Difficult or Defiant: Understanding Oppositional Defiant Disorder

By Rick Shaffer

As any parent can tell you, from the “terrible twos” through to the “rebellious teens,” dealing with the many emotional and intellectual changes every child must go through before reaching adulthood can be difficult. Yet, most parents can take solace in the knowledge that each change is “just a stage” that likely will soon pass.

In some cases, however, a child’s emotional or behavioral difficulties may be the result of a deeper-seated problem or disorder. One often overlooked or undetected condition is oppositional defiant disorder, or ODD. Estimates vary, but some researchers suggest that as many as 16 percent of children and adolescents, mostly boys, have ODD.

What Is ODD?

ODD is a behavioral disorder characterized by the repeated display of negative, angry, defiant behavior. But there’s a twist. Compared with children with other behavioral disorders, children with ODD tend not to violate the rights of others. They do know the difference between right and wrong, and they feel guilty if and when they do something that is seriously wrong.

Is Defiance Normal?

Some defiant behavior in children is absolutely normal, points out Dr. Claudio Toppelberg, a child psychiatrist and researcher at Harvard Medical School and Boston’s Children’s Hospital. “Similar to aggressive behavior, oppositional and defiant behavior is common in the first years of life and decreases subsequently in most children,” Dr. Toppelberg explains. “Children who suffer from ODD, however, tend to display negative behavior much more often, for longer periods of time and with greater intensity than is typical in other children of a similar age."

What Causes ODD?

Unfortunately, the exact cause of ODD is not known. However, there are several theories regarding the cause of the disorder. Researchers believe that the disorder may be related to:

• A child’s temperament and the family’s response to it

• A child’s social skills

• A child’s ability to communicate through language

• How parents discipline and understand the child

• The way a child’s body adjusts to arousal and stimulation

• Having parents who are overly concerned with power and control

• Disrupted childcare – involving, for example, multiple caregivers

• An inherited disposition to the disorder, possibly both environmental as well as genetic

• Neurological damage (such as a head injury)

• Prenatal and perinatal factors.

Symptoms of ODD

Symptoms of ODD usually become apparent around age 8 and they often occur gradually over a number of months. Generally, they include a high amount of hostile, defiant behavior, which lasts for at least six months. A child with the typical symptoms of ODD often:

• argues with adults

• loses his or her temper

• refuses to follow adults’ requests or rules

• deliberately annoys others

• is easily annoyed by others

• is angry and resentful

• is spiteful or vindictive

• blames others for his or her mistakes.

Diagnosing the Disorder

Because the symptoms of ODD tend to mirror common childhood and adolescent behavior, differing primarily in frequency and degree, recognizing and diagnosing the disorder can be difficult. In addition, similar symptoms resulting from other disorders can make the diagnosis more complex. For these reasons, it is important to have the child evaluated by a child psychiatrist, child psychologist or other qualified professional.

“To diagnose ODD, the disruptive behavioral pattern has to be significantly more intense, prolonged and frequent, and cause considerably more dysfunction when compared to children of similar age and developmental level,” Toppelberg explains. “Determining whether the behaviors are significantly different from what would usually be expected in a child at that age can be quite complex and shows how the developmental expertise of a child psychiatrist or child psychologist may be necessary to make an accurate diagnosis and effective recommendations.”

In addition, Toppelberg notes, “problems with the development of language or with learning may also fuel the negativistic and oppositional behavior, making the assessment even more complex.”

If a doctor suspects ODD, he or she will first:

• Talk with the child and with their parents.

• Review the child’s and the family’s history.

• Obtain information about the child’s functioning in school.

• Look for signs of other disorders in the child. (ODD may be accompanied by one or more other psychological disorders, further increasing the difficulty of diagnosis).

A diagnosis of ODD will not be made unless:

• The child displays at least four of the typical behaviors of the disorder.

• These behaviors occur more frequently and have more serious consequences than is typical in children of a similar age.

• The behavior symptoms lead to significant problems in the child’s school, work or social life.

Prevention and Treatment

Since the exact cause of ODD is not known, specific measures to prevent the disorder are not known. However, a number of treatments for ODD are often helpful. These treatments come in the form of one or more types of psychological counseling or therapy (which are needed to address the multiple factors mentioned earlier). This counseling or therapy can be in a group, individual or family setting. The types of counseling or therapy used include:

Parental training to help parents better address the child’s behavior in an age-appropriate manner.

• Family psychotherapy
to improve the family’s communication skills.

• Social skills training
to help the child increase his or her flexibility and improve his or her ability to deal with and tolerate frustration with peers.

• Cognitive-behavior therapy
to aid the child and the family in problem-solving skills and to decrease negativity.

• Child psychotherapy to help the child develop ways to better modulate their negative and angry feelings and to develop a better understanding of what prompts the child to act the way he or she does.

Parental Reaction
How parents react to and approach the problem of ODD is often as important as the treatment.

When a child has ODD without other disorders, it tends to be a relatively benign disorder that many children overcome, Toppelberg explains. When other disorders – such as ADHD – coincide with ODD, however, treatment and prognosis become more complex. Nevertheless, Toppelberg reassures, there are many effective options that will allow the child to grow to his or her full capacity and the family to make progress.

The important thing, he says, is for parents not to get alarmed unnecessarily, not to blame themselves or the child, and to get the professional help they need – for themselves and their child.


American Academy of Child and Adolescent Psychiatry  202-966-7300;    – The academy’s “Facts for Families” series features two items relevant to families interested in ODD. Check out  and