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Oppositional defiant disorder (ODD) - Symptoms and causes

Overview

Even the best-behaved children can be difficult and challenging at times. But oppositional defiant disorder (ODD) includes a frequent and ongoing pattern of anger, irritability, arguing and defiance toward parents and other authority figures. ODD also includes being spiteful and seeking revenge, a behavior called vindictiveness.

These emotional and behavioral issues cause serious problems with family life, social activities, school and work. But as a parent, you don't have to try to manage a child with ODD alone. Your health care provider, a mental health professional and a child development expert can help.

Treatment of ODD involves learning skills to help build positive family interactions and to manage problem behaviors. Other therapy, and possibly medicines, may be needed to treat related mental health conditions.

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Symptoms

Sometimes it's difficult to recognize the difference between a strong-willed or emotional child and one with oppositional defiant disorder. It's common for children to show oppositional behavior at certain stages of development.

Symptoms of ODD generally begin during preschool years. Sometimes ODD may develop later, but almost always before the early teen years. Oppositional and defiant behaviors are frequent and ongoing. They cause severe problems with relationships, social activities, school and work, for both the child and the family.

Emotional and behavioral symptoms of ODD generally last at least six months. They include angry and irritable mood, argumentative and defiant behavior, and hurtful and revengeful behavior.

Angry and irritable mood

  • Often and easily loses temper.
  • Is frequently touchy and easily annoyed by others.
  • Is often angry and resentful.

Argumentative and defiant behavior

  • Often argues with adults or people in authority.
  • Often actively defies or refuses to follow adults' requests or rules.
  • Often annoys or upsets people on purpose.
  • Often blames others for their own mistakes or misbehavior.

Hurtful and revengeful behavior

  • Says mean and hateful things when upset.
  • Tries to hurt the feelings of others and seeks revenge, also called being vindictive.
  • Has shown vindictive behavior at least twice in the past six months.

Severity

ODD can be mild, moderate or severe:

  • Mild. Symptoms occur only in one setting, such as only at home, school, work or with peers.
  • Moderate. Some symptoms occur in at least two settings.
  • Severe. Some symptoms occur in three or more settings.

For some children, symptoms may first be seen only at home. But with time, problem behavior also may happen in other settings, such as school, social activities and with friends.

When to see a doctor

Your child isn't likely to see their own behavior as a problem. Instead, your child will probably complain about unreasonable demands or blame others for problems.

If you think your child may have ODD or other problem behavior, or you're concerned about your ability to parent a challenging child, seek help from a child psychologist or a child psychiatrist with expertise in behavior problems. Ask your child's pediatrician or other health care provider for a referral to a mental health provider.

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Causes

There's no known clear cause of oppositional defiant disorder. Causes may include a combination of genetic and environmental factors:

  • Genetics. A child's natural personality or character — also called temperament — may contribute to developing ODD . Differences in the way nerves and the brain function also may play a role.
  • Environment. Problems with parenting that may involve a lack of supervision, inconsistent or harsh discipline, or abuse or neglect may contribute to developing ODD.

Risk factors

Oppositional defiant disorder is a complex problem. Possible risk factors for ODD include:

  • Temperament — a child who has a temperament that includes difficulty managing emotions, such as reacting with strong emotions to situations or having trouble tolerating frustration.
  • Parenting issues — a child who experiences abuse or neglect, harsh or inconsistent discipline, or a lack of proper supervision.
  • Other family issues — a child who lives with parent or family relationships that are unstable or has a parent with a mental health condition or substance use disorder.
  • Environment — problem behaviors that are reinforced through attention from peers and inconsistent discipline from other authority figures, such as teachers.

Complications

Children and teenagers with oppositional defiant disorder may have trouble at home with parents and siblings, in school with teachers, and at work with supervisors and other authority figures. Children and teens with ODD may struggle to make and keep friends and relationships.

ODD also may lead to other problems, such as:

  • Poor school and work performance.
  • Antisocial behavior.
  • Legal problems.
  • Impulse control problems.
  • Substance use disorder.
  • Suicide.

Many children and teens with ODD also have other mental health conditions, such as:

  • Attention-deficit/hyperactivity disorder (ADHD).
  • Conduct disorder.
  • Depression.
  • Anxiety disorders.
  • Learning and communication disorders.

Treating these other mental health conditions may help reduce ODD symptoms. It may be difficult to treat ODD if these other conditions are not evaluated and treated appropriately.

Prevention

There's no sure way to prevent oppositional defiant disorder. But positive parenting and early treatment can help improve behavior and prevent the situation from getting worse. The earlier that ODD can be managed, the better.

Treatment can help restore your child's self-esteem and rebuild a positive relationship between you and your child. Your child's relationships with other important adults in their life — such as teachers and care providers — also will benefit from early treatment.

By Mayo Clinic Staff

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Oppositional Defiant Disorder (ODD) in Children

What is oppositional defiant disorder (ODD) in children?

Oppositional defiant disorder (ODD) is a type of behavior disorder. It is mostly diagnosed in childhood. Children with ODD are uncooperative, defiant, and hostile toward peers, parents, teachers, and other authority figures. They are more troubling to others than they are to themselves.

What causes ODD in a child?

Researchers don’t know what causes ODD. But there are 2 main theories for why it occurs:

  • Developmental theory. This theory suggests that the problems start when children are toddlers. Children and teens with ODD may have had trouble learning to become independent from a parent or other main person to whom they were emotionally attached. Their behavior may be normal developmental issues that are lasting beyond the toddler years.
  • Learning theory. This theory suggests that the negative symptoms of ODD are learned attitudes. They mirror the effects of negative reinforcement methods used by parents and others in power. The use of negative reinforcement increases the child’s ODD behaviors. That’s because these behaviors allow the child to get what he or she wants: attention and reaction from parents or others.

Which children are at risk for ODD?

ODD is more common in boys than in girls. Children with the following mental health problems are also more likely to have ODD:

  • Mood or anxiety disorders
  • Conduct disorder
  • Attention-deficit/hyperactivity disorder (ADHD)

What are the symptoms of ODD in a child?

Most symptoms seen in children and teens with ODD also happen at times in other children without it. This is especially true for children around ages 2 or 3, or during the teen years. Many children tend to disobey, argue with parents, or defy authority. They may often behave this way when they are tired, hungry, or upset. But in children and teens with ODD, these symptoms happen more often. They also interfere with learning and school adjustment. And in some cases, they disrupt the child’s relationships with others.

Symptoms of ODD may include:

  • Having frequent temper tantrums
  • Arguing a lot with adults
  • Refusing to do what an adult asks
  • Always questioning rules and refusing to follow rules
  • Doing things to annoy or upset others, including adults
  • Blaming others for the child’s own misbehaviors or mistakes
  • Being easily annoyed by others
  • Often having an angry attitude
  • Speaking harshly or unkindly
  • Seeking revenge or being vindictive

These symptoms may look like other mental health problems. Make sure your child sees his or her healthcare provider for a diagnosis.

How is ODD diagnosed in a child?

If you notice symptoms of ODD in your child or teen, you can help by seeking a diagnosis right away. Early treatment can often prevent future problems.

A child psychiatrist or qualified mental health expert can diagnose ODD. He or she will talk with the parents and teachers about the child’s behavior and may observe the child. In some cases, your child may need mental health testing.

How is ODD treated in a child?

Early treatment can often prevent future problems. Treatment will depend on your child’s symptoms, age, and health. It will also depend on how bad the ODD is.

Children with ODD may need to try different therapists and types of therapies before they find what works for them. Treatment may include:

  • Cognitive-behavioral therapy. A child learns to better solve problems and communicate. He or she also learns how to control impulses and anger.
  • Family therapy. This therapy helps make changes in the family. It improves communication skills and family interactions. Having a child with ODD can be very hard for parents. It can also cause problems for siblings. Parents and siblings need support and understanding.
  • Peer group therapy. A child develops better social and interpersonal skills.
  • Medicines. These are not often used to treat ODD. But a child may need them for other symptoms or disorders, such as ADHD.

How can I help prevent ODD in my child?

Researchers don’t know what causes ODD. But certain approaches can help prevent the disorder. Young children be helped by early intervention programs that teach them social skills and how to deal with anger. For teens, talk therapy (psychotherapy), learning social skills, and getting help with schoolwork can all help reduce problem behaviors. School-based programs can also help to stop bullying and improve relationships among teens.

Parent-management training programs are also important. These programs teach parents how to manage their child’s behavior. Parents learn positive reinforcement methods, and also how to discipline their child.

How can I help my child live with ODD?

Early treatment for your child can often prevent future problems. Here are things you can do to help:

  • Keep all appointments with your child’s healthcare provider.
  • Take part in family therapy as needed.
  • Talk with your child’s healthcare provider about other providers who will be involved in your child’s care. Your child may get care from a team that may include counselors, therapists, social workers, psychologists, and psychiatrists. Your child’s care team will depend on his or her needs and how serious the disorder is.
  • Tell others about your child’s conduct disorder. Work with your child’s healthcare provider and school to develop a treatment plan.
  • Reach out for support. Being in touch with other parents who have a child with ODD may be helpful. If you feel overwhelmed or stressed out, talk with your child’s healthcare provider. He or she may direct you to a support group for caregivers of children with ODD.

When should I call my child’s healthcare provider?

Call your child’s healthcare provider right away if your child:

  • Feels extreme depression, fear, anxiety, or anger toward him or herself or others
  • Feels out of control
  • Hears voices that others don’t hear
  • Sees things that others don’t see
  • Can’t sleep or eat for 3 days in a row
  • Shows behavior that concerns friends, family, or teachers, and others express concern about this behavior and ask you to seek help

Call 911 if your child has suicidal thoughts, a suicide plan, and the means to carry out the plan.

Key points about ODD in children

  • Oppositional defiant disorder (ODD) is a type of behavior disorder. Children with ODD are uncooperative, defiant, and hostile toward peers, parents, teachers, and other authority figures.
  • Developmental problems may cause ODD. Or the behaviors may be learned.
  • A child with ODD may argue a lot with adults or refuse to do what they ask. He or she may also be unkind to others.
  • A mental health expert often diagnoses ODD.
  • Therapy that helps the child interact better with others is the main treatment. Medicines may be needed for other problems, such as ADHD.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

  • Know the reason for the visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
  • Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
  • Ask if your child’s condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if your child does not take the medicine or have the test or procedure.
  • If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.

Attention! Oppositional defiance disorder! | Children without problems

6 behavioral signals that should alert you

“I always knew that my son was “special”. His tantrums lasted for hours. Every morning was terrible: hair stood on end at the thought that the day would begin with Dylan's defiance. Every day we waged an incessant struggle for everything and everyone. Sometimes he yelled because his underwear felt too tight, or too down, that is, when he simply was not very comfortable. Sometimes he didn't want to wear sneakers because he thought they were too big or too small, although yesterday he wore them willingly. He could spit at me when, for the words “I hate you, mom,” I suggested that he go into the room and “cool down. ” Such situations could happen every day, all day…”

- Megan Ruffing

So, what behavioral features of children with oppositional defiance disorder do we need to know so that when we meet them, we will try to identify this disorder and be able to feel comfortable? And what is important for the parents of such a child to know?

  1. Tantrums

“They lasted for hours. Just like that, for no reason. Throwing things, fighting, spitting, crying, screaming, whining non-stop. These tantrums are fundamentally different from the whims of your child. Trust me: their you will distinguish.

  1. Defiance

“Whatever you order or ask, the child does exactly the opposite of what was ordered, be it something elementary - brushing your teeth, or something serious - please do not hit anyone. Children with ORD easily and enjoy challenging people; especially adults. You have to think coldly. Do not succumb to provocations, in no case be angry with the child. Maintaining firmness of mind, observe the regime moments adopted in your family.

  1. Mood swings

“A minute ago the child was laughing happily, and the next moment he is sullen and irritated? This may be because the toy does not work the way he wants. Usually children with ORN are hypersensitive, they get tired when they cannot control everything that happens, which manifests itself outwardly as fatigue. If you think these mood swings are causing distress to other family members, you should get tested for Bipolar Disorder .”

  1. The child does not get enough sleep

“Interrupted, shallow sleep enhances the child's explosive nature. The vast majority of children with any behavioral disorder have difficulty falling asleep, waking up, or even both. Imagine that you sleep much less than usual. You may feel tired, tense, somewhat irritated. The same thing happens with your child. Add to everything else a mental disorder, and you get a recipe for very difficult everyday life.

  1. Praise

“Children with ORD don't always like praise. If this is your case, then when the child takes play actions, do something similar. Imitate the game actions that he does. Repeat after him. For example, when a child rolls the car on the carpet with the sound "vroom-vroom", you roll the car too. When the baby is swaddling the baby doll, take the toy and swaddle it while standing or sitting next to the baby. This method of play therapy is applicable always and everywhere. Such a game serves as proof of your involvement. The child feels that you are listening, you are interested in what he lives, what he is fond of.

  1. Inability to verbally indicate feelings

“A child with ORN cannot always express feelings of affection, love. Don't dwell on it and just get on with your life. Enjoy when the baby hugs you.

That's all the advice from the beautiful and heroic Megan. Liked the article? Share it with your friends with a link to our website. In the section "Accessible Environment" there is a lot of interesting things about children with special needs!

Do you have something to add? Unsubscribe in the comments!

©Davydenko Lolita Dmitrievna. Intellectual property of ANO "Infosadik". Translation from English. Original Lyricist: Meagan Ruffing. Journal: Special Needs Guide.

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In the heading Accessible Environment

Lolita Dmitrievna administrator of Infosadik groups in social networks. These groups are for parents of preschoolers. Currently, articles on how to communicate with children with disabilities are relevant. Lolita Dmitrievna translates interesting articles about children with disabilities and publishes them on this site in the "Accessible Environment" section. These articles are unique because their authors are parents with extensive professional and personal experience working with children with disabilities. We see that these publications are also relevant for parents of normal, healthy children. Having got acquainted with them, you can bring new notes of mutual understanding and love into communication with your child.

View all entries by Lolita Davydenko

10 Ways to Respond When Your Child Refuses to Listen

At one time or another, almost all children will push their feet, look at their parents, and respond with a resounding “No!” when told to do something. As painful as it is to hear, breaking rules can be part of a child's healthy development.1

When children are testing boundaries or asserting themselves, they are trying to become more independent. While nascent independence is healthy, persistent defiance is not.1

If your children say "You can't make me!" when you ask them to pack up their toys, or pretend not to hear you when you tell them to go home, taking appropriate action will encourage them to start better listen. Here are ten steps to deal with disobedience.

Positive attention

Failure to comply can be a great way for children to get attention. Even if it's negative attention, some kids still crave it. In fact, one study found that ignoring non-compliant behavior is effective in getting children to be more obedient.1

Another way to shield yourself from attention-seeking non-compliance behavior is to give your child a daily dose of positive attention. Play a game together, spend time talking, or go for a walk. Just a few minutes of positive attention can significantly reduce the level of rebelliousness.

Praise Obedient Behavior

Although it can be difficult to spot good behavior when your child consistently refuses to obey, it is important to find good behavior to praise. You may even have to make simple requests to children only to praise them for doing it.

At the dinner table, you might say, "Please give me a pepper." Then, as soon as the child complies with the request, say: “Thank you for giving me the pepper just when I asked you to. ” With this compliment or praise, you will make it clear that you appreciate their performance.

Give effective instructions

Verify that the challenging behavior you are seeing is really challenging. If your kids can't hear you or are too distracted by video games or the phone, you may need to change the way you give directions.

Making eye contact or putting your hand on their shoulder will help you get their attention before you speak. Turn off background noise and make sure your children are paying attention so they can absorb what you are saying to them.

Offer specific options

One of the best ways to deal with defiant behavior is to offer two options. When you offer a choice, your children feel they have control over the situation. Avoid questions like "Do you want to get dressed now?" because the defiant child will automatically answer "No!".

Ask questions like "Do you want to wear a red or yellow shirt?" Make sure you can come to terms with your child's choices before offering them options.

Use Grandma's Rule of Discipline

Grandma's discipline rule of rewarding rather than pointing out negative consequences can be one of the best ways to encourage submission. With regular use of this rule, children begin to understand that they have some control over when they receive their privileges.

So instead of saying, "You can't play your video game because you didn't clean your room," try saying, "You can play your video game as soon as you clean your room." This small change in your message can motivate your child to get to work.

Create a reward system

Create a reward system that encourages your child to be obedient. Provide frequent positive reinforcement and consider creating a token reward system to keep your child on track. It is a form of behavior modification aimed at encouraging healthy, collaborative behavior by providing positive reinforcements (or rewards)2.

For example, children are awarded a token each time they listen to your instructions without arguing. They then exchange the tokens for larger rewards, such as time spent with electronics or a chance to go to the park.

Develop a behavior contract

Behavior contracts remind children that they can get more privileges if they show they can behave responsibly. An effective behavior contract helps children show when they are ready for more privileges.3

For example, if bedtime is a battle, then this issue can be resolved with a behavior contract. Include in the contract the option to go to bed 15 minutes late after the kids show they can go to bed on time for a week without arguing.

Avoid power struggles

Avoid getting into power struggles with a naughty child. If you fight for power, it will only aggravate defiance. Instead, use a warning, such as an "if...then" statement, to change the behavior.

Give only one warning and follow up if necessary.

It is very important not to waver in your if-then statements. If you do, it will only encourage more defiance because they don't think anything will really happen if they don't obey you.

Use logical consequences

Each case of non-compliance must have negative consequences. Timeout or logical consequences such as revocation of privileges are effective ways to prevent disobedience.

Remember that consistent discipline is the key to reducing challenging behavior.

Seek professional help

Although extreme defiance may be indicative of a more serious problem, such as oppositional deviant disorder4, occasional defiance and non-compliance are normal behavioral problems in children. If you are concerned that your child may have a more serious problem, or if your discipline strategies are not working, talk to your child's pediatrician about getting professional help.

In addition to looking for an explanation for your child's behavior, your doctor may recommend parenting courses or workshops to help you hone your skills.

A word from mentalar

It's easy to get angry and upset when your child challenges you. But it is important to remind ourselves that in most cases, disobedience and non-compliance with the rules are child behavior problems that all parents face from time to time. With a little patience and the right disciplinary strategies, you can help teach your kids how to make the right choices and at the same time reduce the amount of defiant behavior you encounter.

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Bibliography

Leiten P, Gardner F, Melendez-Torres GJ, Knerr W, Overbeck G. Parental Behaviors That Shape Child Consent: A Multilevel Meta-Analysis.
Scott H. C., Jane A., Cogburn M. Behavior modification.

D. G. Sukhodolsky, S. D. Smith, S. A. McCauley, K. Ibrahim, J. B. Piasecka Behavioral interventions for anger, irritability and aggression in children and adolescents.
Ghosh A, Ray A, Basu A. Oppositional defiant disorder: current understanding.

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