Oppositional defiant disorder (ODD) is a childhood mental disorder
characterized by a pattern of angry, antagonistic, hostile, negative,
irritable, and/or vindictive behavior lasting at least six months and
occurring more frequently than is typically observed for the
child's age and developmental stage. Children diagnosed with ODD do
not meet the clinical diagnostic criteria for
Oppositional defiant disorder (ODD), a relatively new clinical
classification, involves an ongoing pattern of antagonistic, defiant, and
hostile behavior toward parents and other authority figures. Children and
adolescents with ODD often have frequent temper
, blame others for their misbehavior, argue excessively with adults,
actively refuse to comply with adult rules and requests, deliberately defy
adults and attempt to annoy or upset them, and are easily annoyed by
, ODD is more common in boys than girls; however, after puberty ODD
occurrence rates are about equal in boys and girls. The disorder typically
begins by the age of eight. According to the American Academy of Child and
Adolescent Psychiatry, approximately 5 to 15 percent of all school-aged
children have ODD.
Causes and symptoms
Although the specific causes of ODD are unknown, genetics and environment
are thought to play a role in its development. As of 2004 several theories
about the causes of oppositional defiant disorder are being investigated.
ODD may be related to the following:
ODD appears to be more common in families in which at least one parent has
a history of a mood disorder, conduct disorder, attention deficit
hyperactivity disorder (ADHD),
antisocial personality disorder
, or a substance abuse-related disorder. Children with one parent who is
alcoholic or who has been in trouble with the law are almost three times
more likely to have ODD. Additionally, some studies suggest that mothers
with a depressive disorder are more likely to have children that develop
ODD. ODD can also occur in conjunction with other conditions such as ADHD,
. About 50 percent to 65 percent of children with ADHD also have ODD.
Symptoms of ODD include a pattern of negative, hostile, and defiant
behavior lasting at least six months. During this time four or more of the
following must be present for a child to be diagnosed with ODD:
Additional problems may be present, including the following:
Parents of children and adolescents who exhibit symptoms of ODD should see
a physician as soon as possible. Usually, a referral to a psychologist,
psychiatrist, or therapist will be given.
ODD is diagnosed by psychological and psychiatric evaluations; interviews
members, teachers, and caregivers; and observation and interviews with
the child or adolescent. Diagnosis is based on clinical criteria defined
in the American Psychiatric Association's
Diagnostic and Statistical Manual of Mental Disorders
, fourth edition, text revision C (DSM-IV-TR).
ODD often has characteristics in common with other psychological disorders
and often occurs in conjunction with other conditions, such as ADHD or
mood disorders. Therefore, diagnosis of ODD usually depends on exclusion
of other disorders. A diagnosis of ODD is not made if the symptoms occur
exclusively in psychotic or mood disorders, or if the child meets clinical
criteria for conduct disorder, or, if the adolescent is 18 years old or
older and meets clinical criteria for antisocial personality disorder.
Children and adolescents with ODD do not exhibit the more serious
aggressive behaviors or physical cruelty that is common in other
Treatment of ODD usually involves medication, and group, individual,
. Of these, individual therapy is the most common. The goal of therapy is
to help provide a consistent daily schedule, support, rules,
, and limits, as well as to help train patients to get along with others
by modifying behaviors. Therapy can occur in residential or day treatment
facilities, in a medical setting, or on an outpatient basis. Therapy can
instruct patients on how to effectively deal with ODD and help them learn
how to do the following:
Therapy can also involve the parents. Parent management training focuses
on teaching parents specific and more effective techniques for handling
the child's opposition and defiance. Research has shown that parent
management training is more effective than family therapy.
Stimulant medication is used only when ODD cooccurs with ADHD.
Occasionally, children and adolescents with ODD may also have depression
or anxiety disorders, and treatment with
and anti-anxiety medications can help alleviate some symptoms of ODD.
The prognosis for ODD varies. In some children, ODD evolves into a conduct
disorder or a mood disorder. ODD, if left untreated, has approximately an
80 percent chance of turning into conduct disorder as a child ages. Later
in life, ODD can develop into passive-aggressive personality disorder or
antisocial personality disorder. ODD can cause significant social,
academic, and/or occupational impairment. Generally, with treatment and
long-term participation in therapy, adjustment in social settings and in
the workplace can be made in adulthood.
As of 2004, ODD could not be prevented.
—An educational setting designed to accommodate educational,
behavioral, and/or medical needs of children and adolescents that cannot
be adequately addressed in a traditional school environment.
Antisocial personality disorder
—A disorder characterized by a behavior pattern that disregards
for the rights of others. People with this disorder often deceive and
manipulate, or their behavior might include aggression to people or
animals or property destruction, for example. This disorder has also
been called sociopathy.
Attention deficit hyperactivity disorder (ADHD)
—A condition in which a person (usually a child) has an unusually
high activity level and a short attention span. People with the disorder
may act impulsively and may have learning and behavioral problems.
—A behavioral and emotional disorder of childhood and
adolescence. Children with a conduct disorder act inappropriately,
infringe on the rights of others, and violate societal norms.
Sutton, James D.
What Parents Need to Know about ODD: Upto-Date Insights and Ideas for
Managing Oppositional Defiant Disorder and Other Defiant Behavior.
Pleasanton, TX: Friendly Oaks Publications, 2003.
Barrickman, L. "Disruptive Behavioral Disorders."
Pediatric Clinics of North America
Greene R. W., et al. "Psychiatric Comorbidity, Family Dysfunction,
and Social Impairment in Referred Youth with Oppositional Defiant
American Journal of Psychiatry
159 (July 2002): 1214–24.
American Academy of Child and Adolescent Psychiatry.
Web site: http://www.aacap.org.
American Psychiatric Association.
1000 Wilson Boulevard, Suite 1825, Arlington, VA 22209–3901. Web
Tynan, W. Douglas. "Oppositional Defiant Disorder."
November 2, 2003. Available online at
http://www.emedicine.com/ped/topic2791.htm (accessed November 21,
Wood, D. "What is Oppositional Defiant Disorder (ODD)?"
Available online at
003E; (accessed November 21, 2004).