Oppositional Defiant Disorder (ODD) in Teens

Adolescence can be a turbulent time in life, and it is normal for teenagers to be defiant to some degree. After all, not only are they grappling with their identities, but they are also facing the changes and pressures of growing into adults. However, there does come a point where rebelliousness in teens goes from being typical to troublesome, both for the teen and the people around them. Oppositional defiant disorder (ODD) in teens can cause strain in relationships and get them into trouble. Here’s everything you need to know about oppositional defiant disorder in teens.

What is ODD in Teens?

ODD in teens is a mental health disorder that is characterized by recurring defiant, hostile, and disobedient behavior towards parents, authority figures, and peers that lasts for at least six months.

Defiant behaviors often manifest as continuous stubbornness, resistance to following directions, and a reluctance to compromise and negotiate with others, including parents, authority figures, and peers. Teenagers who have ODD may keep on testing the limits by arguing, ignoring directions, or not accepting blame for unacceptable behaviors. They display a hostility towards adults and peers and often deliberately annoy others with verbal aggression.

These behaviors are very similar to ODD in children, who also tend to refuse to follow rules, annoy people deliberately, and actively defy adults’ requests.

What Causes ODD in Teens?

The causes of ODD in teenagers are still being studied, but the American Academy of Child and Adolescent Psychiatry lists various factors that play a role in the development of this condition [*].

• Biological Factors. Adolescents are also more susceptible to developing ODD if they have impairment in the part of the brain responsible for reasoning, judgment, and impulse control. Other factors such as exposure to toxins, poor nutrition, and having a mother who smoked during pregnancy can affect the likelihood of having ODD.
• Psychological Factors. Having a poor relationship with one or more parent can affect ODD in adolescents. Parental psychopathology is also an important psychological factor. Adolescents are more likely to develop ODD if they have parents with a history of attention-deficit/hyperactivity disorder (ADHD), ODD, or conduct disorder (CD). Parents with mood and substance use disorders are also more likely to have teenagers who will develop ODD [*].
• Social and Environmental Factors. Factors such as poverty, a chaotic environment, having uninvolved parents, family instability, and inconsistent discipline can lead to ODD.

Teenagers with ODD will often have a co-occurring mental health condition, such as anxiety, bipolar disorder, depression, or a learning disorder.

Which Teenagers Are at Risk for ODD?

Teenagers who are at risk for ODD have the following attributes:

• Mood or anxiety disorders
• Conduct disorder
• ADHD
• Aggression
• Trouble identifying and interpreting social cues
• Parents who have ODD, ADHD, depressive disorders, or bipolar disorder
• Developmental delays
• Family instability

Prevalence of ODD in Teens

The prevalence rate of ODD in children and adolescents ranges from 1% to 11%, depending on the population. It occurs more frequently in boys of prepubescent ages, but its incidence is equal in both sexes once adolescence is reached [*].

What are the Typical Symptoms of ODD in Teens?

Teenagers are known for being argumentative, rebellious, and defiant from time to time. However, adolescents with ODD exhibit these traits and other behaviors such as hostility and anger consistently and with little provocation.

To know if your teen’s behavior is representative of ODD, they must display the following signs for more than six months:

• Argumentative
• Uncooperative
• Frequent temper tantrums (early adolescence)
• Angry outbursts
• Deliberately antagonistic
• Hostility
• Irritability
• Refusal to follow rules
• Defiance toward authority figures
• Negative attitude
• Stubbornness
• Spitefulness
• Verbal aggression, such as hateful and mean language
• Vindictiveness

How is ODD Diagnosed in Teenagers?

ODD is diagnosed in teenagers through a comprehensive assessment process that usually starts with a clinical interview. Here, a mental health professional will ask parents or caregivers about their teen’s behavior, emotions, and relationships.

They will then determine if the adolescent meets the diagnostic criteria for ODD, which includes showing angry or irritable mood, defiant or argumentative behavior, or vindictiveness. Four symptoms must be present for at least six months and must be observed in an interaction with a person who is not a sibling [*].

What Complications are Associated with ODD in Teens?

Several complications can arise when teens develop ODD. These include but are not limited to the following:

• ADHD
• Conduct disorder
• Anxiety
• Depression
• Communication disorders
• Learning disorders

How to Help a Teenager Live with ODD

Helping a teenager manage their ODD is possible. Here are some ways that you can make it easier for both you and your teen.

Always build on the positives

When your teen exhibits positive behavior, such as flexibility or cooperation, make sure to give them praise. This will make your teen feel better about themselves, and they will be more likely to repeat the behavior.

Take breaks

If it feels like an argument or conflict with your teen is escalating, then take a time out. Doing so will not only model good behavior for your teen, but it will also prevent the problem from getting worse. Support your teen if they decide to take a break to keep from overreacting.

Choose your battles

It can be tempting to engage in a power struggle with your teen to show who holds authority. This can be tricky and lead to unfavorable outcomes. Instead, prioritize the things you want your teen to do. For example, if you send them up to their room for misbehavior, don’t add time to argue. Simply say something like, “Your time starts when you go to your room.”

Set limits

Setting limits is important when it comes to helping your teen live with their condition. Always remember to give clear instructions and use reasonable and consistent consequences. Make sure to discuss these limits when both of you are level-headed. You can also help your teen set up a routine to help enforce those limits.

Make time for your interests and hobbies

Make time for interests other than your teen with ODD. This way, managing your son or daughter doesn’t take up all of your time and energy. Try to get support from other adults, as well, including your spouse, teachers, and even coaches.

Don’t forget self-care

Don’t neglect your self-care rituals. This will help you manage your stress levels and cope.

When to Seek Professional Help

It can be challenging to know when it is time to seek professional help. But if your teen’s behavior is starting to create major disturbances at school, home, or with peers for more than several months, then it may be time to talk to someone qualified. Early diagnosis and treatment is essential for oppositional defiant disorder in teens.

What are Treatment Options for ODD in Teens?

Fortunately, ODD in adolescents can be treated, especially if caught early. Here are some effective treatment options that can help your teen:

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is a type of talk therapy that teaches adolescents the relationship between their thoughts, feelings, and behaviors. By understanding why certain old behaviors are unhelpful or unsuccessful, CBT allows teens to discover new, positive ways to deal with certain situations and interactions.

Family Therapy

When teens display difficult or defiant behaviors, it can impact the whole family. Therapy for the entire family can be valuable in helping family members gain a better understanding of the adolescent’s behavior. It can also teach the family how to better support each other.

Social Skills Training

Teens with ODD often struggle with relating to and interacting with peers. Social skills training therapies can help produce more positive and successful peer interactions. This type of therapy is often done in real-world environments, such as schools or social groups.

Parent Management Training

Parental intervention is an effective way to help manage the difficult behavioral symptoms of adolescents with ODD. Parent management training teaches parents and caregivers positive parenting practices and encourages more appropriate punishment and responses for disruptive behaviors. Parent training also involves teaching parents how to manage their reaction to their child’s behavior, clearly demonstrate and define their expectations, and remove common triggers for unwanted behavior.

Medication

Medication can be used to treat symptoms of ODD, but it is rarely used to treat ODD exclusively. Rather, prescribed medications (such as antipsychotics) are often part of a more comprehensive treatment plan to manage the disruptive behaviors of ODD in adolescents.

The Bottom Line

ODD is a challenging condition that can make life difficult for you and your teen. Fortunately, there are ways to manage symptoms through different tools and techniques. You can supplement your teen’s therapy with anger management worksheets and positive parenting techniques. You can also take part in family therapy and discuss medication options with your health provider. ODD is difficult to handle but it is not impossible to treat. With just a little patience and a bit of help, your teen can have a better relationship with you, their teachers, and their peers and go through adolescence with a bit more ease.

References:

1. American Academy of Child and Adolescent Psychiatry. Oppositional Defiant Disorder: A Guide for Families. 2009.
2. Duncombe M, Havighurts S, Holland K, et al. The contribution of parenting practices and parent emotion factors in children at risk for disruptive behavior disorders. 6 March 2012.
3. Substance Abuse and Mental Health Services Administration. DSM-5 Changes: Implications for Child Serious Emotional Disturbance. June 2016.