Oppositional defiant disorder (ODD) is a behavior disorder where children are frequently uncooperative or hostile. It may have genetic, environmental, and psychosocial causes.

Children with ODD have a pattern of argumentative and defiant behavior and may be frequently angry or vindictive.

This article looks at the symptoms, causes, diagnosis, and treatment of ODD in children.

A child looking at their shadowShare on Pinterest
Lorenzo Dominguez/Getty Images

One of the key features of ODD is a frequent pattern of argumentative or defiant behavior, irritability, anger, or vindictiveness toward others.

All children may exhibit these behaviors at times, particularly if they are upset, hungry, or tired, but those with ODD display these behaviors persistently over an extended period.

Their behavior will also affect those around them and harm their home or school life and other areas.

ODD symptoms may include:

  • frequently arguing with adults
  • often being angry or resentful
  • frequent temper tantrums
  • often questioning or defying rules and requests from adults
  • deliberately trying to annoy or upset others
  • being spiteful or vindictive toward others
  • being touchy or easily annoyed
  • blaming others for their own misbehavior or mistakes
  • seeking revenge on others
  • talking in a mean or hateful way when upset

ODD may occur due to a combination of environmental, genetic, and psychosocial factors:

  • Genetics: Genetics can play a part in ODD and may also link to other disorders, including conduct disorder, attention deficit hyperactivity disorder (ADHD), and depressive disorder. Differences in the brain and cortisol levels may also contribute.
  • Environment: Abuse, maltreatment, or harsh, inconsistent parenting may contribute to ODD in children.
  • Psychosocial: Certain factors, such as poverty, neighborhood violence, and rejection from peer groups, may all play a role in ODD. Certain traits, such as impulsivity and high emotional reactivity, commonly link to ODD.

ODD may be more likely to occur in children with families who have a history of the following:

Other risk factors for ODD include:

  • a lack of parental supervision
  • a lack of structure
  • inconsistent discipline
  • exposure to abuse or violence in the community

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR), a child or adolescent must display at least four of the following symptoms on most days over at least 6 months:

  • often losing their temper
  • is often easily annoyed or touchy
  • is often angry and resentful
  • often argues with authority figures or adults
  • often annoys others deliberately
  • often actively defies rules or refuses to follow requests from authority figures
  • often blames others for their own misbehavior or mistakes
  • has been vindictive or spiteful to others at least twice in the last 6 months

A doctor will carry out a full psychiatric examination of the child and rule out any other conditions, such as ADHD and anxiety disorders. They will also carry out an academic assessment to check for any learning disorders.

Treatment for ODD will be individual to each child but may include the following:

  • parent management training, which helps support parents and caregivers in managing the child’s behavior
  • psychotherapy for the child to help with anger management
  • family psychotherapy to help improve communication and understanding within the family
  • cognitive therapies to help develop problem-solving skills and reduce negativity
  • social skills training to help improve social skills, reduce frustration, and improve flexibility toward others

Psychological treatments are the first-line treatment for ODD in children. However, a doctor may recommend medications if psychological treatments are ineffective on their own or to treat any co-existing conditions such as ADHD.

Learn more about treatment for ODD.

Certain interventions may have the potential to help prevent ODD in children who show signs of the disorder.

In preschool children, this may include home visits and Head Start programs for families who have a higher risk of ODD.

In school-age children, prevention strategies may include:

  • parent management training
  • conflict resolution and anger management programs
  • social skills training

For adolescents, programs to reduce behaviors with links to ODD may include:

  • cognitive interventions
  • skills training
  • vocational training
  • academic preparation

Programs within schools, such as anti-bullying programs, may help, although group treatment programs may also have some negative effects.

Ways that parents and caregivers can help support their child with ODD include the following:

  • Use praise and positive reinforcement when a child cooperates or behaves positively.
  • Encourage using time outs during conflict for both adults and children if emotions are running high.
  • Prioritize the behaviors or tasks that are most important and focus on challenging those first.
  • Set age-appropriate, fair limits for a child, with clear consequences that parents enforce consistently.
  • Provide consistency and structure for the child.
  • Seek support from other adults in the child’s life, such as teachers, coaches, and healthcare professionals.
  • Prioritize self-care to maintain energy and manage stress, such as relaxation, exercise, and breaks away.

Below are answers to common questions about childhood ODD.

What triggers ODD in a child?

Certain environmental and social factors may contribute to ODD in children, such as:

  • lack of structure, parental supervision, or discipline
  • abuse
  • neighborhood violence

Other factors linked to ODD in children include:

  • their temperament
  • genetics
  • family history of certain disorders, such as ADHD

Can a child outgrow ODD?

According to the American Academy of Child & Adolescent Psychiatry, ODD improves over time in many children. Research has shown that in around 67% of children, ODD may resolve within 3 years.

However, in around 30% of children, ODD may develop into conduct disorder. This risk is greater in children who had an earlier initial diagnosis of ODD, such as at preschool age.

Children with an early ODD diagnosis may also have an increased risk of developing additional disorders later on, such as anxiety and mood disorders or ADHD.

Around 10% of children with ODD may later develop a long-term personality disorder, such as anti-social personality disorder.

ODD in children is a persistent pattern of argumentative, defiant, or vindictive behavior. Treatment may include psychotherapy, skills training programs, and, in some cases, medications.