What is oppositional defiant disorder?

Oppositional defiant disorder - Tikvah Lake Recovery

Oppositional defiant disorder is when someone shows a pattern of behavior that is angry, belligerent, defiant, and disobedient and that lasts for six months or more. Often known as ODD, it is one of the most common behavior disorders from preschool age to adulthood.

This combative manner is most often directed at authority figures, such as parents and teachers. It can include a refusal to follow rules, openly displaying hostility, temper tantrums, excessive arguing, being vindictive, and purposely setting out to upset others.

Usually, over time it becomes increasingly obvious that it is more than normally seen in the “terrible twos” or during teenage years. The behavior often disrupts the person’s daily routine – and those around them too – including at school and home.

In the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) – the handbook used by healthcare professionals to diagnose mental health disorders – ODD is defined as “a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness”. It was first defined in the DSM-III published in 1980.

Persisting for at least six months, ODD behaviors will need to have significantly disturbed social or academic activities and/or caused significant anguish to the family for a child or teenager to be diagnosed with ODD.

It can greatly affect a child or teenager’s education as well as their ability to make friends. Homelife can be extremely problematic and affect the whole household and sometimes neighbors too.

Adults diagnosed with ODD when they are children have a greater chance of being diagnosed with other emotional and mental health problems during their lifetime.

Who has ODD?

There is no specific reason that has been identified up until now as causing ODD. However, mental health experts consider it to be caused by a combination of environmental, biological, and genetic factors.

Often going undiagnosed, it makes it difficult to ascertain how many people have ODD. Estimates range from two percent to 16 percent of young people under the age of 20 as having some signs that could see them diagnosed with ODD.

Normally there will be symptoms between the ages of six to eight – although it can be seen in children under the age of six as well. In younger children, it is more commonly diagnosed in boys, but in older children and teens it’s seen in both sexes equally, with girls’ prevalence particularly increasing after puberty.

Symptoms for both sexes can persist throughout the teenage years. ODD differs from conduct disorder (CD) as those with ODD aren’t usually physically aggressive in any way towards people or animals, do not steal and act dishonestly in other ways, and do not destroy property.

Two-thirds of children will naturally or with some help “grow out” of ODD. If not treated though, ODD can progress to CD. Occasionally, this can then lead to antisocial personality disorder (ASPD, or sometimes called sociopathy).

Many people who are diagnosed with ODD also have other behavioral issues. Most commonly these are attention deficit hyperactivity disorder (ADHD), depression, and anxiety. It can also mean more likely use of alcohol addictively or substance abuse and addiction.

What are the symptoms of ODD?

In the DSM, ODD is under the Disorder Class: Disruptive, Impulse-Control, and Conduct Disorders. It states that someone must show four of these eight symptoms for six months to be diagnosed with ODD.

For children under five years old, the behavior needs to happen on most days for at least six months. For those aged five years and over, the behavior needs to happen at least once a week for at least six months. 

  1. Often loses temper.
  2. Is often touchy or easily annoyed.
  3. Is often angry and resentful.
  4. Often argues with authority figures or, for children and adolescents, with adults.
  5. Often actively defies or refuses to comply with requests from authority figures or with rules.
  6. Often deliberately annoys others.
  7. Often blames others for their mistakes or misbehavior.
  8. Has been spiteful or vindictive at least twice within the past six months.

If these signs are seen in two settings, then the ODD is viewed as moderate. If the symptoms are observed in three or more settings, then it is considered severe.

What can I do to help a child diagnosed with ODD?

Mental health - Tikvah Lake Recovery

It can be useful to many people who have a child diagnosed with ODD to find support for themselves. Ask at a local health center or find an ODD support group online, such as on Facebook.

There are also some books published that may help. These include The Defiant Child: A Parent’s Guide to Oppositional Defiant Disorder by the child and adolescent psychologist Dr. Douglas Riley.

There are other things that can help, including:

  • Steer clear of power battles, and pick which battles you do take on.
  • Praise your child frequently and especially for good behavior.
  • Set your child up for success and subsequent praise in various tasks around the house and elsewhere.
  • Offer and give rewards for positive behavior, particularly when the child is younger.
  • Have a regular routine with and for your child.
  • Do plenty of things you both enjoy together, making sure to have daily one-on-one time.
  • Let your child have lots of opportunities for creative play, so they can use their imagination.
  • Model positive behaviors you would like in your child, so they can repeatedly see good examples.
  • Try not to ask your child too many questions.
  • Set specific boundaries and limits – with clear consequences for breaking them, although let the child know these are the consequences rather than a punishment.
  • Ensure other family members are all consistently working together.

ODD treatment depends on several factors, including the severity of symptoms and the child’s age. Therapy has been proven to help many children and their families a great deal.

If your child is diagnosed with ODD, it is vital to find help as soon as possible. Treatment can really help – and without it, the situation may worsen at home and school, as well as increase the likelihood of ODD developing into CD.

Our expert team here at our luxury recovery center in Florida has vast experience in helping people with all types of emotional and mental health problems. Get in touch with us today to hear how we can help you or someone you know.

David Hurst - Tikvah Lake Recovery

About David Hurst

David Hurst has four books published on mental health recovery, including 12 Steps To 1 Hero, The Anxiety Conversation and Words To Change Your Life. He has written for national newspapers and magazines around the world for 30 years including The Guardian, Psychologies, GQ, Esquire, Marie Claire and The Times. He has been in successful continual recovery since January 2002.

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