What is oppositional defiant disorder (ODD)?

All children are oppositional sometimes. They might throw temper tantrums or push back against adults’ boundaries. But for some children, these behaviors can become so severe that it can impact their daily functioning. 

These children may be diagnosed with oppositional defiant disorder (ODD) — a mental health condition characterized by defiant or aggressive behaviors, especially toward adults and authority figures. It primarily affects children, though it can persist into adulthood in some cases.

ODD can sometimes be a controversial and stigmatizing diagnosis, so it’s important to consider it with understanding and care. For children who meet the diagnostic criteria for ODD, many effective treatment methods can help them develop healthy coping mechanisms and build healthier relationships. 

Symptoms of oppositional defiant disorder

ODD is listed as a type of “disruptive, impulse-control, and conduct disorder” in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which health professionals use to make psychological diagnoses. This is a group of mental health conditions that are characterized by aggressive behaviors and problems with self-control. 

ODD is mostly diagnosed in children, but it can affect adults as well. Reports estimate that up to 16% of children are diagnosed with ODD. Around 3% to 5% of the general population (including adults) are affected. Boys are more likely to be diagnosed with ODD than girls.

According to the DSM-5, a child (or adult) must have a pattern of angry, irritable, argumentative, or intentionally hurtful behavior that is more severe than typical development and causes significant problems in social, academic, or occupational functioning to meet the criteria for an ODD diagnosis. 

Examples of specific behaviors that could fall into these three patterns include:

• Argumentative behavior: People with ODD may argue with authority figures, refuse to comply with instructions, rules, or requests, deliberately annoy others, and often blame others when they get into trouble.
• Angry behavior: Frequent temper outbursts, irritability or lashing out can be signs of ODD. 
• Intentionally hurtful behavior: People with ODD may intentionally say mean or hurtful things to others or engage in revenge-seeking behavior. 

These symptoms have a lot in common with those of conduct disorder, another related mental health condition. But ODD is unique because people who live with it are especially argumentative and defiant with authority figures. For example, a child with ODD might be friendly toward peers but aggressive with teachers or other adults. People with ODD also typically don’t exhibit the more extreme behaviors that people with conduct disorder sometimes do, like violence toward animals.

Some argue that ODD is an unnecessary label for common child behaviors like temper tantrums. While it’s true that many children occasionally throw tantrums, become irritable, or challenge their parents, this doesn’t mean they have ODD. Testing boundaries is a normal part of child development. 

But children, teens, and adults with ODD experience these types of behaviors so consistently, leading to significant problems in at least one area of life. For example, they might struggle to make friends, be constantly reprimanded at home, or receive disciplinary action at school. In addition, they need to have experienced these symptoms for at least six months for a diagnosis to be given.

ODD diagnosis

Diagnosing ODD can be challenging and, at times, controversial. Research has highlighted significant racial and gender disparity when it comes to ODD diagnosis. Specifically, Black people assigned male at birth are much more likely to be diagnosed with ODD. That’s while their white counterparts (presenting with the same symptoms) are diagnosed with other conditions that aren’t as stigmatized, including adjustment disorder, autism, and attention-deficit hyperactivity disorder (ADHD). 

Usually, children start showing symptoms of ODD before age 12, but they can also persist into adulthood. In children, parents may notice disruptive behaviors and seek assessment, or a teacher may refer the child for evaluation. In adults, people may seek help when they experience persistent issues with authority or relationships. 

During an assessment, a mental health professional will typically gather information from both the individual and their family or close contacts to understand the patterns of behavior. They may also consider the person’s medical history and observe their behavior in different settings.

If you disagree with an ODD diagnosis — particularly in cases where there might be historical biases affecting diagnosis, such as in certain racial or gender groups — then tell a trusted healthcare professional right away. It’s important to get the right diagnosis, because the way ODD is treated can be very different from how other conditions, like ADHD, are treated.

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What causes ODD?

We’re still not sure what causes ODD. But, like most other mental health conditions, it’s thought to be caused by a combination of genetic, biological, and environmental factors.

Some factors that can increase a person’s risk for developing ODD include:

• Genetics and family history: Those with relatives who have ADHD, substance use disorder, or other types of conduct disorders are at higher risk of developing ODD.
• Brain differences: Researchers have found that people with ODD may have differences in the areas of their brain responsible for reasoning and judgment.
• Social and environmental factors: People sometimes develop ODD behaviors when exposed to community violence or neglect. 
• Personality and temperament: Lastly, some of the risk factors of ODD may be related to each person’s personality. For example, children who have poor frustration tolerance or are emotionally reactive may be at a higher risk for developing ODD.

Treatment approaches and outcomes

If you or someone you know is experiencing ODD, it’s important to get treatment as soon as possible. Untreated ODD can sometimes develop into conduct disorder, which can come with much more severe symptoms.

Sometimes the symptoms of ODD get better on their own. But treatment is essential. Studies have found around 67% of children who have received treatment experience a significant reduction in symptoms. When left unaddressed, some children with ODD may go on to develop more serious symptoms. 

The best treatment depends on you (or your child’s) unique personality traits, symptoms, family dynamics, and age.

Some treatment options for those with ODD include:

• Behavioral therapy: Sometimes different individual therapy techniques are used. Behavioral therapy, like cognitive behavioral therapy (CBT), can teach you healthier strategies to use when you are feeling frustrated or upset. 
• Family therapy: Sometimes, the whole family, including siblings, may need to be involved in treatment to ensure the best outcome. In family therapy, you can explore the dynamics between each family member and start to heal relationships — especially those with the person who has ODD. 
• Parent management training: Parents play an enormous role, and the way they interact with their child can make a big difference in their symptoms. In parent management training, you’ll learn skills like positive reinforcement techniques to manage your child’s behaviors.

Find care with Rula

An ODD diagnosis can carry stigma and it may be difficult to understand what the diagnosis means for you. However, having an ODD diagnosis doesn’t mean you or your loved one can’t learn healthier coping mechanisms and build strong relationships. With the right treatment, most people with ODD see improvement.

Many of Rula’s 10,000+ therapists work with individuals of all ages, including children, teens, and adults. They can help you work through ODD symptoms and set you up for success at any stage of life. Plus, you can see a therapist as soon as tomorrow.

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