Oppositional defiant disorder (ODD)

Oppositional defiant disorder (ODD) is a childhood behavioural problem characterised by constant disobedience and hostility. Around one in 10 children under the age of 12 years are thought to have ODD, with boys outnumbering girls by two to one.

ODD is one of a group of behavioural disorders known collectively as disruptive behaviour disorders, which include conduct disorder (CD) and attention deficit hyperactivity disorder (ADHD).

Early intervention and treatment is important, since children with untreated ODD may continue to be difficult and antisocial into their adult years. This can impact on their relationships, career prospects and quality of life. Some children with ODD will develop the more serious conduct disorder (CD), which is characterised by aggressive law-breaking and violent behaviours.

Characteristics of ODD

ODD behaviours usually surface when the child is at primary school, but the disorder can be found in children as young as three years of age.

A child with ODD may:

• Become easily angered, annoyed or irritated
• Have frequent temper tantrums
• Argue frequently with adults, particularly the most familiar adults in their lives such as parents
• Refuse to obey rules
• Seem to deliberately try to annoy or aggravate others
• Have low self-esteem
• Have a low frustration threshold
• Seek to blame others for any accidents or bad behaviour.

Link to conduct disorder

Without intervention and treatment, some children with ODD progress to develop conduct disorder (CD), which is characterised by aggressive and delinquent behaviours including:

• Lying
• Being sadistic or cruel to animals and people
• Physically or sexually abusing others
• Law-breaking behaviours such as deliberately lighting fires, vandalism or stealing.

Family life and ODD

The cause of disruptive behaviour disorders is unknown, but the quality of the child’s family life seems to be an important factor in the development of ODD. Some studies have found that certain environmental factors in the family increase the risk of disruptive behaviour disorders. These include:

• Poor parenting skills (inadequate supervision, harsh or inconsistent discipline, rejection)
• Marital conflict
• Domestic violence
• Physical abuse
• Sexual abuse
• Neglect
• Poverty
• Substance misuse by parents or carers.

Diagnosis of ODD

ODD is professionally diagnosed by a child psychologist, child psychiatrist or paediatrician specialising in behavioural disorders. Diagnosis involves detailed interviews with the child (if they are old enough), parents and teachers, and comparing the child’s behaviour with the checklist for ODD contained in the Diagnostic and Statistical Manual of Mental Disorders from the American Psychiatric Association.

Treatment of ODD

Treatment options for ODD may include:

• Parental training – to help the parents better manage and interact with their child, including behavioural techniques that reinforce good behaviour and discourage bad behaviour. This is the primary form of treatment and the most effective. Social support is increased if the parents are trained in groups with other parents who have children with ODD
• Functional family therapy – to teach all family members to communicate and problem-solve more effectively
• Consistency of care – all carers of the child (including parents, grandparents, teachers, child care workers and so on) need to be consistent in the way they behave towards and manage the child.
• Oppositional defiant disorder (ODD) is a childhood behavioural problem characterised by constant disobedience and hostility.
• The quality of parenting seems to be an important factor in the development of ODD.
• Treatment options include parent management training and family therapy.
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