Oppositional defiant disorder

What is oppositional defiant disorder (ODD)? Children with ODD are constantly defiant, hostile and disobedient. They don't like responding to instructions or taking orders from others, and they actively refuse simple requests.

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What is oppositional defiant disorder?

Oppositional defiant disorder (ODD) is a disorder where children have disruptive and oppositional behaviour that is particularly directed towards authority figures, such as parents or teachers.

ODD is less severe and more common than conduct disorder.

Children with ODD are constantly defiant, hostile and disobedient. They don't like responding to instructions or taking orders from others, and they actively refuse simple requests.

Sometimes they eagerly blame others for their own mistakes, can lose their temper easily, and act in an angry, resentful or touchy manner.

Term watch

Oppositional: hostile or confrontational action or behaviour.

All children occasionally react in this way on a bad day or if upset by a situation, and many teenagers go through troublesome times. But children with oppositional defiant disorder are like this much of the time, making them very hard to deal with.

Symptoms

The key behavioural symptoms of ODD are negative, hostile and defiant behaviour. For ODD to be diagnosed, symptoms have to have been present for at least six months and involve four or more of the following:

  • 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 mistakes or misbehaviour
  • often touchy or easily annoyed by others
  • often angry and resentful
  • often spiteful or vindictive.

    To be classified as ODD, the behaviour also has to have caused a significant degree of disturbance to home, social or school life.

    How does it cause problems?

    For parents, having a child with ODD can be very difficult.

    A child with ODD will:

    • deliberately take the most difficult path, eg to say 'no' on principle
    • enjoy challenging and arguing with people
    • refuse to do what he's told.

      It's common for a child with ODD to blame everyone else for his problems, and at his worst he can be hostile, spiteful and vindictive.

      These types of problem behaviours are typically directed towards parents and teachers, plus others in authority although they can also be directed as siblings and peers. Coping with a consistently disruptive attitude can be extremely frustrating and physically, mentally and emotionally exhausting.

      ODD is common in children with ADHD, however many of the same general approaches to parenting and behaviour management can be used in either disorder.

      How common is it?

      Term watch

      Co-morbidity: when two or more conditions exist at the same time.

      For example, oppositional defiant disorder can exist alongside ADHD.

      In the general population, ODD is believed to affect around 5 per cent of boys and 2 per cent of girls. It's common for it to co-exist with ADHD, especially as children get older.

      In fact, figures suggest between 35 and 60 per cent of those with ADHD also have oppositional defiance disorder.

      What causes ODD?

      It's not clear what causes ODD. It may be caused by biological factors, such as the makeup of a child's temperament and possibly through a neurological imbalance in the brain. But ODD is also affected by parenting styles.

      A child brought up by parents who are constantly hostile, confrontational and forceful has an increased risk of ODD.

      Why are children with ADHD more likely to have ODD?

      Children with ADHD are difficult to parent, and their impulsivity often upsets others. They often receive a lot of negative feedback and critical comments and are less likely to have good peer relationships than other children.

      It's thought it's these negative parenting and relating styles and the lack of peer relationships that lead to ODD being found more often in children with ADHD.

      How is it treated?

      Oppositional defiant disorder is generally not treated with medication in the UK, but with a behavioural approach.

      If you think your child may have ODD, make an appointment with your GP as a first step to seeking treatment. If ODD is if left untreated and undiagnosed, it may lead to a more serious conduct disorder.

      Behavioural approach

      A typical behavioural approach will help you learn how to deal with your child's defiance in an effective manner, using tried and tested techniques such as setting achievable goals and reinforcing positive behaviours.

      It can be carried out on a one-to-one basis with parents, or in a group if there are several families needing help at any one time.

      Group work can be helpful because it offers extra support for parents and confirmation that it's not just your family going through the difficulties of ODD.

      ODD children can be very demanding, so learning new ways of dealing with your child's behaviour can prove challenging.

      For example, although you may feel at the end of your tether, arguing or shouting back at your child isn't the best approach.

      Instead you'll be encouraged to learn new ways of dealing with behaviour such as confrontations, arguing and impulsive rages. Insight will be given into how oppositional children think, so you can begin to understand why your child acts this way.

      Treatment is likely to encourage talking to your child and helping him to acknowledge his behaviour. It will also focus on ways of using praise to improve behaviour and address the issue of control – one of the things ODD children strive for.

      Treating ODD with ADHD

      If ODD exists alongside ADHD, treatment for ADHD often needs to get underway before ODD can be tackled.

      It's worth noting that if your child is being treated for ADHD and ODD, sometimes ADHD medication can make some of the ODD symptoms appear worse.

      This is because ADHD drugs help children become more focused and predictable, but it can make ODD symptoms such as irritability more focused, too.

      Although ADHD can be treated well, getting ODD under control can take some time and a lot of hard work.

      Other people also read:

      ADHD (attention deficit hyperactivity disorder): what else could it be?

      Cognitive behavioural therapy: how can it help ADHD?

      Why is ADHD controversial? some experienced clinicians and specialists believe the condition isn't adequately recognised.

      Based on a text by Dr Dan Rutherford, GP

      Last updated

      Consultant paediatrician and neurologist
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