What Are the Symptoms of ODD (Oppositional Defiant Disorder)?

Because many children act out as a usual part of childhood development, it can be difficult to know the difference between typical rebelliousness and oppositional defiant disorder.

ODD is defined by the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) as a childhood disorder characterized by persistent anger or irritability and defiant and noncompliant behavior lasting at least 6 months.

Although ODD is typically a childhood diagnosis beginning about 4 years old, it can also manifest in teens and adolescents.

Several other conditions usually occur with ODD, including ADHD and conduct disorder.

Although acting out generally occurs as part of childhood development, not every child who behaves defiantly is diagnosed with ODD. Instead, oppositional defiant disorder is diagnosed using a specific set of symptoms.

According to the DSM-5, ODD can be diagnosed if a child displays at least 4 symptoms from the following categories for at least 6 months:

• Angry or irritable mood: often losses temper, is touchy or easily annoyed, becomes angry and resentful
• Argumentative and defiant behavior: frequently argues with authority figures or adults, actively defies or refuses to comply with rules or requests from authority figures
• Vindictiveness: has been spiteful or vindictive at least twice within the past 6 months, deliberately annoys others, blames others for mistakes or misbehavior

According to the DSM-5, a child’s behavioral disturbance must be significant enough to cause distress, negatively impacting:

• family
• peers
• academic performance
• social activities
• occupational functioning

These symptoms must be present during an interaction with at least one person who is not a sibling. Also, symptoms should not occur only during substance use or if the child is experiencing psychosis.

A child cannot be diagnosed with ODD if they meet the criteria for disruptive mood dysregulation disorder.

Severity of symptoms

Some oppositional behaviors are a common part of early childhood and adolescence, making it challenging to recognize symptoms and severity.

The DSM-5 provides specific age-based guidance on how to tell when disruptive behaviors in childhood might be considered a potential indicator of ODD.

The potential severity of ODD is ranked by how widespread the behavior is:

• Mild ODD. Involves oppositional behaviors that are confined to only one setting, such as school.
• Moderate ODD. The behavior is present in at least two settings, like school and home.
• Severe ODD. Symptoms are present in three or more settings, such as school, home, and an extracurricular club, for example.

Potential impact

Depending on the severity of the case, ODD may have several adverse effects on a child or adolescent’s functioning. Stigma and self-esteem issues may also occur in children affected by ODD.

This condition can negatively impact:

• academic performance
• social life
• home environment

Because the main symptoms of ODD involve anger and aggression, children with this disorder sometimes face stigmatization and judgment from their peers, who may not know their behavior is beyond their control.

Oppositional defiance disorder can often co-occur with other mental health conditions, which might worsen functioning.

ADHD is one of the most common co-occurring conditions with ODD. According to the American Academy of Family Physicians, 14% to 40% of children diagnosed with ODD also have ADHD.

Anxiety and depression are also common co-diagnoses with ODD. Up to 50% of children with ODD may also be living with either anxiety or depression.

An oppositional defiance disorder diagnosis can be tough on kids and parents. But regardless of a child’s age at diagnosis, ODD symptoms can be managed with a personal treatment plan for your child.

The two main branches of treatment for ODD are therapy and prescribed medications. You may have to try multiple strategies and a combination of things to find what works best.

Working with your family pediatrician, therapist, or psychiatrist to develop the best plan for your child is often the best strategy for finding ODD treatment.

Treatment options are often the first step in seeking treatment for ODD. Like any other treatment strategy, you may have to try multiple forms of therapy before you find what works best for your child and family.

There are several approaches to therapy that have been proven to help manage symptoms of ODD in children and adolescents:

• Parent management training (PMT): therapy specifically for addressing behaviors in children and adolescents associated with ODD, emphasizing positive parent-child relationships and parenting techniques that help children develop healthy coping strategies
• Cognitive behavioral therapy (CBT): especially effective for helping teens and older children with ODD learn to regulate their emotions and process anger in more constructive ways by teaching awareness of negative thought patterns
• Multisystemic therapy (MST): intensive, home-based therapy for adolescents 12 to 17 years old with severe ODD involving family evaluation, individual and group family therapy, peer interventions, crisis stabilization, and case management
• Collaborative problem solving (CPS): parent-based intervention for ODD behavior that teaches parents, educators, and other caregivers how to help children and adolescents regulate emotions and build problem-solving skills

Currently, there’s no Food and Drug Administration-approved medication to specifically treat ODD. But some physicians and psychiatrists might prescribe certain medications to treat ODD symptoms.

Being prescribed medication for ODD is rare and typically recommended only for severe or treatment-resistant cases.

Atypical psychotics risperidone (Risperdal) and aripiprazole (Abilify) may reduce irritability and aggression. These medications are sometimes prescribed to treat symptoms in cases where a child’s academic or home life is significantly affected by ODD.

Most children experience a defiant streak as a typical part of childhood development. But if a child’s behavior becomes persistently disruptive, it could signify a condition like oppositional defiant disorder.

ODD may present challenges for both your child and family and a diagnosis could be upsetting for your child at first. However, know that you and your child are not alone in this relatively common childhood diagnosis, which affects roughly 1% to 16% of school-age kids.

ODD may negatively impact a child’s academics, home life, and relationships with peers. Sometimes, children with ODD are stigmatized because of aggression or anger, which could cause low self-esteem and social issues.

These adverse effects may drive you to seek a diagnosis or treatment for ODD. Treatment options are available for children and adolescents with ODD to help manage symptoms and get back on track.

Therapy is the most common treatment for ODD, with multiple therapeutic modalities proven to help ease the symptoms of ODD:

• parent management training (PMT)
• cognitive behavioral therapy (CBT)
• multisystemic therapy (MST)
• collaborative problem solving (CPS)

Currently, there is no FDA-approved medication for ODD. Still, two atypical antipsychotic medications, risperidone (Risperdal) and aripiprazole (Abilify) may be prescribed in rare cases of severe or treatment-resistant ODD.

You may have to try multiple strategies — or a combination of approaches — before finding a treatment plan that works for your child. A pediatrician and therapist experienced with ODD can help you navigate the best treatment plan for your child and family.

If your child is showing symptoms of ODD, here are some points of support:

• ODD: A guide for families by the American Academy of Child and Adolescent Psychiatry
• (American Academy of Family Physicians)
• Back From the Brink: Two families’ stories of Oppositional Defiant Disorder
• Defuse Defiance: Treating oppositional defiant disorder in kids and adults (ADHD experts podcast episode)