What is oppositional defiant disorder?

Oppositional defiant disorder (ODD) is a childhood mental health condition involving disruptive behavior.

Nearly every child will have occasional outbursts of frustration and disobedience, of course. ODD doesn’t refer to developmentally appropriate temper tantrums or willful behavior. Instead, ODD involves:

  • a long standing pattern of defiant and argumentative behavior or attitudes toward caregivers, teachers, or other adults
  • vindictiveness toward others
  • a frequently irritable and angry mood or short temper

ODD can make it very challenging to interact with other people. Again, the behaviors that characterize this condition go beyond what’s typical for a child’s age and developmental stage.

Tantrums generally begin to taper off by the age of 4. So, you might have some cause for concern when a school aged child continues to have regular tantrums, especially ones severe enough to disrupt everyday life.

Here’s a closer look at ODD, including how it shows up in both children and adults and what treatment approaches are available.

How common is ODD?

According to a 2008 review, experts estimate that between 1 and 16 percent of children and adolescents may meet the criteria for diagnosing ODD.

The condition seems to appear more often in boys before adolescence, but at roughly the same rate in people of any gender during adolescence and adulthood.

The evidence supporting its prevalence in boys, however, is somewhat inconsistent. In a 2011 study, some experts suggested using different criteria to diagnose ODD in girls, who might display symptoms differently than boys.

What are the symptoms?

Symptoms of ODD often begin by the time a child enters preschool, but nearly always by early adolescence. In general, children typically show signs by the time they enter school.

Sometimes, these signs only show up in one environment or with one individual. For example, children with ODD might only show symptoms at home with family members, or around people they know fairly well.

More severe symptoms, however, usually show up in multiple contexts, where they can affect social relationships and development along with school or work.

In children and adolescents

The most common symptoms of ODD in children and adolescents include:

  • frequent episodes of anger
  • irritable mood
  • a short temper or touchy mood
  • being argumentative
  • a habit of refusing to comply with requests from adults
  • excessive arguing with adults and authority figures
  • a habit of questioning or actively disregarding rules
  • a pattern of behavior intended to upset, annoy, or anger others, especially authority figures
  • a tendency to blame others for mistakes and misbehavior
  • vindictive, spiteful, or resentful behavior, including unkind acts or saying mean things when angry or frustrated

Keep in mind that just one or two of these symptoms alone don’t suggest ODD, especially when they’re temporary. Someone with ODD will have at least 4 of these symptoms, recognizable over a period of at least 6 months.

In adults

ODD generally isn’t diagnosed in teenagers or adults. But childhood ODD can continue into late adolescence and adulthood, especially when it goes undiagnosed and untreated.

While the general symptoms remain the same, adults with ODD might also:

  • have a lot of anger toward the world
  • feel generally misunderstood, unappreciated, or disliked
  • have strong attitudes of disdain or disrespect for authority figures
  • be impatient
  • have a habit of defending themselves forcefully and refusing to consider feedback from others
  • lash out at others when they feel slighted, and have low frustration tolerance
  • have trouble maintaining jobs, romantic relationships, and friendships, due to frequent tension and conflict
  • find it hard to follow rules and expectations at home and work
Symptom overlap

Some of these signs share similarities with traits associated with other conditions, including:

This overlap can make it more difficult for experts to identify ODD in teens and young adults.

It’s also worth noting that some of these behaviors are pretty common during the teenage years. As a result, parents and teachers might not always find it easy to tell the difference between milder symptoms of ODD and more typical teenage attitudes.

What causes ODD?

Experts haven’t found one single cause of ODD. Instead, they believe it likely develops due to a combination of different factors, including genes, environment, personality, and temperament.

Genetic and biological factors

ResearchTrusted Source suggests genes are responsible for about 50 percent of a child’s risk for the condition.

Children with a family history of depression or ADHD also have a higher chance of developing ODD.

Some brain imaging research from 2016Trusted Source also points to differences in some parts of the brain. These parts help regulate impulse control, problem solving, social behavior, and empathy.

These irregularities may factor into the development of ODD, especially when combined with other factors.

Environment and upbringing

Many environmental factors at home may contribute to ODD, including:

  • harsh or permissive parenting
  • negative reinforcement for problematic or disruptive behavior, which can promote future acting out
  • inconsistent or neglectful parenting
  • having a series of caregivers, especially ones who offer inconsistent or detached care
  • rejection from peers
  • violence and abuse in the home or neighborhood
  • a stressful or unpredictable home life
  • living in a low-income household or underserved community
Personality and temperament

Underlying personality traits linked to ODDTrusted Source include:

  • impulsivity
  • irritability
  • high emotional reactivity
  • difficulty with emotional regulation
  • callous-unemotional traits, like emotional insensitivity and lower empathy
  • low frustration tolerance

Of course, not everyone with these traits will go on to develop ODD.

Both nature (biologic factors) and nurture (environment and upbringing) contribute to personality, not to mention overall mental and emotional health, as well as risk and protective factors. A traumatic or difficult childhood can affect a child’s temperament and personality and make it more likely they’ll go on to develop ODD, or another mental health condition.

Understand, too, that people with ODD often don’t recognize their own behavior as defiant or oppositional. Instead, they might simply believe they’re reacting to unfair circumstances or unjust demands from parents, adults, and other authority figures.

Link: https://www.healthline.com/health/oppositional-defiant-disorder

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