Oppositional defiant disorder (ODD) is a behavioural disorder characterised by persistent defiant and argumentative behaviour towards authority figures/ adults, anger, irritability, vindictiveness, and problems managing emotions. Other symptoms include becoming easily frustrated, having poor impulse control, and showing antisocial behaviour. Symptoms commonly appear in early childhood and are usually diagnosed before early adolescence. These behaviours occur more than is expected in the individual's culture and for their age and gender, and last for more than six months.
ODD is likely caused by a mix of genetic and environmental factors. Having a family history of mental health conditions and having a certain temperament are factors associated with an increased risk of developing ODD. ODD is more common in children who have been neglected, had inconsistent or harsh parenting, experienced abuse, trauma or stress, and those whose parents have mental health issues or problems with substance abuse.
ODD can be defined as mild, moderate or severe. When ODD is mild this means behaviours occur in one setting. Moderate means behaviours are present across two settings, and in severe cases behaviour is present across three or more settings. For those with mild ODD the symptoms tend to lessen over time. Those with more severe ODD are at risk of developing conduct disorder and other mental health conditions, such as substance use disorders and antisocial personality disorder.
It is important to identify and treat ODD early as it can lead to problems later in life. The symptoms can impact on academic and work performance, and lead to difficulties in maintaining relationships.
- Defiant, argumentative, disrespectful behaviour toward authority figures/ adults.
- Angry and irritable mood.
- Easily frustrated and annoyed, and loses temper often.
- Refuses to follow instructions, requests, rules.
- Annoys or upsets others deliberately.
- Vindictive or spiteful.
- Blames circumstances or others for their mistakes and poor behaviour.
Treatment for ODD usually involves a combination of individual and family therapy.
Individual Therapy:
Individual psychological therapy, such as cognitive behavioural therapy (CBT), can be used to treat ODD. The aims of therapy are to learn how to better manage emotions and express emotions appropriately, learn how to cope with stress, develop problem solving skills, and improve interpersonal skills.
Social skills training can be incorporated into individual therapy. This aims to help the individual learn how to better interact and communicate with others, and form better relationships.
It is also important to identify and treat any other mental health conditions or issues the individual is facing.
Family Therapy:
Having a family member with ODD can be challenging. Many families benefit from parent training, family therapy, and support. Family therapy aims to teach parents/ caregivers and other family members how to increase good behaviour, reduce problem behaviour, and improve relationships and communication within the family.
Parent Management Training (PMT):
PMT teaches parents/ caregivers how to change behaviour through positive reinforcement. Parents learn how to use praise and reinforcement to increase good behaviour and decrease problem behaviour, and learn how to provide consistent parenting.
Parent-Child Interaction Therapy (PCIT):
PCIT is a form of therapy in which parents/ caregivers learn how to reinforce positive behaviour, develop good parenting skills, and improve parent-child relationships. During coaching sessions the therapist will guide the parent using an “ear-bug” or similar device as they interact with their child.
Collaborative Problem Solving (CPS):
CPS involves teaching problem solving skills to the child/ teen and their parents/ caregivers so they can work together to overcome challenges. The aims are to improve problem solving, reduce problem behaviours, and improve relationships. This is more commonly used with older children and teens.
Medication:
Medication is not usually used to treat ODD. However, it may be useful in treating other co-occurring disorders such as ADHD, anxiety, or depression.
This video was created for teachers of students with ODD. It provides practical tips for the classroom and advice on how to interact with a child with ODD. These strategies aim to help improve the child's behaviour, improve their learning and school experience, and help to build a good teacher-student relationship.
This Osmosis video outlines the different disorders under the ‘Disruptive, impulse control, and conduct disorders’ chapter in the DSM-5. It provides an overview of ODD, as well as conduct disorder, antisocial personality disorder, and other disorders in this category, and the main forms of treatment for these conditions.
“Overcoming ODD”, written by Dr. Gina Atencio-MacLean, is a guide to parenting a child with ODD while looking after your own wellbeing. This book outlines an approach in which you and your child work together to overcome ODD, and provides advice on helping your child manage their emotions in order to change defiant behaviours.