Oppositional Defiant Disorder (ODD)

Oppositional Defiant Disorder (ODD) is a mental health disorder in children that involves defying parents, breaking rules, and other serious behavior problems. All children act out sometimes, but kids with ODD struggle with their behavior regularly. They are often angry or irritable, and their behavior problems are more extreme.

What are the symptoms of ODD?

Children with ODD have a pattern of behavior problems with the following common symptoms:

Core Symptoms

Angry or irritable mood:

– Often losing temper

– Often touchy or easily annoyed

– Often angry or resentful

Argumentative or defiant behavior:

– Often arguing with adults or authority figures

– Often defiant or refusing to follow rules or requests

– Often annoying others on purpose

– Often blaming others for mistakes or misbehaviors

Vindictiveness:

– Spitefulness or vindictiveness happening at least twice in the past 6 months

Associated Symptoms

– Frequent conflicts with caregivers, siblings, and peers

– Family stress

– Frequent conflicts with teachers or other authority figures in school

– Issues with social functioning

– Issues with academic functioning

How is ODD Diagnosed?

A child-adolescent psychiatrist may diagnose a child with ODD after determining whether the symptoms they are experiencing meet the diagnostic criteria; that their symptoms have been present for at least six months; and that the symptoms are having a significant impact on others in the child’s or teen’s life (e.g., family, peers, colleagues) or other parts of everyday functioning (e.g., social, family, school, etc.).

The psychiatrist may interview and/or assess both the child or teen and a caregiver to figure out the specifics of their behaviors. Many practitioners also use behavior and emotion rating forms to help with the diagnosis. The practitioner will also try to determine that the symptoms are not related to something unexpected.

ODD facts

Worldwide frequency of the condition:

It is estimated that Oppositional Defiant Disorder (ODD) is present in approximately 3.3% of the world population.

Impact of the condition in Brazil:

Nationally representative data on the prevalence of ODD in children and adolescents in Brazil are lacking. Local studies have found prevalence rates of around 2 to 3% in this age group.

Gender ratio:

Data indicate that boys are more likely to be diagnosed with ODD than girls, with a ratio of approximately 1.59 to 1.

Peak age of onset:

Studies show that ODD can have two peaks of onset: the first around 3 years of age, and the second between 6 and 7 years of age.

Proportion of the condition that emerges before age 18:

ODD is often not diagnosed in adults, so 100% of cases are diagnosed before the age of 18.

What are the associated factors for ODD?

Some common factors linked with ODD are:

– Genetic and familial factors: A tendency toward ODD most likely results from a combination of multiple genes interacting with environmental factors.

– Attention-Deficit/Hyperactivity Disorder (ADHD): There is a high overlap in kids that have ADHD who are also diagnosed with ODD.

– Temperament: Children who have a lot of difficulty calming themselves as toddlers and continue to struggle with controlling their emotions when disappointed or frustrated can sometimes develop ODD. The adults around them might be more likely to give in to their demands to keep the family peaceful.

– Environmental factors: Kids who have experienced a lot of life stress and trauma are also more likely to develop ODD.

What other disorders co-occur with ODD?

ODD is commonly found with ADHD and also puts children at higher risk for other mental health disorders, including anxiety and depression.

How is ODD treated?

ODD is usually treated with behavioral parent training (BPT), family therapy, cognitive-behavioral therapy (CBT), or a combination of psychotherapy and medication.

Improving the caregiver-child relationship is often a priority during treatment for ODD. This means that caregivers play a large role in BPT, and therapists will work with caregivers alone, as well as together with caregivers and their kids. BPT programs can help caregivers learn to set clear expectations, use effective praise when kids meet expectations, and use effective consequences when they do not meet expectations. These techniques can also be taught to teachers through teacher training. They also teach kids how to manage their emotions and improve their own behavior. There is also some evidence that kids benefit from additional types of psychotherapy, including social skills training to improve their peer relationships, CBT if they are struggling with anxiety or depression, or dialectical behavior therapy (DBT) if they are struggling with extreme emotions.

There is no medication that specifically treats ODD. However, there are medications that treat some of the core and associated symptoms. There is some evidence that stimulants (e.g., methylphenidate) and non-stimulant (e.g., atomoxetine) medications may improve oppositional behaviors and impulsivity. Antidepressant medications, such as selective serotonin reuptake inhibitors (SSRIs), may be used if a child also has depression or anxiety. Lastly, there is some evidence that antipsychotic medications, such as risperidone and aripiprazole, may be effective for reducing aggression in kids with ODD. Medications can have side effects, but they are safe for kids to use with proper monitoring by their doctor and close supervision from their caregivers. A child or teen who is taking one of these medications should see their doctor regularly, especially if their dosage has recently changed.

References

Clinical description, symptoms, and diagnostic information

– American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.

– Child Mind Institute. (2022, April 8). Quick guide to oppositional defiant disorder (ODD). _https://childmind.org/guide/quick-guide-to-oppositional-defiant-disorder/_

– Ehmke, R. (2022, July 14). What is Oppositional Defiant Disorder? _https://childmind.org/article/what-is-odd-oppositional-defiant-disorder/_

– World Health Organization. (2022, February). ICD-11 for mortality and morbidity statistics. 6C90 Oppositional Defiant Disorder. _https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/1487528823_

Facts

– American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.

– Institute for Health Metrics and Evaluation (IHME). (2019). GBD Compare Data Visualization. Seattle, WA: IHME, University of Washington. Available from _http://vizhub.healthdata.org/gbd-compare_. (Accessed 11/15/2022)

– Kerekes, N., Lundström, S., Chang, Z., Tajnia, A., Jern, P., Lichtenstein, P., Nilsson, T., & Anckarsäter, H. (2014). Oppositional defiant- and conduct disorder-like problems: Neurodevelopmental predictors and genetic background in boys and girls, in a nationwide twin study. PeerJ, 2, e359. _https://doi.org/10.7717/peerj.359_

– Polanczyk, G. V., Salum, G. A., Sugaya, L. S., Caye, A., & Rohde, L. A. (2015). Annual research review: A meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. Journal of Child Psychology and Psychiatry, 56(3), 345–365. _https://doi.org/10.1111/jcpp.12381_

– Sacco, R., Camilleri, N., Eberhardt, J., Umla-Runge, K., & Newbury-Birch, D. (2022). A systematic review and meta-analysis on the prevalence of mental disorders among children and adolescents in Europe. European Child & Adolescent Psychiatry. _https://doi.org/10.1007/s00787-022-02131-2_

Associated factors

– American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.

– Azeredo, A., Moreira, D., & Barbosa, F. (2018). ADHD, CD, and ODD: Systematic review of genetic and environmental risk factors. Research in Developmental Disabilities, 82, 10–19. _https://doi.org/10.1016/j.ridd.2017.12.010_

– Ghosh, A., Ray, A., & Basu, A. (2017). Oppositional defiant disorder: Current insight. Psychology Research and Behavior Management, Volume 10, 353–367. _https://doi.org/10.2147/PRBM.S120582_

– Lin, X., He, T., Heath, M., Chi, P., & Hinshaw, S. (2022). A Systematic Review of Multiple Family Factors Associated with Oppositional Defiant Disorder. International Journal of Environmental Research and Public Health, 19(17), 10866. _https://doi.org/10.3390/ijerph191710866_

Co-occurring disorders

– American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition Text Revision DSM-5-TR. American Psychiatric Association Publishing, Washington, DC.

– Ghosh, A., Ray, A., & Basu, A. (2017). Oppositional defiant disorder: Current insight. Psychology Research and Behavior Management, Volume 10, 353–367. _https://doi.org/10.2147/PRBM.S120582_

Interventions

– Battagliese, G., Caccetta, M., Luppino, O. I., Baglioni, C., Cardi, V., Mancini, F., & Buonanno, C. (2015). Cognitive-behavioral therapy for externalizing disorders: A meta-analysis of treatment effectiveness. Behaviour Research and Therapy, 75, 60–71. _https://doi.org/10.1016/j.brat.2015.10.008_

– Boldrini, T., Ghiandoni, V., Mancinelli, E., Salcuni, S., & Solmi, M. (2023). Systematic Review and Meta-analysis: Psychosocial Treatments for Disruptive Behavior Symptoms and Disorders in Adolescence. Journal of the American Academy of Child & Adolescent Psychiatry, 62(2), 169–189. _https://doi.org/10.1016/j.jaac.2022.05.002_

– Ghosh, A., Ray, A., & Basu, A. (2017). Oppositional defiant disorder: Current insight. Psychology Research and Behavior Management, Volume 10, 353–367. _https://doi.org/10.2147/PRBM.S120582_

– Nelson-Gray, R. O., Keane, S. P., Hurst, R. M., Mitchell, J. T., Warburton, J. B., Chok, J. T., & Cobb, A. R. (2006). A modified DBT skills training program for oppositional defiant adolescents: Promising preliminary findings. Behaviour Research and Therapy, 44(12), 1811–1820. _https://doi.org/10.1016/j.brat.2006.01.004_

– Pringsheim, T., Hirsch, L., Gardner, D., & Gorman, D. A. (2015). The pharmacological management of oppositional behaviour, conduct problems, and aggression in children and adolescents with Attention-Deficit Hyperactivity Disorder, Oppositional Defiant Disorder, and Conduct Disorder: A systematic review and meta-analysis. Part 1: Psychostimulants, alpha-2 agonists, and atomoxetine. The Canadian Journal of Psychiatry, 60(2), 42–51. _https://doi.org/10.1177/070674371506000202_

– Riise, E. N., Wergeland, G. J. H., Njardvik, U., & Öst, L.-G. (2021). Cognitive behavior therapy for externalizing disorders in children and adolescents in routine clinical care: A systematic review and meta-analysis. Clinical Psychology Review, 83, 101954. _https://doi.org/10.1016/j.cpr.2020.101954_

– Zarakoviti, E., Shafran, R., Papadimitriou, D., & Bennett, S. D. (2021). The Efficacy of Parent Training Interventions for Disruptive Behavior Disorders in Treating Untargeted Comorbid Internalizing Symptoms in Children and Adolescents: A Systematic Review. Clinical Child and Family Psychology Review, 24(3), 542–552. _https://doi.org/10.1007/s10567-021-00349-1_