Over the course of normal development, children are expected to assert their independence or autonomy, test limits, and defy authority at times, and this often predictably occurs during particular developmental periods (e.g., at 2 to 3 years of age, or during adolescence). The diagnosis of Oppositional Defiant Disorder (ODD) should not be made in instances in which a child's conduct falls generally within an age-expected range and is not exerting any significant impact on daily functioning. Typically, children who meet the criteria for this diagnosis display pronounced anger and irritability. They often argue and engage in frequent outbursts when they are denied their way. Oftentimes, the question or minimize rules, and actions fail to comply with or defy requests, instructions, or rules set by parents, teachers, or other authority figures. Children with ODD are often known to deliberately annoy or provoke reactions from others, and they may appear vengeful or vindictive when their wishes are thwarted. Upon making mistakes or held accountable, they frequently fail to acknowledge responsibility and displace blame onto others.
In order for an ODD diagnosis to be assigned, problems related to it should be relatively pronounced and long-standing. For a child younger than five years, the symptoms listed above should occur most days over a period of six months or more. A child that is older than five years of age is expected to exhibit these tendencies at least once weekly over a six-month period. Typically, these concerns begin well before eight years of age and no later than early adolescence.
Oppositional Defiant Disorder should be distinguished from a diagnosis of Conduct Disorder, which is characterized by more concerning and potentially harmful problems of aggressive behavior (e.g., fighting, bullying, cruelty to animals, etc.) and serious rule-breaking (e.g., staying out all night or running away, truancy from school, etc.).
Research and clinical experience show that tendencies toward oppositional and defiant behavior among children who are formally diagnosed with ODD often vary greatly across people and settings. For example, a child with ODD may be decidedly more defiant in the presence of some adults (e.g., parents, teachers, coaches, etc.) than others. Moreover, children with ODD are often more non-compliant and defiant in some situations than others (e.g., at home versus school or stores, etc.). A determination of severity (i.e., mild, moderate, severe) is made based upon the pervasiveness of these difficulties and the degree to which they interfere with day-to-day functioning.
As is the case with other developmental and psychiatric disorders in childhood, the specific ideology or cause of Oppositional Defiant Disorder has not been definitively established but is regarded to involve a complex interplay of biological, psychological, and social factors. Thus, within our culture, boys are decidedly more likely to be diagnosed with ODD than girls and the diagnostic rate varies somewhat based upon one's socioeconomic background. Moreover, in addressing the challenging concerns presented by children with this disorder, one must consider other known risk factors and comorbid conditions within the individual and family (e.g., ADHD, learning problems, serious mood, and psychiatric disorders, parental drug, and alcohol usage, or criminal behavior, abuse, and neglect, etc.), which are all known to exacerbate ODD-related difficulties.
While the impact of Oppositional Defiant Disorder on family functioning and a child's long-term development can be severe if unaddressed, it is reassuring to know that there are effective and well-established treatment approaches available.
1) Parent Training/Behavior Management Training/Family Therapy & Training-
These therapeutic modalities seek to promote a child's ability to comply with rules and responsibilities, respect authority, and be accountable to others by fostering a consistent and predictable approach to conduct within and outside of the household. Within this model, the therapist "teaches" or "coaches" the parents and family in strategies and techniques to effectively communicate, relate securely and respectfully, and appropriately connect a child's responsibilities and privileges. Motivational strategies and behavioral intervention plans which formalize rules, rewards, and consequences are often utilized as a part of this approach.
2) Cognitive Behavioral Therapy (CBT)-
For older children and adolescents, individual and group-based CBT approaches that promote anger management and frustration tolerance, problem-solving skills, and age-appropriate social skills are often utilized.
While there are no medications or pharmacological interventions that are explicitly designed to address oppositional and defiant behavior, these are sometimes an important adjunct to psychological treatment if the child has also been diagnosed with co-morbid conditions such as ADHD, major depression, bipolar disorder, or other serious mental illness.