’s take a closer look at ODD and what you can do to help your child have positive social interactions.
What is oppositional defiant disorder?
ODD is a mental health condition. People with ODD have behavioral outbursts that are difficult to control. These outbursts cause trouble in social interactions. Children with ODD tend to have:
Temper tantrums: These temper tantrums are more extreme than those in other children their age. They also last longer and happen more frequently than is usual for their age.
Frequent arguments: Arguing with others from time to time is common and normal. But people with ODD argue to the point that it affects relationships with family and friends.
Outbursts of anger: These can happen more often than expected. Feeling angry is completely normal. But in ODD, these feelings of anger are more extreme and difficult to work through.
Expressions of vindictiveness: Such expressions include vengeful behavior.
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These behaviors are upsetting to the person experiencing them. People with ODD don’t want to have these outbursts, but they can’t control them. These outbursts make it hard to maintain relationships with family and friends. And outbursts can cause trouble at school and work.
What causes oppositional defiant disorder?
The cause of ODD isn’t clear, but certain things like genetics and environment can play a role:
Genetics: ODD is common among family members, suggesting that ODD is passed down from parent to child.
Personality: Some people experience emotions like anger more intensely than others.
Environment: Certain adverse or negative childhood experiences can increase the likelihood of developing ODD.
Biology: ODD has been linked to differences in brain areas (like the amygdala and frontal lobes) that regulate emotions.
What are the symptoms of ODD?
Children and adults with ODD have trouble regulating behaviors and emotions. They may have outbursts where they are argumentative, angry, and vindictive — often out of proportion to the situation.
ODD in children and adolescents
Children usually start to show ODD behaviors around 6 to 8 years old. Some behaviors you might notice include:
Temper tantrums that are more severe than expected
Frequent arguments with adults, including parents and teachers
Frequent fights (verbal or physical) with siblings and peers
Rule breaking
Blaming others for their mistakes
Becoming annoyed with others
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Among children with ODD, 10% develop a more severe behavior condition called “conduct disorder.” Children and teens with conduct disorder can do alarming things like steal, set fires, and hurt people. Fortunately, getting early treatment for ODD reduces the risk of ODD progressing to conduct disorder.
ODD in adults
Most children with ODD learn to manage their emotions by the time they are adults. This is especially true when children receive treatment. But some people have ODD that continues even into their adult years. Adults with ODD can have trouble with relationships and keeping their jobs. Some behaviors of ODD in adults include:
Arguments with significant others, bosses, and co-workers
Frequent anger outbursts
Irritable mood
Inability to handle criticism
Tendency to be easily offended
Statements that are hurtful to others
Almost all adults with ODD have another mental health condition. The most common are:
Anxiety
Depression
Bipolar disorder
Substance use disorder
Antisocial personality disorder
How is oppositional defiant disorder diagnosed?
A diagnosis for ODD is based on symptoms and a healthcare provider’s observations. Some tools healthcare providers use include the:
Child Behavior Checklist (CBCL): This is a survey that parents complete.
DSM-V: Healthcare providers use the DSM-V (Diagnostic and Statistical Manual of Mental Disorders) to diagnose mental health conditions. To be diagnosed with ODD, children need to show symptoms for at least 6 months. The symptoms have to impact day-to-day activities.
How is oppositional defiant disorder treated?
The most effective treatments for ODD are individual and family-based behavioral therapy. There are many types of therapy that can help with ODD, including:
Parent-Child Interaction Therapy (PCIT): PCIT focuses on the relationship between the caregiver and child. Therapists work with the family to develop structured and consistent responses to behaviors. Children learn to manage behaviors. Caregivers learn how to respond to behaviors and to be a positive role model.
Family therapy: Family therapy helps family members develop effective communication and coping skills.
Cognitive behavioral therapy (CBT): CBT teaches people how to identify and change thought patterns that trigger disruptive and impulsive behaviors.
Individual counseling: Individual therapy teaches people anger management skills. This includes anger management relaxation techniques such as mindfulness and deep breathing. It also teaches people how to engage in healthy activities that reduce stress, such as yoga and exercise.
Social skills training (SST): SST teaches people how to interact with others in a positive way.
How can I help my child?
If your child has ODD, there’s a lot you can do to help them:
Start therapy as soon as possible: Children who receive early treatment do better long term than those who don’t.
Be engaged and present at therapy sessions: Success depends on the whole family. You’ll learn important skills like de-escalation techniques as well as how to set expectations and provide positive feedback.
Be your child’s advocate: Make sure your child’s school understands ODD and provides appropriate accommodations.
Set expectations with others: Let family and friends know what to expect from your child’s behaviors. Prepare your child for social interactions, and step in when you see your child’s behavior escalating.
Be a role model: Show your child how to respond to conflict in everyday situations.
Be empathetic: Your child’s outbursts are difficult for everybody, but these outbursts upset your child most of all. Your child wants to be loved and have positive interactions with their friends and family.
Having a child with ODD can be challenging. Don’t forget to take care of yourself, too. Reach out to your support system and seek mental health support for your own needs.
The bottom line
Oppositional defiant disorder is a mental health condition where people, usually children, experience uncontrollable outbursts of aggression and anger. These outbursts are upsetting to children and make it difficult for them to succeed in school and in social situations. There is treatment for ODD to help children learn to identify and manage their emotions. With early and consistent therapy, children with ODD can overcome their outbursts and positively express their emotions.
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References
American Academy of Child and Adolescent Psychiatry. (2021). Temper tantrums.
American Association for Marriage and Family Therapy. (n.d.). Oppositional defiant disorder.
American Psychiatric Association. (n.d.). Diagnostic and statistical manual of mental disorders (DSM-5).
Fairchild, G., et al. (2019). Conduct disorder. Nature Reviews Disease Primers.
Ghosh, A., et al. (2017). Oppositional defiant disorder: Current insight. Psychology Research and Behavior Management.
Katzmann, J., et al. (2019). Social skills training and play group intervention for children with oppositional-defiant disorders/conduct disorder: Mediating mechanisms in a head-to-head comparison. Psychotherapy Research: Journal of the Society for Psychotherapy Research.
Mazefsky, C. A., et al. (2011). Child behavior checklist scores for school-aged children with autism: Preliminary evidence of patterns suggesting the need for referral. Journal of Psychopathology and Behavioral Assessment.
Pasalich, D. S., et al. (2014). Chapter 40. oppositional defiant disorder. Gabbard’s Treatments of Psychiatric Disorders.
PCIT International. (n.d.). What is parent-child interaction therapy (PCIT)?
Riley, M., et al. (2016). Common questions about oppositional defiant disorder. American Family Physician.
Sukhodolsky, D. G., et al. (2016). Behavioral interventions for anger, irritability, and aggression in children and adolescents. Journal of Child and Adolescent Psychopharmacology.
For additional resources or to connect with mental health services in your area, call SAMHSA’s National Helpline at 1-800-662-4357. For immediate assistance, call the National Suicide Prevention Lifeline at 988, or text HOME to 741-741 to reach the Crisis Text Line.
