Oppositional defiant disorder​

From: Chapter 8, "Diagnosis," in Acting Out (© 2007)

All young people are oppositional (verbally contrary or defiant) from time to time, particularly when they are tired, hungry or emotionally upset. They may argue or talk back, and may disobey parents, teachers and other adults. Oppositional behaviour is most frequently observed among two- to three-year-olds and early adolescents.

Some young people are more oppositional than the average young person. Young people may be diagnosed with oppositional defiant disorder (ODD) when:

• their unco-operative and hostile behaviour is so frequent and consistent that it makes them stand out from other children or youth who are of the same age and developmental level, and
• it affects their family, social and school life.

The causes of ODD are unknown, but both genetic and environmental factors may play a role. ODD has some symptoms that overlap with conduct disorder, described below. It tends to be diagnosed in younger children, usually those who are younger than eight. Some children who are diagnosed with ODD are later diagnosed with conduct disorder. A young person who shows symptoms of aggression that are more severe than those associated with ODD may be diagnosed with conduct disorder from the start. ODD often occurs along with attention-deficit/hyperactivity disorder.

Studies have shown different rates of ODD among young people, ranging from two per cent to 16 per cent.

Symptoms of ODD

ODD may be diagnosed in young people if they display negative, hostile and defiant behaviour that lasts for six months or more, with four or more of the following symptoms present:

• excessive arguing with adults
• active defiance and refusal to comply with adult requests and rules
• repeated attempts to annoy or upset people
• often blaming others for their own mistakes or misbehaviour
• often acting touchy or easily annoyed by others
• frequent loss of temper
• frequent feelings of anger and resentment
• often acting spiteful or vindictive*

Managing ODD

You may come into contact with young people who you know have (or might have) ODD. Here are some simple techniques to encourage them to behave in more socially acceptable ways:

• Always build on the positives. Give young people praise and positive reinforcement whenever they show flexibility or co-operation.
• Don't have too many rules, but focus on a few important ones, such as those that involve safety.
• Instead of using direct commands, stay more neutral. For example, say, "We need to tidy up before we go outside" instead of "Tidy up." When dealing with older children and adolescents, consider making requests for them to do chores or activities in writing rather than giving verbal commands.
• If you are in the middle of a conflict with a young person who has ODD, pause for a moment—especially if you think the conflict is getting worse rather than being resolved. You might say, for example, "It seems that we are not understanding each other clearly. We are just getting angrier. Let's count to 10 and take a few deep breaths." By taking a break from an argument, you model a method the young person can use to gain self-control and prevent overreacting to a situation. When you see young people using this "time out" technique themselves, support them with praise.
• Pick your conflicts. Since young people with ODD have trouble avoiding power struggles, prioritize the things you want them to do.
• Set up reasonable, age-appropriate limits with consequences that can be enforced consistently.

Effective treatment programs, or interventions, for young people with ODD include:

• cognitive-behavioural therapy to decrease negativity
• anger management training to help with temper control
• parent management skills training programs to help parents learn to manage their children's behaviour.   

* Adapted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Copyright 2000, American Psychiatric Association.