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 the oppositional defiant disorder are a 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 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 before adolescents.

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.

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 other mental health disorders. 

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.

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