Oppositional defiant disorder refers to the persistent display of irrationally rebellious behavior and anger at authority figures over an extended period.
Oppositional defiant disorder (ODD) typically occurs in children, but it can also be present in early adolescence. Children can often be disobedient and argumentative, but consistent patterns of these behaviors could indicate an underlying disorder.
This article will discuss what ODD is, how to recognize it, and methods of treating the disorder.
Fast facts on ODD:
- ODD is a type of conduct disorder that more commonly occurs in younger children.
- Those with ODD are easily annoyed and frequently disobey rules.
- The most common form of treatment is psychotherapy.
Children and teenagers can display aggressive behavior as a result of many environmental and developmental factors.
Research into how the brain develops throughout childhood and adolescence suggests such behavior may not necessarily be the product of any identified structural disorder.
In fact, a greater understanding of how social factors affect a person's behavior means that some disobedient or argumentative behaviors is now perceived as normal or expected — not a conduct disorder.
What classifies as a disorder?
Conduct disorders describe a group of mental and behavioral disorders characterized by persistent patterns of behavior considered to be irritable, argumentative, aggressive, or disobedient.
To be classified as having a conduct disorder, a person must display these behaviors to a much greater extent than their peers.
Examples of behaviors that can result from a conduct disorder include:
- frequent lying
- aggressive and violent behavior
- persistent theft
- alcohol or drug use
Conduct disorders are relatively common in young people and can have an adverse impact on their social, educational, and home-life.
Children and young people with ODD characteristically display ongoing patterns of defiant, vindictive, angry, and argumentative behavior toward authority figures. For a trained mental health professional to diagnose ODD, these patterns of behavior must continue for at least 6 months and significantly impair a person's daily functioning.
Compared to other conduct disorders, ODD tends to present as disobedience or arguing with authority figures, such as teachers or parents, rather than antisocial behavior. It is a formally recognized disorder in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). ODD is not the same as autism spectrum disorders, despite sharing some behavioral similarities.
The symptoms of ODD often emerge when a child is 6 to 8 years old. It is also possible for some residual symptoms of ODD to be present in adults, who display very similar symptoms to children and adolescents. For example, an adult with ODD may display feelings of anger towards their manager at work, as opposed to a teacher or parent.
The cause of ODD is unknown, but it is likely to be a product of multiple environmental, developmental, and genetic factors. For example, a combination of environmental risk factors, such as childhood trauma or poverty and genetic factors, such as a predisposition for aggressive behavior, could cause ODD to develop.
Identifying the symptoms of ODD or any conduct disorder is challenging. All behaviors associated with ODD can occur in a child or teenager with varying degrees of frequency. In most cases, this is not a cause for concern.
However, behaviors that carry on for at least 6 months and have a serious impact on a child's daily life may indicate ODD.
These behaviors must be demonstrably more severe and more frequent than that of their peers.
In attempting to identify whether a person has ODD, it is essential to be sure how often they behave in a certain way.
If a person regularly displays the same behavior in a particular situation, an individual who suspects them of having ODD may then assume that this behavior happens more frequently than it does — this is because they expect the behavior to occur.
To help identify ODD, it can help to consult with others who regularly come into contact with the individual.
If a pattern of symptoms cannot be reliably established, the behavior is unlikely to be the product of a conduct disorder.
In such situations, it is best to avoid talking to the person about having a conduct disorder, or insisting they seek unnecessary medical attention, as this could cause them to feel alienated or resentful, possibly creating further problems.
All conduct disorders are diagnosed by a mental health professional, such as a psychiatrist. They will use diagnostic questions and follow the guidance set out in the DSM-5 to assess whether a person has ODD.
Criteria for diagnosing ODD according to DSM-5 include:
- A pattern of angry or irritable mood, argumentative or defiant behavior, or vindictiveness over a period of at least 6 months, expressed through interacting with an individual who is not a sibling.
- Behavior causes significant disruption to social, educational, occupational, or home functioning.
- Behavior is not caused by a different mental health problem, such as attention deficit hyperactivity disorder (ADHD).
ODD can vary in severity:
- Mild: symptoms are expressed in specific contexts, such as at school or home.
- Moderate: symptoms are expressed in at least two contexts.
- Severe: symptoms are expressed in three or more contexts.
To help them make an assessment, a psychiatrist may require reports from those who regularly interact with the individual. They will examine the person's medical and psychiatric history and may recommend further psychiatric testing if they suspect that another condition is causing the symptoms.
The symptoms of ODD can often overlap with different disorders, such as ADHD or bipolar disorder, which must first be ruled out.
Treating ODD is challenging because the causes of such behavior can be complex.
Each person is assessed individually, and treatment will differ from person-to-person.
Psychotherapy is a popular treatment option, but the specific type of psychotherapy will depend on the individual; the primary goal is to help the person find new ways of coping with stress, dealing with authority figures, and expressing emotion.
Other forms of treatment may be recommended to treat any underlying conditions that may be contributing to symptoms. For example, family therapy may be helpful if a problematic home-life is influencing the disorder.
Medication is not used to treat ODD but may be administered to treat a different underlying condition, such as ADHD.
ODD is often highly disruptive to daily functioning and can have some serious consequences, including substance abuse or incarceration. However, if diagnosed early enough, ODD can be successfully managed.
However, it is important that individuals who witness aggressive or unruly behavior be cautious about labeling it as a conduct disorder.