Oppositional behavior is a normal part of development for two to three year olds and early adolescents. However, openly uncooperative and hostile behavior becomes a serious concern when it is so frequent and consistent that it stands out when compared with other children of the same age and developmental level and when it affects the child’s social, family, and academic life. Oppositional defiant disorder (ODD) is a type of disruptive, impulse-control behavior disorder. It is mostly diagnosed in childhood. Oppositional Defiant Disorder, is an ongoing pattern of uncooperative, defiant, and hostile behavior toward authority figures that seriously interferes with a child’s day to day functioning.

Oppositional Defiant Disorder Defined

The essential features of oppositional defiant disorder is a frequent and persistent pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness. It is not unusual for individuals with oppositional defiant disorder to show the behavioral features of the disorder without problems of negative mood. However, individuals with the disorder who show angry/irritable mood symptoms typically show the behavioral features as well. The symptoms of oppositional defiant disorders may be confined to only one setting and this is most frequently the home. Individuals who show enough symptoms to meet the diagnostic threshold, even if it is only at home, may be significantly impaired in their social functioning. The rate of oppositional disorder may vary depending on the age and gender of the child. The disorder appears to be somewhat more prevalent in males than in females prior to adolescents.

Different Types of Oppositional Defiant Disorder

While there are not different types of oppositional defiant disorders, there are levels of severity. These levels are listed in the Diagnostic Statistical Manual for Mental Disorder V.

  • Mild: Symptoms are confined to only one setting (e.g., at school, home, at work, with peers).
  • Moderate: Some symptoms are present in at least 2 settings.
  • Severe: Some symptoms are present in 3 or more settings.

Oppositional Defiant Disorder Causes

Oppositional defiant disorder can be caused by various factors but there is no one known cause. Oppositional defiant disorder has been linked to a combination of inherited and environmental factors. A child’s natural disposition or temperament and possibly neurobiological differences in the way nerves and the brain function may be the cause of ODD. Other factors may be problems with parenting that may involve a lack of supervision, inconsistent or harsh discipline, or abuse or neglect.

Oppositional Defiant Disorder Symptoms

To be diagnosed with oppositional defiant disorder, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the following criteria must be met:

A. A pattern of angry/irritable mood, argumentative/defiant disorder behavior, or vindictiveness lasting at least 6 months as evidenced by at least four symptoms from any of the following categories, and exhibited during interaction with at least one individual who is not a sibling.                                                                              

Aggression to People and Animals

    1. Often loses temper.
    2. Is often touchy or easily annoyed.
    3. Is often angry and resentful.

        Argumentative/ Defiant Behavior

    1. Often argues with authority figures or, for children and adolescents, and adults.
    2. Often actively defies or refuses to comply with requests from authority figures or with rules.
    3. Often deliberately annoys others.
    4. Often blames others for his or her mistakes or misbehavior.

        Vindictiveness

    1. Has been spiteful or vindictive at least twice within the past 6 months.

Note: For children younger than 5 years old, the behavior should occur on most days for a period of at least 6 months unless otherwise noted. For individuals 5 years or older, the behavior should occur at least once per week for at least 6 months, unless otherwise noted.

B. The disturbance in behavior is associated with distress in the individual or others in his or her immediate social context (e.g., peer group, family, work colleagues), or it impacts negatively on social, occupational, educational, or other important areas of functioning.

C. The behaviors do not occur exclusively during the course of a psychotic, substance use, depressive, or bipolar disorder. Also, the criteria are not met for disruptive mood dysregulation disorder.

How to Approach a Loved One:

Depending on the loved one, there can be different way to approach them. It is important to let a loved one know to seek the help of a mental professional, or if you are a caregiver, take them for an evaluation as soon as possible. Be as supportive as possible and depending on who the loved one is, consistently participating in treatment can also be helpful. 

Types of Oppositional Defiant Disorder Treatment

There are effective treatments for oppositional defiant disorder. Treatments for oppositional defiant disorder are designed to decrease or eliminate as many identified problem behaviors as possible in the short-term and also to work towards the long-term goal of preventing children’s behavioral problems from worsening over time (for instance, becoming Conduct disorder). The earlier the condition is diagnosed, the more successful the therapy will be. 

Psychotherapy

Psychotherapy, also known as talk therapy or psychological counseling is used to identify the patterns of behaviors, thoughts, beliefs, etc. that may impact individuals with oppositional defiant disorder.

In cognitive behavioral therapy the child learns to better solve problems and communicate. The individual also learns how to control impulses and anger. Other aspects of therapy may be aimed at helping an individual identify and change thought patterns that lead to behavior problems.

  • Family Therapy

Family therapy will help makes changes in the family dynamic as a whole. Family therapy can help improve communication skills and family interactions. It will also provide support for the siblings that may also be impacted by the individual with the OCD diagnosis.

Parent training

The development of parenting skills can help create an environment that is less frustrating for everyone and more positive. In some cases, a child may participate in parenting training. A child can work together with their parents to come up with solutions that work for both of them, consequently helping improve ODD-related problems.

 Involving other authority figures, such as teachers, in the training may be an important part of treatment.

Medications

Medications alone generally aren’t used for ODD unless an individual also has another mental health disorders. If an individual has coexisting disorders, such as ADHD, anxiety or depression, medications may help improve these symptoms.

Social Skills Training

Children may benefit from therapy that will help him or her be more flexible and learn how to interact more positively and effectively with peers.

Differences Between Common Disorders

There are other possible causes that resemble oppositional defiant disorder but do not qualify as a oppositional defiant disorder. These are common disorders but the differences between them and oppositional defiant disorder. 

  • Conduct disorder- Conduct disorder and oppositional defiant disorder are both related to conduct problems that bring the individual in conflict with adults and other authority figures (e.g., parents, teachers, supervisors). The behaviors of ODD typically  are of a less severe nature  than those of individuals with oppositional defiant disorder and do not include aggression toward individuals or animals, destruction of property, or a pattern of theft or deceit. Oppositional defiant disorder includes problems of emotional dysregulation (i.e., angry and irritable mood) that are not included in the definition of conduct disorder.
  • Attention-deficit/hyperactivity disorder (ADHD)- ADHD is often comorbid with oppositional defiant disorder. It is important to determine that the individual’s failure to conform to requests of others is not solely in situations that demand sustained effort and attention or demand that the individual sit still. 
  • Depressive and bipolar disorders- Depressive and bipolar disorders often involve negative affect and irritability. Oppositional defiant disorder should not be diagnosed if the symptoms occur exclusively during the course of a mood disorder.
  • Disruptive mood dysregulation disorder- Oppositional defiant disorder shares with disruptive mood dysregulation disorder the symptoms of chronic negative mood and temper outbursts. However, the severity, frequency, and chronicity of temper outbursts are more severe in individuals with disruptive mood dysregulation disorder than in those with oppositional defiant disorder.
  • Intermittent explosive disorder- Intermittent explosive disorder also involves high rates of anger. However, individuals with this disorder show serious aggression toward others that is not part of the definition of oppositional defiant disorder. 
  • Intellectual disability (intellectual developmental disorder)- In individuals with intellectual disability, a diagnosis of oppositional defiant disorder is given only if the oppositional behavior is markedly greater than is commonly observed among individuals of comparable mental age and with comparable severity of intellectual disability.
  • Language disorder- Oppositional defiant disorder must also be distinguished from a failure to follow directions that is the result of impaired language comprehension (e.g., hearing loss).
  • Social anxiety disorder (social phobia)- Oppositional defiant disorder must be differentiated from defiance due to a fear of negative evaluation associated with social anxiety disorder. 

 

Resources

American Psychiatric Association (2019). Diagnostic and statistical manual of mental disorders. (5th ed.) Arlington, VA: American Psychiatric Association.

American Academy of Child and Adolescent Psychiatry. (2019). Retrieved from: https://www.aacap.org/aacap/families_and_youth/facts_for_families/fff-guide/Children-With-Oppositional-Defiant-Disorder-072.aspx

John Hopkins Medicine. (2019). Oppositional Defiant Disorder in Children. Retrieved from: https://www.hopkinsmedicine.org/healthlibrary/conditions/mental_health_disorders/oppositional_defiant_disorder_90,p02573

Mayo Clinic. (2019). Retrieved from: https://www.mayoclinic.org/diseases-conditions/oppositional-defiant-disorder/diagnosis-treatment/drc-20375837

WebMD. (2019). Retrieved from: https://www.webmd.com/mental-health/oppositional-defiant-disorder#1