What is Oppositional Defiant Disorder?

​Oppositional Defiant Disorder is characterized by a pattern of angry, irritable mood and argumentative and defiant behavior lasting at least 6 months. The behaviors often occur in more than one situation (such as home and school), but are often worse at home.  To be diagnosed, a child must have at least 4 of the following symptoms (not including behavior with siblings):

*   Often loses temper
*   Is touchy or easily annoyed
*   Is often angry or resentful
*   Often argues with authority figures
*   Often actively defies requests from authority figures
*   Often deliberately annoys others
*   Often blames others for his/her mistakes or misbehavior
*   Has been spiteful or vindictive in past 6 months

What causes Oppositional Defiant Disorder?

ODD is likely caused by a combination of factors, including 1) an inborn tendency in the child to experience low frustration tolerance, poor impulse control, and higher emotional reactivity, and 2) a history of ineffective parenting practices (such as being overly inconsistent, harsh, permissive, or neglecting). Often, parents of children with ODD themselves have low frustration tolerance and report higher levels of stress, mood disorders, and low social support, making it harder to parent effectively.

What other Risk Factors are Associated with Oppositional Defiant Disorder?

Children with ODD frequently have an additional diagnosis, including Attention Deficit Hyperactivity Disorder (ADHD), and a mood or anxiety disorder. Children with depression and autism spectrum disorders also have a higher risk for ODD. Many children with ODD will develop further problems as they get older, including more serious depression and anxiety. In addition, they are at increased risk for developing conduct disorder, which is characterized by aggression toward others and serious disregard of rules. Thus, it is critical to intervene as early as possible to help reduce the risk of more serious problems.

What Steps Should a Parent Take to Help a Child with Oppositional Defiant Disorder?

If you suspect your child has ODD, schedule an evaluation with a psychologist or other mental health professional who is experienced in working with the disorder. It can also be helpful for a parent to seek out his/her own therapy. It is very stressful having a child with ODD, and taking care of your own needs is one of the best gifts you can give your child. The most effective treatments for ODD are listed below.

Behavior Management Training and Parent-Child Interaction Therapy. Generally, treatment for ODD in young children (before age 6) involves working with parents to help change the pattern of interactions between parents and children. This can last between 5 and 20 sessions, and involves providing skills and support to parents. Therapy can be delivered either in an individual or group format. Parents learn the following key strategies:
*   Spending play time with the child, during which the parent learns to attend to and take child’s lead
*   Providing effective instructions, praise, and rewards
*   Planned ignoring of arguing, tantrums, and other annoying but non-harmful behaviors
*   Effective use of consequences for more serious misbehavior, including aggression and noncompliance

​Cognitive Behavioral Therapy.   After about age 8, individual or group therapy with the child can also be helpful, although only in addition to teaching parents new skills. Cognitive Behavioral Therapy (CBT) teaches children to understand their thoughts and feelings and to develop more helpful ways of thinking about situations. It also targets their problem solving skills and helps them to improve how they interact with other people.

What Doesn’t Work?

Medication. There is no medication specifically for ODD.  However, if your child also has ADHD, depression, or anxiety, or other mood issue, medication may be used to treat those specific symptoms and may help to improve ODD symptoms. 
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Play Therapy. While a skilled child therapist may incorporate play into an effective treatment model (such as cognitive behavioral therapy), play therapy alone is not strongly supported as a stand alone treatment for ODD. Any therapy with young children who have oppositional defiant disorder should be accompanied by a significant behavior management component for parents. 

Ignoring ODD. Although being oppositional and defiant at times is part of normal development, the more severe and frequent symptoms seen in ODD are not likely to be outgrown. In fact, if untreated, ODD tends to put children at risk for later problems, including anxiety, depression, delinquency, and high risk behaviors such as substance abuse and risky sexual activity.

Further Information
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The following books are recommended for parents:

Your Defiant Child: Eight Steps to Better Behavior by Barkley and Benton (2013).  ISBN 1462510078

Your Defiant Teen, 10 Steps to Resolve Conflict and Rebuild Your Relationship (2nd edition) by Barkley, Robin, and Benton (2013). ISBN
# 146251166X

10 Days to a Less Defiant Child: The Breakthrough Program for Overcoming Your Child's Difficult Behavior by Bernstein (2015). ISBN # 0738218235

Try and Make Me!: Simple Strategies That Turn Off The Tantrums and Create Cooperation by Levy and O’Hanlon (2002). ISBN # 0451206452

Parenting the Strong Willed Child by Forehand and Long (2010). ISBN # 0071667822
 
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