Oppositional defiant disorder

Is your child getting increasingly difficult for you to control, and creating ruckus in home as well at school with complaints pouring in with alarming regularity? Watch out, for your kid could be suffering from a mental ailment known as ‘Oppositional defiant disorder.’ Read and know all about the disorder, including its possible causes, symptoms, diagnosis and treatment options.

Oppositional defiant disorder Definition

Also referred to as ODD, it is a condition arising in children or teens and is marked by argumentative, disruptive or angry behavior directed towards authority figures, such as parents or teachers. Children who are best-behaved at other times can be very difficult to handle during episodes of ODD.

Oppositional defiant disorder ICD9 Code

The ICD9 Code for this disorder is 313.81.

Oppositional defiant disorder Incidence

True ODD, or the form of ODD that can be clinically detected, affects around 1-4% of all children. It is more common in boys than girls.

Oppositional defiant disorder Causes

The exact causes or trigger factors for this condition have not yet been clearly found out. The contributory causes for the disease may be a combination of various environmental and inherited factors. These include:

  • Lack of proper supervision
  • Neglect or abuse
  • Harsh or inconsistent discipline
  • Neglect or abuse
  • An imbalance of some brain chemicals like Serotonin
  • Developmental delays or restricted ability of a child to process feelings and thoughts

Mental healthcare providers theorize that the problem could arise in children with parents having an antisocial tendency, low socioeconomic background and loss of a parent figure or caregiver. However, intelligent children who think outside set social patterns and question authority are also labeled as ODD sufferers. Gifted children usually grow out of such behaviors with advancing age.

Various mental health disorders are said to be associated with ODD. These include:

  • Depression
  • Anxiety
  • Attention-deficit/hyperactivity disorder

Oppositional defiant disorder Symptoms

ODD is typically characterized by the following signs and symptoms:

  • Easy loss of temper
  • Negativity
  • Arguments with adults
  • Disobedience
  • Anger and resentfulness for others
  • Defiance
  • Having few or no friends
  • Spitefulness or seeking revenge on others
  • Easy annoyance
  • Deliberately annoying other people
  • Having problems in academic life
  • Hostility towards those in authority
  • Acting aggressively towards peers
  • Having a lack of self-esteem
  • Being touchy on seemingly trivial issues
  • Not following the requests of adults actively
  • Blaming others for the mistakes of self

The problems associated with the disease are typically manifested in 4-5 year old kids, who are normal otherwise. The difficulties disappear with advancing age. The signs of ODD usually arise before a child is 8 years old. Sometimes, the condition may develop at a later stage although almost always prior to the early teen years. In case of ODD, the symptoms tend to arise slowly and worsen over a period of months or years.

Oppositional defiant disorder Diagnosis

It is essential to detect and cure this condition as well as any co-occurring syndromes as they can lead to or worsen the problems of defiance and irritability if left without being treated. The condition would also persist even when a child has turned into an adult. It us not uncommon to find adults with this syndrome displaying violent and anti-social behavior. It is also important to diagnose and treat any other causative factors, such as substance abuse or dependence on some object or individual which can bring about a change in personality and result in irritability.

Oppositional defiant disorder – DSM Diagnostic Criteria

The Diagnostic and Statistical Manual of Mental Disorders (DSM) has laid down the diagnostic criteria for ODD. For the condition to be diagnosed and confirmed, it must persist for at least 6 months and must be characterized by problems that are greater in frequency and intensity than those exhibited by mischievous but normal children. The behavioral pattern of such kids must vary from those of other kids of around the same age and level of development.

Affected kids must exhibit at least four of the following problems:

  • Frequent argument with adults
  • Frequent loss of temper
  • Frequently getting vindictive or spiteful
  • Frequently becoming angry and resentful
  • Deliberately annoying other people on a frequent basis
  • Often getting easily annoyed or touchy by the actions of others
  • Often blaming others for their own mistakes
  • Actively defying adults or refusing to comply with their orders or requests

A child suspected of having ODD should also:

  • Cause much problems at home, school or during work
  • Occur on its own and not as a symptom of some other mental disorder, such as bipolar disorder or depression
  • Not meet the diagnostic criteria for conduct disorder, or antisocial personality disorder (if the sufferer is more than 18 years old)

Oppositional defiant disorder – Diagnostic tests

Diagnosticians should also question parents whether or not a child is causing severe problems in school, social gatherings and while pursuing other activities.

Kids exhibiting problems similar to ODD should be assessed by a mental healthcare expert, such as a psychologist or a psychiatrist.

The diagnostic examinations for this disorder involve interviewing affected kids and their parents, putting children through various psychological tests. Often, other medical tests are also carried out to rule out the possibility that the problems are caused some underlying physical disorder.

Oppositional defiant disorder Differential Diagnosis

The differential diagnosis for this condition includes excluding its symptoms from associated diseases, such as Attention-deficit/hyperactivity disorder (ADHD). ODD is often commonly detected along with ADHD.

Oppositional defiant disorder Treatment

The treatment of ODD typically involves various forms of physiotherapy and training sessions. Training may b imparted to affected children as well as their parents/co-parents. The curative process often extends for a span of several months or even more.

Treatment for this condition generally involves:

Parent-child interaction therapy (PCIT)

In this method, parents are taught how to interact with their kids. One technique consists of therapists guiding parents on effective strategies to reinforce positive behavior in their affected children. Parents are given audio equipment known as the “ear-bug” that lets therapists guide them from behind a one-way mirror as they deal with their children.

Individual and family therapy

In this technique, counselors guide children about ways to help them manage their anger and express their feelings in a more positive manner. Family counseling can be beneficial in improving relationships and communication in sufferers as well as help family members know how to work together.

Parent training

Parents are taught skills that make parenting easier and more positive for them as well as their kids. In certain cases, children are encouraged by therapists to participate in this form of training. This lets parents as well as children develop shared goals on effectively handling the problems.

Social skills training

Such therapeutic measures help children learn how to interact in a more effective and positive manner with their peers and make friends.

Cognitive problem-solving training

In case of children with co-existing disorders such as ADHD, medicines may be helpful in alleviating the symptoms. However, unless some other condition also exists, medications are not helpful alone in curing the disease.

Oppositional defiant disorder Risk Factors

There is no single factor that can result in this disease. ODD is a complicated condition that is supposed to arise as a result of combination of various genetic, environmental and social factors.

The possible risk factors for ODD include:

  • Lack of supervision
  • Being neglected or abused for a prolonged duration
  • Absence of positive involvement of parents
  • Financial problems in family
  • Inconsistent or harsh discipline
  • Having parents with a significantly troubled marriage
  • Family instability issues due to multiple locality changes, divorce of parents or frequent changes in school or caregivers
  • Having parents with a medical history of conduct problems, ADHD or oppositional defiant disorder

Anything that changes the feeling of consistency in a child, such as stressful occurrences in the form of a divorce of parents or change of care providers, can elevate the risk of development of ODD. It is essential for parents or existing care providers to talk about such happenings with a mental healthcare expert to help him or her diagnose and treat ODD successfully in a child.

Oppositional defiant disorder Complications

The majority of children suffering from ODD can develop other mental ailments, such as:

  • Anxiety
  • Depression
  • Learning disability
  • Communication disorders
  • Attention-deficit/hyperactivity disorder (ADHD)

In the absence of proper and timely treatment, it can be extremely difficult for parents to manage a child with ODD. It can also be frustrating for an affected kid. Those suffering from ODD may experience problems in school to have a healthy relationship with authority figures, teachers and even peers. Such individuals struggle to make friends and have few or no companions.

In some cases, the condition may be a precursor to more severe ailments such as acute delinquency or conduct disorder. Such children may also take to substance abuse to overcome frustration and seek support.

Oppositional defiant disorder – Home Remedies and Management

Home remedy for ODD involves lifestyle management measures, such as:

  • Appreciating the positive actions and behavior of an affected child
  • Spending quality time together, to build a rapport
  • Setting up a routine
  • Avoiding power struggles with child or partner/spouse
  • Working together with partner/spouse to ensure proper discipline at home
  • Assigning a household chore to child to inculcate a sense of responsibility and belonging in him/her
  • Setting limits on action and behavior, and enforcing consequences consistently

Oppositional defiant disorder Prognosis

Some children show excellent outcome while others do not. It is not easy being the parent of an ODD-sufferer. Seeking proper counseling can help you deal with your own frustrations. This would help you be better prepared to deal with the problematic behaviors of your kid. Counseling can train you to calm yourself. Now and then, you should also spend time away from your child to rejuvenate yourself.


If you suspect your child to be exhibiting symptoms similar to that of Oppositional defiant disorder (ODD), and you have a family history of mental conditions, get in touch with a mental healthcare provider on an immediate basis. Timely diagnosis and treatment can prevent worsening of the condition and development of additional mental problems. However, immediate detection and cure can check the disorder at an early stage and help patients recover faster from ODD.







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