Oppositional defiant disorder (ODD) is a childhood mental health condition involving disruptive behavior.
Nearly every child will have occasional outbursts of frustration and disobedience, of course. ODD doesn’t refer to developmentally appropriate temper tantrums or willful behavior. Instead, ODD involves:
- a long standing pattern of defiant and argumentative behavior or attitudes toward caregivers, teachers, or other adults
- vindictiveness toward others
- a frequently irritable and angry mood or short temper
ODD can make it very challenging to interact with other people. Again, the behaviors that characterize this condition go beyond what’s typical for a child’s age and developmental stage.
Tantrums generally begin to taper off by the age of 4. So, you might have some cause for concern when a school aged child continues to have regular tantrums, especially ones severe enough to disrupt everyday life.
Here’s a closer look at ODD, including how it shows up in both children and adults and what treatment approaches are available.
How common is ODD?
According to a 2008 review, experts estimate that between 1 and 16 percent of children and adolescents may meet the criteria for diagnosing ODD.
The condition seems to appear more often in boys before adolescence, but at roughly the same rate in people of any gender during adolescence and adulthood.
The evidence supporting its prevalence in boys, however, is somewhat inconsistent. In a 2011 study, some experts suggested using different criteria to diagnose ODD in girls, who might display symptoms differently than boys.
Symptoms of ODD often begin by the time a child enters preschool, but nearly always by early adolescence. In general, children typically show signs by the time they enter school.
Sometimes, these signs only show up in one environment or with one individual. For example, children with ODD might only show symptoms at home with family members, or around people they know fairly well.
More severe symptoms, however, usually show up in multiple contexts, where they can affect social relationships and development along with school or work.
In children and adolescents
The most common symptoms of ODD in children and adolescents include:
- frequent episodes of anger
- irritable mood
- a short temper or touchy mood
- being argumentative
- a habit of refusing to comply with requests from adults
- excessive arguing with adults and authority figures
- a habit of questioning or actively disregarding rules
- a pattern of behavior intended to upset, annoy, or anger others, especially authority figures
- a tendency to blame others for mistakes and misbehavior
- vindictive, spiteful, or resentful behavior, including unkind acts or saying mean things when angry or frustrated
Keep in mind that just one or two of these symptoms alone don’t suggest ODD, especially when they’re temporary. Someone with ODD will have at least 4 of these symptoms, recognizable over a period of at least 6 months.
ODD generally isn’t diagnosed in teenagers or adults. But childhood ODD can continue into late adolescence and adulthood, especially when it goes undiagnosed and untreated.
While the general symptoms remain the same, adults with ODD might also:
- have a lot of anger toward the world
- feel generally misunderstood, unappreciated, or disliked
- have strong attitudes of disdain or disrespect for authority figures
- be impatient
- have a habit of defending themselves forcefully and refusing to consider feedback from others
- lash out at others when they feel slighted, and have low frustration tolerance
- have trouble maintaining jobs, romantic relationships, and friendships, due to frequent tension and conflict
- find it hard to follow rules and expectations at home and work
Some of these signs share similarities with traits associated with other conditions, including:
- attention deficit hyperactivity disorder (ADHD)
- conduct disorder
- bipolar disorder
- disruptive mood dysregulation disorder
- antisocial personality disorder
This overlap can make it more difficult for experts to identify ODD in teens and young adults.
It’s also worth noting that some of these behaviors are pretty common during the teenage years. As a result, parents and teachers might not always find it easy to tell the difference between milder symptoms of ODD and more typical teenage attitudes.
Experts haven’t found one single cause of ODD. Instead, they believe it likely develops due to a combination of different factors, including genes, environment, personality, and temperament.
Genetic and biological factors
Children with a family history of depression or ADHD also have a higher chance of developing ODD.
Some brain imaging
These irregularities may factor into the development of ODD, especially when combined with other factors.
Environment and upbringing
Many environmental factors at home may contribute to ODD, including:
- harsh or permissive parenting
- negative reinforcement for problematic or disruptive behavior, which can promote future acting out
- inconsistent or neglectful parenting
- having a series of caregivers, especially ones who offer inconsistent or detached care
- rejection from peers
- violence and abuse in the home or neighborhood
- a stressful or unpredictable home life
- living in a low-income household or underserved community
Personality and temperament
Underlying personality traits
- high emotional reactivity
- difficulty with emotional regulation
- callous-unemotional traits, like emotional insensitivity and lower empathy
- low frustration tolerance
Of course, not everyone with these traits will go on to develop ODD.
Both nature (biologic factors) and nurture (environment and upbringing) contribute to personality, not to mention overall mental and emotional health, as well as risk and protective factors. A traumatic or difficult childhood can affect a child’s temperament and personality and make it more likely they’ll go on to develop ODD, or another mental health condition.
Understand, too, that people with ODD often don’t recognize their own behavior as defiant or oppositional. Instead, they might simply believe they’re reacting to unfair circumstances or unjust demands from parents, adults, and other authority figures.
Only trained mental health professionals can diagnose ODD. To do so, they’ll take several things into account.
Is there a pattern?
A diagnosis requires at least four symptoms of defiance, argumentativeness, anger, irritable mood, or vindictiveness. These behaviors need to happen consistently over a 6-month period:
- at least once per week, for anyone over the age of 5
- on most days, for children under the age of 5
- with at least one other person besides a sibling
These signs might include:
- having frequent arguments with authority figures, adults, and peers
- outright defying requests from authority figures
- refusing to follow directions or comply with requests from authority figures
- a habit of purposely annoying others
- a habit of blaming others for mistakes and misbehavior
- frequently losing their temper
- touchiness and becoming annoyed quickly
Are symptoms affecting their daily life?
Before diagnosing ODD, a mental health professional will also consider how the behavior affects daily life.
ODD can cause distress for the person living with the condition and the people they interact with most often, like family, peers, and co-workers. Symptoms of ODD can have a negative impact on:
- social interactions
- family life
- participation in school
- performance at work
- ability to hold a job
Are symptoms related to any other factors?
A mental health professional will also first ensure that symptoms aren’t related to:
- substance use
- bipolar disorder
They’ll also confirm that diagnostic criteria aren’t met for disruptive mood dysregulation disorder.
How severe are symptoms?
When making a diagnosis, experts will also consider symptom severity:
- Mild symptoms happen only in one setting, such as home, school, or with peers.
- Moderate symptoms appear in at least two settings.
- Severe symptoms happen in three or more settings.
Prompt treatment can go a long way toward improving symptoms of ODD and quality of life.
Professional support can also help treat or prevent other mental health conditions that might occur with ODD, including:
Treatment usually involves some combination of the following:
One-on-one therapy with a mental health professional creates an opportunity to learn new methods of regulating emotions and behavior, including skills to:
- manage anger and irritability
- communicate effectively
- control impulses
- solve problems
- cope with frustration and stress
Therapy also offers a safe environment to share and address potential contributing factors, including:
- challenges with relationships at school or work
- neglect or abuse at home
- learning difficulties
- ADHD, depression, anxiety, and other mental health symptoms
Social skills training can also provide an environment to learn and practice skills for interacting with peers respectfully and more effectively.
Considering online therapy?
Our review of the best online therapy options for children can help you find the right fit.
A therapist who specializes in family therapy can offer guidance on improving communication and strengthening relationships within the family.
Family therapy can support all members of the family by teaching productive strategies for addressing and managing behaviors related to ODD. A family therapist can also offer parents more support with learning and using effective parenting techniques, including consistent discipline and positive reinforcement.
Treatment for ODD might also include programs specifically designed to teach parents new skills to more effectively interact with their children and provide more constructive discipline.
A therapist might teach these skills directly or through “on the spot” coaching.
Some popular parent training programs include:
- Parent Management Training
- Incredible Years
- Parent-Child Interaction Therapy
- Positive Parenting Program
Interventions at school
Support at school can also benefit students with ODD. This can come from teachers, guidance counselors, and other school staff.
School interventions might include:
- offering breaks when needed to give the student space to manage feelings of overwhelm and frustration
- changing classroom seating
- helping connect the student with supportive peers
- encouraging positive behavior in the classroom and with peers through positive reinforcement
- creating a plan to support any learning difficulties and mental health symptoms
- school-based mental health support
- regular check-ins with a teacher or other trusted adult
No medication specifically treats ODD. Still, some medications can help address co-occurring symptoms that might complicate treatment, including severe:
- disruptive behaviors, such as aggression
Any of these could make ODD worse and affect overall well-being. When symptoms don’t respond to therapy, medication could lead to enough improvement that therapy becomes more effective.
A psychiatrist might prescribe:
ODD often improves as a child gets older, especially when symptoms are mild or moderate. Both family support and therapy can make a major difference in whether ODD improves.
Without professional treatment and supportive parenting, ODD symptoms often get worse. People with the condition may:
- find it challenging to maintain social relationships
- have regular conflicts and other problems at school
- have difficulty succeeding at school or work
Teens and adults with ODD may experience substance use disorders at higher rates and have a higher risk of attempting suicide.
Conduct disorder, another mental health condition typically diagnosed in children, is another potential complication of ODD. Some children with ODD go on to develop this condition, which involves more severe and aggressive behavior. Conduct disorder also serves as a risk factor for antisocial personality disorder.
Treatment and support for ODD can help improve symptoms and lower the likelihood of developing either conduct disorder or antisocial personality disorder.
What’s the difference between ODD and conduct disorder?
Conduct disorder involves behavior that consistently violates rules, social norms, and the rights of others. People living with conduct disorder don’t just show anger, irritability, and defiance. They often:
- break rules and laws
- show aggression toward people and animals
- deliberately destroy property
ODD might involve some destruction of property, but this generally happens during an outburst rather than intentionally. Someone might angrily throw a classmate’s toy without intending to break it, for example.
Along with therapy and other supportive approaches, a few key changes can help improve ODD symptoms.
Parents can support their children by:
- increasing positive reinforcements and reducing negative reinforcements
- providing consistent consequences for misbehavior
- using predictable and immediate parenting responses
- modeling positive interactions in the household
- taking steps to reduce environmental or situational triggers, like overstimulation, lack of sleep, or stressful routine changes
Teens and older adults might find it helpful to:
- get more comfortable accepting responsibility for mistakes and impulsive actions
- work with a therapist to learn skills for managing emotions and navigating conflict, plus get support for any co-occurring symptoms
- practice mindfulness and deep breathing techniques to help calm anger in the moment
- try new stress-relieving activities, like exercising, spending time with friends, or enjoying hobbies
- create a self-care routine to better support overall well-being
Parents aren’t the only ones challenged by defiance and anger related to ODD. These symptoms might also show up at school, or only at school, in some cases.
Teachers can use the following strategies to help students with ODD stay in the classroom:
- Collaborate with parents to find the most effective behavior modification techniques.
- Provide clear expectations and rules. Keep classroom rules in a visible place and offer reminders when needed.
- Recognize that any changes in the school day, including a fire drill or the order of lessons, can upset students with ODD.
- Hold students accountable for their actions and provide consistent consequences.
- Work to establish trust through clear and consistent communication.
- Offer encouragement and praise for positive changes.
Symptoms of ODD gradually improve for many children with the condition, especially when they have both professional and family support.
A therapist who specializes in childhood mental health conditions can offer more guidance.