Oppositional Defiant Disorder in Children: How to Spot Symptoms and Get Treatment

All children are occasionally difficult and unruly. However, if that behavior turns into a pattern of hostility, you may be dealing with oppositional defiant disorder in children, or ODD. This is a behavior disorder hallmarked by excessive anger, argumentativeness, and vindictiveness. These patterns may disrupt family life, social activities, and your child’s schooling. In severe cases, this behavior may even affect your work. 

While dealing with ODD can feel hopeless, a licensed mental health professional can help develop strategies to manage these hostile behaviors.

What Is Oppositional Defiant Disorder in Children?

When a child is consistently stubborn, angry, or disobedient, they may have ODD. In many cases, this disorder manifests with constant arguing, regular disobedience, and an inability to own up to their mistakes. Your child might be hostile to you, their teachers, their siblings, and even their friends. Oppositional defiant disorder isn’t just boundary-pushing, however—it’s dramatic, atypical behavior that puts stress on caregivers, family, and friends. 

ODD usually develops during the preschool years, although it can manifest later. In many cases, ODD co-manifests with another mental health disorder, particularly ADHD, or a learning disability. In approximately 30% of cases, ODD may develop into a more serious mental health concern called conduct disorder. This shares many characteristics with ODD, including poor rule-following, impulsivity, and a lack of empathy. Conduct disorder also may include lawbreaking behavior such as aggression to both people and animals, theft, and destruction of property.

However, many cases of ODD are resolved during childhood. Around 70% of children with ODD will be symptom-free by age 18—and 67% stop meeting ODD criteria within three years of diagnosis.

How Can You Tell If a Child Has ODD?

You can’t self-diagnose ODD in your child. An easily reactive and frustrated kid does not necessarily have ODD—only a mental health professional can make that determination. However, reviewing the DSM-V guidelines for the disorder—the Diagnostic and Statistical Manual of Mental Disorders, the diagnostic tool produced by the American Psychiatric Association—may help you decide whether to reach out to a therapist or psychologist for ODD.

The primary diagnostic hallmark of ODD is anger and defiant or vindictive behavior lasting for six months or more. (The DSM specifies that this behavior must be directed toward at least one non-sibling.) 

Mental health professionals will want to see at least four of the following symptoms to make a diagnosis:

• Frequently losing their temper
• Being easily annoyed
• Feeling angry or resentful
• Arguing with adults and authority figures
• Defying orders or requests or having trouble with rules
• Intentionally annoying other people
• Blaming other people for mistakes or disobedience
• Acting with spite or vindication toward others.

ODD can be mild, moderate, or severe, depending on how frequently your child experiences these symptoms. 

How to Determine Normal, Age-Appropriate Behavior vs. ODD?

Pushing boundaries is normal. Just because your child goes through a difficult period does not mean an ODD diagnosis is inevitable—in fact, most children grow out of their stubborn, limit-testing phases. Kids learn by pushing boundaries.

However, if these behaviors happen frequently or cause significant ongoing problems at home, school, or with friends, you should contact a licensed mental health professional—especially if the behaviors seem exceptionally intense. You’re the parent and it’s important to trust your gut: If something feels off or excessive to you, talking to a professional can be beneficial, even in ruling out the disorder. A therapist or counselor can determine if your child is dealing with ODD, or simply experiencing the trials and tribulations of growing up. 

What Causes ODD in Children?

Researchers don’t yet understand exactly what causes ODD. The disorder occurs in 3.3% of the population, according to the American Psychiatric Association. Boys experience this disorder more frequently than girls, and particularly boys coming from impoverished backgrounds. Risk factors include a low tolerance for frustration and poor emotional reactivity—or oversized reactions to stressors. Childhood neglect may also contribute to the development of ODD.

According to Boston Children’s Hospital, two primary theories attempt to explain the origins of ODD: 

Developmental theory of oppositional defiant disorder in children

The developmental theory proposes that a child’s temperament affects how quickly they become angry and calm down. If they’re easily angry and struggle to self-soothe, they may experience behavioral problems starting in toddlerhood. These children may have experienced separation anxiety when younger, too. 

Learned theory of oppositional defiant disorder in children

The learned theory suggests that ineffective patterns of communication between children and caregivers can lead to escalating cycles of conflict that unintentionally result in children learning that the only way to get a caregiver’s attention is to act out in increasingly harmful ways.

There’s also evidence that there may be some genetic component of ODD—there may even be genes that contribute to both ODD and ADHD, explaining the frequent comorbidity of the two disorders. 

However, risk factors are merely that: factors. Just because oppositional defiant disorder runs in your family or your toddler child is slow to calm down doesn’t mean that a diagnosis is inevitable. And even if that diagnosis does come, don’t panic—with the right therapeutic approach, ODD is extremely treatable. 

Treatments for ODD in Children

There are a number of effective treatment approaches to ODD that can help your child and family live a happier, more peaceful life. Early intervention is essential, so connect with a licensed therapist if you see early warning signs, like frequent and unabating temper tantrums and constant arguments.

A mental health professional can identify the best strategy for your child’s unique needs. However, most approaches include some of the following elements.

Behavioral interventions

A therapist or psychologist might use cognitive behavioral therapy (CBT) to help your child manage their anger and respond more calmly to difficult or stressful situations. Better problem-solving skills will encourage your child to think more logically about their concerns, anger, or annoyances before resorting to disruptive behavior. 

Parent training

Your child’s therapist may also recommend parent training. And just remember, this isn’t a repudiation of your parenting skills—instead, in therapy you’ll learn better ways to respond to your child’s behavior. This training may also address communication issues between you and your child and underscore the importance of consistent discipline. A mental health specialist can also help you identify home-life factors that may be exacerbating your child’s disorder. 

In your parent training therapy sessions, you may discuss:

• Consistent rules and boundaries
  Make sure rules are clear and all caregivers are on the same page. 
• Positive reinforcement
  Focus on what your child does well, not just their challenging, negative behaviors. 
• Effective communication
  Open and respectful communication encourages your child to come to you before escalating conflicts.
• Modeling appropriate behavior
  Children learn by observing their parents, so demonstrate the kind of behavior you want them to emulate.
• Staying calm
  ODD behaviors can be frustrating, but staying calm and composed during conflicts will help you and your child avoid power struggles and escalations.

A support group for parents also struggling with oppositional defiant disorder in children may help deal with some of these difficult feelings. 

Medication

Medication isn’t the typical first-line defense for ODD, but it can be a useful tool if other treatments prove ineffective. Medication can also be useful if coexisting conditions like ADHD or mood disorders cause complications. 

One therapy to be certain to steer clear of: boot camps or programs for “troubled teens,” or any other therapeutic methods that attempt to frighten children into good behavior. These programs are rarely effective, and may harm your child instead of help. 

The Challenges of Parenting a Child with ODD

Dealing with a child who has an ODD diagnosis causes a parent understandable stress. Providing the best care for your child also requires maintaining your own well-being. Start by accepting and validating your own negative emotions, including frustration, anger, guilt, and helplessness. It’s okay to feel these things—but parent training can also help you modulate your reactions. 

Remember self-care isn’t selfish. Make time for activities you enjoy, connect with your support network, and keep up with your own therapist to help manage stress. 

As you and your child work through their behaviors, remember that progress may be slow, and setbacks may occur. A regression doesn’t mean your child isn’t on the road toward recovery—it’s a common, and sometimes important, part of the process. 

Be patient, and don’t hesitate to reach out for help. With the right strategies and support, you and your child can survive and thrive despite the murky waters of oppositional defiant disorder in children.

If you need further support or assistance, you shouldn’t hesitate to reach out to start with a free consultation from a licensed Handspring Health therapist today, who can offer you and your child the tools and support to overcome and deal with oppositional defiant disorder.

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