What Is Oppositional Defiant Disorder (ODD)?

Nearly every child acts out from time to time, but some kids have behavioral problems that are so severe and persistent that it seems like they are angry and argumentative all the time. These children may have oppositional defiant disorder (ODD).

ODD is a recognized disorder that can be diagnosed and treated by a child psychologist, psychiatrist, or other mental health professional. Researchers think that between 2% and 11% of children have ODD, although many never receive a diagnosis and are just written off as "bad" or "problem" kids. Learn how to recognize the symptoms of ODD and how to get help that may lead to more peace and harmony for the whole family.

What Is ODD?

"When I think of the child with ODD, I think of children who don't always adhere to rules," says Jennifer Pritt, PhD, a child and adolescent psychologist based in Mount Kisco, New York. "When they receive a different reaction from others, it fuels a need or desire to get that attention and reaction. They lack the inhibition and impulse control to be able to stop and think about their behavior or the consequences."

It's natural for kids to resist authority sometimes. After all, kids will naturally push boundaries as they go through different phases, like "the terrible twos" and teen rebellions. However, kids with oppositional defiant disorder typically express a behavior pattern that is consistently hostile, negative, and defiant. This pattern is also more severe when compared with other kids.

ODD usually starts when a child is between 8 and 12 years old. According to the American Academy of Child and Adolescent Psychiatry (AACAP), the following behaviors are red flags for ODD:

• Frequent tantrums and meltdowns
• Excessive arguing, especially with adults or authority figures
• Refusal to follow rules or intentionally breaking rules
• Constant questioning of rules and boundaries
• Spitefulness, seeking revenge, or vindictiveness
• Blaming others for their mistakes
• Easily aggravated or irritable with other people
  

How ODD Is Diagnosed

It's one thing to see occasional or even frequent meltdowns in kids of all ages, but if your child's outbursts are disruptive to family and school life and are usually directed toward authority figures like parents, teachers, and coaches, then it may be more than a troublesome stage. If these behaviors persist for more than six months, you may want to talk to your child's doctor about screening for ODD.

Your child's doctor will likely refer you to a specialist—usually a psychologist or psychiatrist—who can properly assess your child for ODD and other behavioral disorders. This doctor will do a comprehensive evaluation that will include multiple questionnaires for you and other authority figures in your child's life like teachers. Research shows that a child is most likely to be diagnosed with ODD if their parents say they frequently “actively disobey or refuse to follow adults' requests or rules” and "is angry or bitter" over a long period.

Causes of ODD

There are many reasons why a child may develop ODD. The disorder is known to be highly heritable, which means that children who have a biological parent with ODD are at higher risk for having it, too. If your child is predisposed to developing ODD, stressful or traumatic episodes in their life may trigger the disorder. Things like divorce, a death in the family, and academic struggles may bring ODD to the surface, doctors say.

It's common to blame parenting for a child's behavior, but ODD isn't due to a specific parenting style or action, says Dr. Pritt. One of the most important things to know about ODD is that if your child is diagnosed, it's not your fault. But you can take steps to get your kid the help they need.

"I tend to see two different kinds of parents," says Erina White, PhD, MPH, MSW, a therapist and clinical researcher at Boston Children's Hospital. "One type knows that there's something wrong, and they want to figure it out. For them, the labeling piece is important."

"For other parents," she continues, "it's very, very scary to think that their kid might be different, and they are grieving the loss of the dreams they had for their child. Just like with every loss, sometimes denial can feel really good, and you can spend a lot of time in that place, which is OK. It's important to be kind and patient and loving to yourself because it is a loss for a parent, regardless of which type you are."

How Is ODD Treated?

Experts encourage parents to seek out help if they suspect ODD. "If it's not diagnosed and treated earlier on, it can become more of a conduct disorder or even a personality disorder," says Dr. Pritt. About 30% of children with ODD eventually develop conduct disorder—when repetitive behaviors seriously violate rules or harm other people—and 10% develop a more lasting personality disorder, like anti-social personality disorder.

With help, ODD often improves over time. Research shows that ODD behaviors resolve themselves within three years in approximately 67% of children who are diagnosed.

According to experts, the first-line treatment for ODD is a group of therapies known as parent management training (PMT). In PMT, parents learn to use rewards and consequences to motivate kids to make safe, smart, and respectful decisions. In sessions, clinicians model these techniques for parents, who use them at home. Kids, in turn, practice communication and coping skills. Research shows PMT reduces ODD behaviors and also reduces parent stress and strengthens overall family bonds.

With consistent treatment, the child "learns and practices skills so often that these skills become their default," says Dr. White. She recommends at-home apps like Mightier to help kids reinforce the positive behavioral skills they are learning through games. With these games, children experience what it's like to feel upset and then practice bringing their heart rate back down, over and over again.

Regardless of how well your child responds to help with their ODD, both Dr. Pritt and Dr. White emphasize that they have never met a child who wants to be "bad." They all want to be good kids, even though they might behave poorly. When you teach them the skills they need, it can help them be kinder to themselves and others, in childhood and beyond.