Oppositional Defiant Disorder in Children and Adolescents

Signs and Symptoms of Oppositional Defiant Disorder

An Oppositional Defiant Disorder (ODD) is diagnosed with a pattern of negative, hostile and defiant behavior, when four or more of the following are present, for at least 6 months:

  • Often loses temper
  • Often argues with adults
  • Often actively defies or refuses to comply with adults' requests or rules
  • Often deliberately annoys people
  • Often blames others for his or her mistakes or behavior
  • Is often touchy or easily annoyed by others
  • Is often angry and resentful
  • Is often spiteful or vindictive

These criteria are the signs and symptoms currently designated by the American Psychiatric Association for this disorder.  They are published in the Diagnostic and Statistical Manual of Mental Disorders (fourth edition, 1994), and available in the public domain.  Diagnoses for mental health remain dominated by the medical model in this country.  A diagnosis is necessary for insurance coverage for services, and for determining a proper treatment plan.

These disturbances of behavior need to cause significant interference in social and academic performance.  They are also not the result of (happening only during) a Mood Disorder or a Psychotic Disorder.  These behaviors would have to occur more frequently than what is typical for a child or adolescent's age or level of development.

An Oppositional Defiant Disorder is usually seen with authority figures (like parents and teachers).  Children with this condition are generally persistent in their defiance.  They reisist direction from others.  They are unwilling to compromise, give in, or negotiate with adults or peers.  Children with ODD may deliberately test limits by ignoring orders, arguing, and failing to accept responsiblity for their actions.  They may be hostile through deliberately annoying authority, or by verbal aggression.  This is not the more serious physical aggression found in a Conduct Disorder.  Individuals with this ODD generally justify their behavior as a response to unreasonable demands or circumstances imposed by authority or by peers.

For boys, this disorder is seen more with preschoolers that have difficult temperaments, like being highly reactive or hard to soothe, or having a high activity level.  For school age boys, there may be low self esteem,  wide and sudden mood variations, low frustration tolerance, swearing, and early use of alcohol, tobacco or drugs.  Peer conflict is frequent.

Often there is a vicious cycle where parent and child or adolescent bring out the worst in each other.  When caretakers are changed or disrupted, or when parenting is harsh, inconsistent or neglectful, this disorder is more common.  ODD is common in children having an Attention Deficit Disorder (ADHD).  Learning Disabilities and Communication Disorders are also associated with this condition.

Opposition naturally increases with age, and is a normal part of adolescent development of a sense of self as different from others.  This disorder occurs more with males than with females before puberty, but the rates are equal after puberty.  Symptoms are similar in boys and girls, but boys may be more confrontational and more persistent.  Rates of ODD are between 2% and 16% of the population.  This condition usually appears before age 8, and the onset is most often gradual.  Many times, children or adolescents with an Oppositional Defiant Disorder will develop into a Conduct Disorder.

It is more common in families where a parent has a history of having a Mood Disorder, Oppositional Defiant Disorder, Conduct Disorder, ADHD, Antisocial Personality Disorder, or a Substance Abuse Disorder.  It is more common in families where there is a high degree of parental conflict.  Many times, a mother with a Depressive Disorder will have a child with oppositional behavior, but it is unclear whether a mother's depression results from or causes this.

Counseling or psychotherapy, following an accurate diagnosis, can be helpful both for a child or adolescent with an Oppositional Defiant Disorder, and for their family as a whole.  Learning to communicate respectfully and compromise or negotiate so that all members of a family are satisfied is a practical goal.  Willingness to change is more likely when parents are involved in treatment.

If you think that your child or adolescent might have ODD, you should talk to a professional about what to do and how to get help.  If you live in southeast Massachusetts, in Plymouth county, Cranberry Counseling, P.C. in Marshfield would be more than happy to answer your questions and to make an appointment to help diagnose and start a treatment plan for your child or adolescent and your family.  See the Cranberry Counseling, P.C. page, or use the Contact Us form.