Oppositional Defiant Disorder (ODD) in Children

All children, whether they have easy or more challenging temperaments and personalities, can be difficult at times. They are still learning how to understand and regulate their emotions, after all. But some children are more difficult than others to the point where it disrupts their daily lives and relationships. There comes a point where a child’s defiance is no longer normal. This is where oppositional defiant disorder (ODD) in children comes in. Here, we’ll explore what ODD is, its causes, symptoms, and treatment.

What is ODD in Children?

ODD in children is a behavior disorder that is characterized by defiant, negative, irritable, and uncooperative behaviors toward parents, teachers, authority figures, and even peers.

Children who have ODD cause distress and trouble to others more than being distressed or troubled themselves.

What Causes ODD in a Child?

The exact cause of ODD is unknown, but two theories can explain how and why the condition develops in children.

The developmental theory suggests that ODD develops when children of toddler age are unable to separate themselves from their primary caregiver, to whom they are emotionally attached. Since they have not achieved autonomy from that primary person, their “bad attitudes” carry over to the rest of the developmental years because they were not resolved during the toddler years.

On the other hand, learning theory suggests that the negativistic characteristics of ODD are learned from negative reinforcement techniques employed by parents and other authority figures. Using negative reinforcement increases the rate and intensity of oppositional behaviors in children.

Which Children Are at Risk for ODD?

ODD is a complex problem. Several risk factors can influence the development of oppositional defiant disorder in children.

Different parts of the brain are implicated in the development of ODD. Studies found that reduced volume in the left amygdala, insula, and frontal gyrus was associated with ODD and OCD, while other research also found even more volume reduction in the anterior cingulate cortex and the medial prefrontal cortex, parts of the brain responsible for impulse control, emotion, and decision-making [*].

Parenting issues can also affect the likelihood of developing ODD. Children who are abused, neglected, or rejected are more likely to develop ODD. Other family issues such as living in unstable family environments or being around parents with a mental health condition or substance use disorders can increase the likelihood of developing ODD.

Psychological health and temperament also play their respective roles. For instance, children with ADHD are more likely to develop ODD. Children who have temperamental issues such as being easily frustrated or emotionally reactive are also at a higher risk for developing ODD.

The environment is another risk factor. Children may display problem behaviors that are reinforced through attention from their peers. They may also experience inconsistent disciplinary measures from authority figures, such as teachers.

Prevalence of ODD in Children

The prevalence of OCD in children ranges from two to 11 percent [*], though estimates vary widely due to different informant sources, the timing of diagnosis, and whether children met the criteria for conduct disorder. ODD is also rarely diagnosed in older children and adolescents because it overlaps with the normal discord that occurs b between parents and children. ODD is also more common in male preadolescents compared to females at a rate of 1.4 to 1.

ODD Symptoms in Children

Defiant disorder in children manifests as patterns of behavior problems. Here are some common symptoms:

• Easily annoyed
• Frequently losing their temper
• Unusually angry, irritable, and resentful
• Refusal to follow rules
• Annoying people deliberately
• Arguing with authority figures
• Actively defies adults’ requests or rules
• Blames others for own mistakes or misbehaviors
• Often says mean things when upset
• Vindictive behavior

Some children with ODD struggle only at home with family. Others may have difficulty with disruptive behavior in school.

How is ODD Diagnosed in Children?

For a child to be diagnosed with ODD, they need to display a pattern of disruptive behavior, including at least four of the symptoms listed above. They also need to show these behaviors for at least six months and involve at least one person who isn’t a sibling [*].

ODD is usually diagnosed in children in elementary school.

Complications Related to ODD in Children

There are some complications related to ODD in kids, including the following:

• Poor school performance
• Antisocial behavior
• Impulse control problems
• Substance use disorder later on in life
• Legal problems later on in life
• May develop into conduct disorder

How to Help a Child Live with ODD

Early treatment for children showing signs of ODD can often prevent future problems. Here are some things you can do to help:

Consult your child’s healthcare provider

Ask your child’s pediatrician about other providers who will be included in your child’s care. You may have just one specialist or a team of professionals working with your child depending on their needs and how severe the disorder is.

Build on the positives

Focus on the positives as you interact with your child. Give them praise and positive reinforcement when they show desirable behaviors, such as cooperation and flexibility.

Be consistent

Be consistent in setting reasonable, age-appropriate limits for your child. Consequences for poor behavior should be fair, easy to apply, and carried out consistently. Rules should also be regularly enforced.

Reach out for support

Getting in touch with other parents or guardians with a child who has ODD may be helpful. You can also reach out to your child’s healthcare provider for support, especially in times of stress. They may be able to direct you to a support group.

Take breaks and practice self-care

If you feel the conflict with your child escalating, then take a break and step away. This behavior also sets a good example for your child. Praise and reward your child as well if they decide to take a break to prevent the situation from worsening. Remember to maintain your interests and hobbies and practice self-care as well.

When to Seek Professional Help

If your child is showing symptoms that are affecting their daily life and causing problems with relationships that are becoming unmanageable, then it may be time to seek professional help.

You can make an appointment with your family doctor or your child’s pediatrician to discuss your concerns. They will conduct a physical exam to ensure that other conditions aren’t causing your child’s symptoms. If your family doctor or pediatrician suspects ODD, then they will refer you to a specialist who has experience in diagnosing and treating the condition.

How is ODD Treated in a Child?

Fortunately, there are several ways that ODD in kids can be treated. Here are several of the treatment methods commonly implemented for this condition:

Therapy

Cognitive behavioral therapy (CBT) is a type of talk therapy that helps individuals of all ages understand how negative thoughts, emotions, and behaviors are related. Through CBT, children with ODD can unlearn negative thought patterns and change behavior to better solve problems and communicate. Kids will also learn how to control impulses and anger.

Family therapy is another type of therapy that can help children with ODD. It improves interactions and communication skills between family members. Both parents and siblings will receive support and understanding.

Children with ODD can also learn better social skills with peer group therapy.

Medication

Antipsychotics such as Risperidone are sometimes prescribed to reduce aggression that is often present with ODD. Doctors may prescribe this in instances where stimulant medication has not worked. Doctors may also prescribe medication to treat other co-occurring conditions with ODD, such as ADHD or anxiety drugs.

Frequently Asked Questions

How can I help prevent ODD in my child?

Early detection and intervention are key, especially when the child is surrounded by negative family and social experiences. Improving skills such as communication, parenting, anger management, and conflict resolution can disrupt the pattern of negative behaviors and reduce the presence of oppositional and defiant behaviors in interpersonal relationships with adults and peers. Parent-management training programs can also help parents manage their children’s behavior by learning positive reinforcement and disciplinary methods.

At what age does ODD typically emerge?

ODD typically emerges in children as young as five years of age, though most children usually show symptoms during school age.

In which gender is ODD more common?

ODD is more common in male children. However, this pattern is not observed in adolescents or adults with ODD.

The Bottom Line

ODD can be challenging and sometimes even overwhelming for parents and caregivers to manage. But there is hope for children with this condition. With early intervention, consistent efforts, and helpful tools such as anger management worksheets, your child will eventually learn to be more cooperative, less temperamental, and generally easier to interact with. It just takes some patience, the right support system, and persistence.

References:

1. Ghosh A, Ray A, Basu A. Oppositional defiant disorder: current insight. 29 November 2017.
2. Aggarwal A & Marwaha R. Oppositional Defiant Disorder. 19 September 2022.
3. Substance Abuse and Mental Health Services Administration. DSM-5 Changes: Implications for Child Serious Emotional Disturbance [Internet]. June 2016.