Every child and adolescent react to difficult situations in their own way according to different factors. Some of them may include character, genetics, education, and culture. However, when the reaction is not functional, is excessive, constant and affects several aspects of the kid’s relationship with the environment (home, school or other scenarios) we might consider it a problem. That is the case of the Oppositional Defiant Disorder. Here’s some important information about this behavioral disorder. 

What is the Oppositional Defiant Disorder?

The Oppositional Defiant Disorder (ODD) is defined by the National Institute of Health as “a persistent pattern of defiant, disobedient and hostile behavior towards authority figures; a frequent loss of temper, arguing, becoming angry or vindictive, or other negative behaviors”.

In addition, Oppositional Defiant Disorder belongs to the group of Disruptive Behavior Disorders (DBD). Children or adolescents experiencing this disorder have a tendency to disrupt or disturb those around them and the environment they live in. Very often they rebel and have arguments with adults, refusing to obey. Moreover, they might even develop a lack of self-control, having tantrums and behaving verbally aggressive towards parents and teachers.

What are the causes of Oppositional Defiant Disorder?

The exact cause of this disorder is still unknown. Nonetheless, experts have found biological, psychological and social risk factors. The combination of these three influence the development of Oppositional Defiant Disorder.

• Some biological factors include:
  1. Having a parent with a history of ADHD, ODD, CD or mood disorder
  2. A parent presenting substance abuse problems
  3. Having a mother who smoked during pregnancy
  4. Brain-chemical imbalance
  5. Impairment on the part of the brain in charge of judgment, reasoning and impulse control.

Damage or alterations in some areas of the brain can influence the appearance of behavioral problems, especially those of the frontal lobe. This area is responsible for executive reasoning and functions, care, planning, inhibition and behavior control. If there is a problem in this area, the person will not be able to control their behavior, leading to aggressive and impulsive behavior.

An imbalance in neurotransmitters or brain chemicals or comorbidity with other disorders, like ADHD, depression, anxiety, can lead to the appearance of ODD. There are clinical programs of cognitive evaluation that allow us to detect possible deficits or cognitive dysfunctions through a simple battery of computer games.

• Psychological factors involved:
  1. Neglectful or absent parent/s
  2. Poor relationship with a parent/s
• Social risk factors implicated:
  1. Poverty
  2. Neglect
  3. Abuse
  4. Disorganized or chaotic environment
  5. Inconsistent discipline

Oppositional Defiant Disorder Symptoms

When should you start worrying about your children suffering from Oppositional Defiant Disorder? How to differentiate between bad mood or a regular tantrum and a disorder? While it may be hard for you to consider that your child might have a behavioral disorder, it’s a crucial part of helping them overcome it. How can you tell if your child needs help?

According to the diagnostic manual of the American Psychiatric Association, the following criteria must be met:
A. A pattern of angry/irritable mood, argumentative/defiant 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.

Angry/Irritable Mood

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, with 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.

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

Specify current severity:

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

You have to take into account the child’s developmental stage and age. For example, in children younger than 5 years, to be considered ODD, symptoms should appear almost every day for at least 6 months. In children older than 5 years old, symptoms or signs should appear at least once a week.

Other Characteristics of Oppositional Defiant People:

• They violate other people’s rights or social norms.
• Their actions are not because of stress or a stressful event.
• They tend to show symptoms with their family members first, then the behavior starts to generalize to others (schools, friends, etc).
• They feel more comfortable showing symptoms like the ones mentioned above with people they trust.
• They have low self-esteem, anger management issues, emotional lability, impulsive behavior and even drug abuse.
• Usually, the behaviors are a consequence of not wanting to do something.
• Signs and symptoms are common around 8-9 years old and can last until adolescence or even adulthood.

Signs and Symptoms of Oppositional Defiant Disorder in Children and Adolescents

Here are some signs and symptoms that may give us clues to identify this disorder

• Your child is easily offended or angry.
• Having frequent tantrums
• He blames others for his mistakes.
• Insults have become normal in his vocabulary.
• When he doesn’t like something you said or disagree with him, he insults you.
• He has outbursts of anger or resentment as soon as he is told to do something.
• He is vindictive and spiteful.
• He challenges adults and refuses to follow orders or rules.
• He deliberately annoys others, without any apparent cause.
• Argues excessively with adults and authority figures.
• He continuously justifies his behavior.
• He is often punished in class for misbehaving, such as throwing things in class, insulting or hitting his classmates.
• Punishments don’t work on him.

Many children start showing symptoms in late preschool or early school age. In general, more boys than girls have this disorder, but in school-age children and adolescents, it develops evenly in both boys and girls.

Signs and Symptoms of Oppositional Defiant Disorder in adults

Your partner is very argumentative. Your roommate is hostile for no apparent reason. These are some of the most common signs of ODD in adults.

• He always needs to “win” the discussions.
• Fights authority figures.
• He does things to provoke others, for example, he leaves his socks on the floor just to annoy his roommates.
• He has been summoned by the police for public order disturbances.
• He has had fights in bars or physical altercations in public.
• He has a very susceptible temperament, the slightest thing can alter him.

Oppositional Defiant Disorder signs at work

• She argues with your co-workers or boss.
• She feels overwhelmed by the rules of the office.
• She purposely behaves irritant to annoy other coworkers. For example making annoying noises, talking unnecessarily loud, etc.  
• She has been sanctioned by the human resources department for violating company policies.
• She has been dismissed for losing control with co-workers.
• Loses control when receives constructive criticism.

In adults, if ODD is not treated, it can easily lead to antisocial personality disorder, which is much more difficult to treat.

How and when to diagnose Oppositional Defiant Disorder?

As mentioned before, not every tantrum or argument with your kid means he or she has Oppositional Defiant Disorder. Therefore, to diagnose a child, he or she must present an extreme ongoing pattern of hostility, aggressiveness, and defiance. The symptoms must be persistent for, at least, 6 months. Also, this aggressiveness is always directed towards an authority figure, is excessive compared to the child’s age and disruptive at home and/or school. In order for the symptoms to lead to an Oppositional Defiant Disorder diagnosis, they should not be better described by other conditions such as ADHD, learning disabilities and mood or anxiety disorders.

Furthermore, when a parent starts doubting whether their child might present Oppositional Defiant Disorder, it’s important to seek professional advice (read more about the difference between a psychologist and psychiatrist). Sometimes it’s difficult to spot the symptoms and some parents might want to wait to see if the child grows out of the phase. Nevertheless, the sooner the treatment starts, the better for the child to overcome the disorder.

Differential Diagnosis of Oppositional Defiant Disorder

It is sometimes difficult to distinguish in consultation between Oppositional Defiant Disorder from other behavioral problems.

• Attention deficit hyperactivity disorder: Breaking the rules is done because of impulsive behaviors, however without a defiant attitude.  He does this because he is unable to regulate his behavior or pay attention, not because he wants to annoy others.
• Antisocial disorder: Violation of the norms and others’ rights. In many cases, the Antisocial disorder appears as a complication of Oppositional Defiant Disorder or a more serious version of it.
• Intellectual disability: ODD will be diagnosed only if it is more relevant or greater than expected for the person’s age, gender, and degree of disability.
• Negative behavior typical of the developmental stage: Around 3 years old and in adolescence there tends to be certain defiant behavior, however, it spontaneously stops. It’s important to keep in mind that saying “no” and refusing to do something is completely acceptable and doesn’t always have to reflect defiance.

Treating Oppositional Defiant Disorder

The treatment for Oppositional Defiant Disorder is crucial to prevent more serious mental health conditions. Surely, each child’s characteristics must be taken into consideration in order to plan the best intervention for him or her. The child’s age, the severity of the symptoms and the possible causes of the disorder also play an important role in determining a plan of action.

Consequently, parent training programs, cognitive behavioral therapy, family therapy, social skills programs and sometimes medication, are the most common treatments. In general, the goals are:

• Anger management (read more about child anger)
• Coping with stressful events in a positive way
• Enhance problem-solving skills
• Improving relationships with peers
• Teaching discipline techniques to parents, family, and teachers

Even though the treatment can last several months or longer, improvement can be achieved in most cases. Studies show that in  67% of the cases, the symptoms disappear after three years. The other ˜30% could develop a Conduct Disorder (CD).

Medication

It’s important to note that medication alone hasn’t been proven to be effective. However, it can be prescribed for treating and controlling specific behavior, especially when Oppositional Defiant Disorder is combined with other conditions like ADHD, anxiety and/or mood disorders. In these cases, effectiveness has been successful (need help choosing the best ADHD medication for your child?).

Parent-Management Training

Parent training programs have been proven to be effective. Sometimes the parent-child relationship is so damaged from past negative experiences that it’s difficult to change the techniques without professional help. For this reason, these programs are focused on positive ways of managing behavior, discipline techniques, and accurate strategies according to the child’s age.

Many of the techniques that are taught in these parent training programs focus on positive reinforcement. The parent is encouraged to acknowledge and celebrate when their child is flexible and cooperative. The program also tries to help parents shy away from punishment and using negative reinforcement, as it has been proven to be less effective.

Also, being a model for the kid is important. Taking a time-out if you’re noticing the situation is going the wrong way will surely prevent the conflict from ending up worse. Respect when your child asks for a time-out. Give them their space and don’t press the issue any further until they’ve calmed down. Being conscious and aware of when the child might lose control is an important step towards progress and should be recognized.

Tips for Parents with Children with Oppositional Defiant Disorder

Here are some tips that can help parents reduce their child’s challenging behavior:

• Base parenting on the positive, reinforce, reward desirable behaviors, be flexible and cooperate. This is very important, even if this behavior seems obvious. Discover the attachment theory and how to develop a correct bond with your child.
• As a parent, learn to distinguish when you are very upset and don’t continue the discussion because this can make your child’s behavior worse. Take a deep breath and give yourself time to not overreact. Be a role model for your child.
• Children with Oppositional Defiant Disorder have difficulties to abide by norms, and sometimes as parents, it seems logical to maintain a strict discipline so that they learn to obey the authority. However, this can get just have the opposite effect. A flexible discipline with reasonable and appropriate limits may be the best.
• Don’t over scold your child. Try communicating positively with him and creating a positive family climate.
• Don’t let your child consume all your time and energy. Try to have hobbies and other activities that can ease the stress of your child’s upbringing. Seek support from other adults.
• Finally, reading books or professional articles about Oppositional Defiant Disorder is a good way to understand better your child’s condition. As a result, this will help improve the relationship parent-child and avoid labeling.

Marcela Salazar

Marcela is a psychologist specialized in Neuropsychological Rehabilitation by the Universidad Autónoma de Barcelona and is currently specializing on Rational Emotive Behavior Therapy. She’s passionate about volunteering and sharing experiences with people with brain injury as well as trying to help the disabled improve their quality of life. She believes that random acts of kindness make a difference in the world.