Oppositional Defiant Disorder (ODD) in Children and Adolescents

Oppositional defiant disorder (ODD) is a disorder characterized by angry, hostile, defiant behavior that is beyond the norm of typical childhood behavior.   Children and teens suffering from this disorder may appear very stubborn and often angry. If the child has already been diagnosed with a conduct disorder (CD), he cannot also be diagnosed with ODD. 

What Causes Oppositional Defiant Disorder?
The exact cause of ODD is not known, but it is believed that a combination of biological, genetic, and environmental factors may contribute to the condition.  Biologically, there may be defects in certain areas of the brain, or there may be abnormal amounts of certain types of brain chemicals or neurotransmitters.  

Many children and teens with ODD have close family members with mental illnesses, including mood disorders, anxiety disorders, and personality disorders. This suggests that ODD may have a genetic component.  

Environmental factors include a dysfunctional family life, a family history of mental illnesses and/or substance abuse, and inconsistent discipline by parents; all these may contribute to the development of ODD.  Some research indicates that children of alcoholic parents, or whose parents have "been in trouble with the law" have a greater chance of developing ODD.  

Many children and teens with ODD also have other mental illnesses, such as ADHD, learning disorders, depression, or an anxiety disorder, which may also contribute to their behavior problems.

How Common Is Oppositional Defiant Disorder?
It is estimated that 2%-16% of children and teens have ODD. In younger children, ODD is more common in boys. In older children, it occurs about equally in boys and in girls. It typically begins by age 8.  

What are some of the Signs and Symptoms of ODD? 
A child who presents with oppositional defiant disorder (ODD) will display behaviors that include excessive, often persistent anger, frequent temper tantrums or angry outbursts, and a disregard for authority and rules. Children and adolescents with ODD often purposely annoy others, blame others for their own mistakes, and are easily disrupted. They tend to be more rigid, and tend to become irritable more easily and intensely.  In addition, children and teens with ODD may appear resentful of others; so for example,   if someone does something they don’t like, they will be quicker to take revenge and be spiteful and vindictive than to try to work out a more thoughtful solution.

The child or teen  with a diagnosis of ODD must display behaviors that cause considerable distress for the family and/or interfere significantly with academic or social functioning. Interference might take the form of preventing the child or adolescent from learning at school or making friends, or placing him or her in harmful situations. These behaviors must also persist for at least six months. Effects of ODD can be greatly amplified by other disorders in comorbidity such as ADHD, depression or substance abuse.

What is the best treatment for ODD?
There are several ways to treat ODD, but behavior therapies have proven the most effective. Behavioral therapy for children and adolescents focuses primarily on how to prevent problematic thoughts or behaviors from accidentally getting reinforced unknowingly within a child’s or teen’s environment.  Cognitive behavior therapy (CBT) can be used with children and teens to ensure that they can try a new way of thinking about or acting out their problems.  It can also ensure that negative behaviors are not (unintentionally) reinforced by parents.  In addition, researchers have found that the use of positive reinforcement and praise for appropriate behaviors are two key elements in effective interventions.  In other words, instead of giving a lot of attention to or punishing negative behaviors, the parent should immediately praise and reinforce positive behaviors when the child behaves appropriately.  Positive reinforcement and praise not only builds a child's self-esteem but also serves to strengthen the bond between a child and their parent or caregiver. 

Other approaches to the treatment of ODD include parent training programs, individual psychotherapy, family therapy, anger management training, and social skills training.  For adolescents at risk for ODD, cognitive interventions, vocational training, and academic tutoring have shown to be effective in preventing ODD. 

While there is no medication formally approved to treat ODD, various drugs may be used to treat some of its distressing symptoms, as well as any other mental illnesses that may be present, such as ADHD or depression.

If a child or teen is showing signs of ODD, it is important to seek treatment as quickly as possible from a qualified mental health professional.   Without treatment, children with ODD may experience rejection by classmates and other peers because of their poor social skills and aggressive and annoying behavior. In addition, a child with ODD has a greater chance of developing a more serious behavioral disorder called conduct disorder.  The treatment of ODD can be very effective if it is started early. 

Conduct disorder is a serious behavioral and emotional disorder that can occur in children and teens. A child with this disorder may display a pattern of disruptive and violent behavior and will have a significant problem following rules.  A child with a conduct disorder displays behaviors that have been continuous and long lasting and are disruptive to the child’s or family’s everyday life.  

How common is Conduct Disorder?
It is estimated that 2%-16% of children in the U.S. have conduct disorder. It is more common in boys than in girls and most often occurs in late childhood or the early teen years.

What are the signs and symptoms of Conduct Disorder?
The symptoms of a conduct disorder vary depending on the age of the child and whether the disorder is mild, moderate, or severe. In general, symptoms of conduct disorder fall into four general categories:

- Deceitful behavior: This may include repeated lying, shoplifting, or breaking into homes or cars in order to steal. 
- Destructive behavior: This involves intentional destruction of property such as arson (deliberate fire-setting) and vandalism (harming another person's property). 
- Violation of rules: This involves going against accepted rules of society or engaging in behavior that is not appropriate for the person's age. These behaviors may include running away, skipping school, playing pranks, or being sexually active at a very young age.
- Aggressive behavior: These are behaviors that threaten or cause physical harm and may include fighting, bullying, being cruel to others or animals, using weapons, and forcing another into sexual activity.

In addition, many children with conduct disorder are irritable, have low self-esteem, and tend to throw frequent temper tantrums. Some may abuse drugs and alcohol. Children with conduct disorder often are unable to appreciate how their behavior can hurt others and generally have little guilt or remorse about hurting others.

What Causes Conduct Disorder?
As with ODD, the exact cause of conduct disorder is not known, but it is believed that a combination of biological, genetic, environmental, psychological, and social factors play a role.

Biologically, there may be defects in certain areas of the brain, or there may be abnormal amounts of certain types of brain chemicals or neurotransmitters.  

Many children and teens with conduct disorder also have other mental illnesses, such as ADHD, learning disorders, depression, or an anxiety disorder, which may also contribute to their behavior problems.

Many children and teens with conduct disorder have close family members with mental illnesses, including mood disorders, anxiety disorders, and personality disorders. This suggests that a conduct disorder may have a genetic component.  

Environmental factors include a dysfunctional family life, childhood abuse, traumatic experiences, a family history of substance abuse, and inconsistent discipline by parents.

Some experts believe that conduct disorders can reflect psychological problems with moral awareness (notably, lack of guilt and remorse) and deficits in cognitive processing.  Social factors include low socioeconomic status and not being accepted by their peers; both appear to be risk factors for the development of conduct disorder.

What is the best treatment for Conduct Disorder?
Treatment for conduct disorder is based on many factors, including the child's age, the severity of symptoms, as well as the child's ability to participate in and tolerate specific therapies. Treatment usually consists of a combination of psychotherapy, CBT, family therapy, or parent management training (PMT).  Although there is no medication formally approved to treat conduct disorder, various drugs may be used to treat some of its distressing symptoms, as well as any other mental illnesses that may be present, such as ADHD or major depression.

A child or teen who displays symptoms of a conduct disorder must obtain help by a qualified mental health professional immediately.   If the conduct disorder is left untreated, the  child or teen runs the risk of developing other mental disorders as an adult, such as antisocial personality disorder, mood or anxiety disorders, and substance use disorders.  Children and teens with conduct disorder are also at risk for school-related problems, such as failing or dropping out, substance abuse, legal problems, injuries to self or others due to violent behavior, sexually transmitted diseases, and suicide. 

At OHEL we can help.
The diagnosis and treatment of oppositional defiant disorder or conduct disorder in children and adolescents can be done by one of our licensed mental health professionals or by one of our licensed psychiatrists.  OHEL’s competent mental health professionals can provide the help needed to empower children and teens impacted by ODD or CD and allow them to regain control and improve their quality of life.

Remember, at OHEL, we are only a phone call or a click away from your road to recovery.