Oppositional Defiant Disorder (ODD) is very similar to Conduct Disorder (CD), in that the behavioral problems described are almost identical. The one key difference is that youth with ODD are less prone to antisocial and delinquent behavior, whereas this is a heavy component of conduct disorder.
ODD is typically used to diagnose behavioral problems in younger children, whereas conduct disorder is more common in older kids. The average age of “onset” for ODD is usually between the ages of five and eight, though it can also be diagnosed in adolescents. Oppositional defiant disorder and conduct disorder are best viewed as different points along the same spectrum rather than separate disorders, with ODD being the milder of the two, and sometimes a precursor to conduct disorder.
The key difference between ODD and CD
Youth with ODD can be generally disruptive but usually don’t actively violate the rights of others.
Youth with ODD generally aren’t delinquent or law-breaking, whereas kids with conduct disorder typically are.
ODD may appear only at home or primarily in one setting, whereas conduct disorder is more pervasive.
While ODD is often a precursor to conduct disorder, the good news is that the majority of children with ODD will not develop full-fledged conduct disorder, especially with the help of treatment interventions. Approximately 67% of kids diagnosed with ODD are symptom free in 3 years, whereas 30% will go on to develop conduct disorder. (Connor, 2002) Across all age groups, 10% of kids with ODD eventually develop adult antisocial personality disorder. (Rutter, Giller & Hagell, 1999)
The definition of oppositional defiant disorder
Oppositional defiant disorder is defined as a pattern of disobedient, defiant behavior toward authority figures. Andrea Glenn & Adrian Raine write that ODD “involves persistently hostile, defiant, and disruptive behavior, as well as low frustration tolerance, occurring outside the normal range of behavior.” (2011, p. 885) Further information describing the disorder can be found on our signs and symptoms page.
How many children have oppositional defiant disorder?
Prevalence estimates for ODD are all over the place, ranging from 2% to 16% of all kids. A more realistic range is probably between 5% and 8%. (Maughan et al., 2004) ODD is more common among boys in childhood, but equally common in boys and girls after puberty
Causes of oppositional defiant disorder
A number of factors have been shown to contribute to the development of oppositional defiant disorder in children:
- A history of ADHD, ODD, CD or mood disorders in a parent
- Substance abuse in the family
- Smoking during pregnancy
- Family problems
- Abuse or neglect (including bullying)
- Instability (frequent moves, etc.)
Oppositional defiant disorder often arises in response to something a child is unhappy with, such as conflict in the home or parental divorce. It is a type of stress reaction; a child’s way of lashing out at the world. Some children may even develop such behaviors as a way of coping with an undiagnosed anxiety disorder.
Other conditions that exist alongside oppositional defiant disorder
ODD has a high rate of comorbidity, meaning it often exists alongside other psychological or behavioral disorders. (Costello et al., 2003) It is also a strong predictor of adult mental health problems, which is why it’s important to address these issues early on and not allow them to fester. (Copeland et al., 2009) Attention Deficit Hyperactivity Disorder (ADD and/or ADHD) is the most common coexisting condition, followed by anxiety disorder. Mood disorders such as depression also commonly exist alongside a diagnosis of ODD.
Understanding the child with oppositional defiant disorder
The child with ODD typically feels bad in one way or another, whether it be stressful and upsetting things in their life or the mere fact that they are stuck in a pattern of negative interaction wherein they can’t seem to get others to react to them as they’d like, which fuels further frustration and animosity. They are angry, and therefore easily irritable; prone to acting in an overly emotional way whenever things don’t go their way. Often times the behavior that triggers negative reactions in adults (hyperactivity, lack of attention, etc.) are normal childhood traits that they have difficulty controlling, so it can feel like others are treating them badly simply for being who they are. This frustration in turn feeds into the defiance and emotional outbursts that are typical of ODD.
When it comes to childhood onset ODD, symptoms are typically stable between the ages of 5 and l0, then either decline or morph into conduct disorder. Which is a pretty good indicator that many children are being diagnosed with ODD because adults struggle to deal with what is typical childhood behavior. The earlier such symptoms develop, the more stubborn this condition is: The chance of developing conduct disorder is 3-times greater in children who were initially diagnosed in preschool. Early diagnosis is also linked to higher rates of comorbidity, which could just mean that more seriously disturbed children start showing symptoms earlier.
Dealing with oppositional defiant disorder
Methods for dealing with oppositional defiant disorder are outlined in our book Difficult Children, but generally involve…
- Ignoring those behaviors you can and not over-reacting or getting emotional in response to their misbehavior
- Finding more ways to empower the child in everyday situations
- Involving them in the rule-making process and giving them the choice between 2 options whenever possible
- Reversing the pattern of negative reinforcement that usually develops
- Making rules clear and simple rather than abstract.
Treatment for oppositional defiant disorder
The most effective treatment for oppositional defiant disorder is parent-child interaction therapy or some other form of family therapy that focuses on patterns of interaction between adults and children. Head Start and home visit programs have also been shown to lower rates of ODD. As for pharmaceuticals, “There is no evidence that medication is effective for the treatment of ODD.” (Quy & Stringaris, 2012, p. 11)