Oppositional Defiant Disorder: Diagnosis, Symptoms, and Treatment
Oppositional defiant disorder is more than just kids “acting out” during a rebellious phase. This disorder, classified in the disruptive, impulse-control, and conduct disorders category according to the Diagnostic and Statistical Manual for Mental Disorders 5, Text Revision (DSM-5-TR), presents as a repetitive pattern of “openly uncooperative and hostile” behavior across contexts and social settings. While most children occasionally exhibit defiant or unruly behavior as they grow and mature, those with oppositional defiant disorder will ‘stand out’ compared to their peers because of their persistent and concerning behavior.
What causes Oppositional Defiant Disorder?
There is not a single, definitive cause of oppositional defiant disorder. Instead, a combination of biological, environmental, and social factors can predispose a child to develop this condition. Family instability, parental history of psychiatric conditions, poverty, abuse, and brain-chemical imbalances are all factors that may increase one’s risk of developing ODD, though not a guarantee.
There are several characteristics and behaviors included in the diagnostic criteria of oppositional defiant disorder. To receive this diagnosis, individuals must have at least four symptoms present for at least six months. Additionally, the behaviors and symptoms, such as persistent angry mood and intentional vindictiveness, must appear during interactions with at least one non-sibling individual.
Symptoms of Oppositional Defiant Disorder
ODD symptoms are severe, disruptive, and ultimately impact the individual’s social functioning. At home and school are where symptoms are often most noticeable. When examining oppositional defiant disorder symptoms, a few words stick out: deliberate, arguing, spiteful, excessive. These symptoms go beyond the occasional temper tantrum or argument on the playground.
Key symptoms include:
- Deliberate attempts to upset others
- Questioning rules
- Frequent anger and resentment
- Active defiance, argumentativeness, and refusal to comply with rules or requests from adults and authority figures
- Hateful speech when upset or angry
Treatment of Oppositional Defiant Disorder
Like many other mental disorders, treatment of oppositional defiant disorder requires a holistic, collaborative approach. Both the parents and the affected individual must be committed to the treatment process, as there is no ‘quick fix’ for oppositional defiant disorder. Interventions include both individual and family counseling and psychotherapy. The goals of therapy are to improve family communication skills, develop understanding, and, for the individual, develop healthy, effective anger management and problem-solving skills.
Parents of children with oppositional defiant disorder may also consider Parent-Management Training, which provides families with positive reinforcement techniques to address their child’s behavior healthily. Medications may also be used in conjunction with psychotherapy to manage co-existing disorders and symptoms, such as anxiety or attention deficit hyperactivity disorder (ADHD).
Oppositional Defiant Disorder in Adults
While ODD primarily affects children and adolescents, research suggests that adults who have a history of oppositional defiant disorder in childhood are significantly more likely to be diagnosed with other psychiatric conditions in adulthood. Symptoms of oppositional defiant disorder can continue into adulthood and can lead to significant impairment in functioning, with an increased risk of substance abuse and suicide.