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Oppositional defiant disorder

It is a fact that children don’t always do what their parents tell them to do. However, oppositional defiant disorder (ODD) is far more than just the "terrible twos" or teenage rebellion.

Symptoms of oppositional defiant disorder include negative and disruptive behaviour, often to people in authority, including parents and teachers.

Oppositional defiant disorder is common among children with ADHD.

What are the symptoms of oppositional defiant disorder?

Symptoms of ODD may include:

  • Throwing repeated temper tantrums
  • Excessively arguing with adults
  • Actively refusing to comply with requests and rules
  • Deliberately trying to annoy or upset others, or being easily annoyed by others
  • Blaming others for your mistakes
  • Having frequent outbursts of anger and resentment
  • Being spiteful and seeking revenge
  • Swearing or using obscene language
  • Saying mean and hateful things when upset

Many children with ODD are also moody, easily frustrated and have a low self-esteem. They also may use drugs and alcohol.

What causes oppositional defiant disorder?

The exact cause of ODD is not known, but it is believed that a combination of biological, genetic and environmental factors may contribute to the condition.

  • Biological. Some studies suggest that defects of, or injuries to, certain areas of the brain can lead to serious behavioural problems in children. ODD has also been linked to abnormal amounts of specific chemicals in the brain called neurotransmitters. Neurotransmitters help nerve cells in the brain communicate with each other. If these chemicals are out of balance or not working properly, messages may not make it through the brain correctly, leading to symptoms of ODD and other mental health conditions. Many children and teens with ODD also have other mental health conditions such as ADHD, learning disorders, depression, or an anxiety disorder, which may contribute to their behaviour problems.
  • Genetics. Many children and teens with ODD have close family members with mental health conditions, including mood disorders, anxiety disorders and personality disorders. This suggests that a vulnerability to develop ODD may be inherited.
  • Environmental. Factors such as a dysfunctional family life, a family history of mental illnesses and/or substance use, and inconsistent discipline by parents, may contribute to the development of behaviour disorders.

How common is oppositional defiant disorder?

Estimates suggest that between 2% and 16% of children and teenagers have ODD. In younger children ODD is more common in boys. In older children it occurs about equally in boys and in girls. It typically begins by eight years old.

How is oppositional defiant disorder diagnosed?

As with adults, mental health illnesses in children are diagnosed based on signs and symptoms that suggest a particular illness. If symptoms are present, the doctor will begin an evaluation by performing a complete medical history and physical examination. Although there are no laboratory tests to specifically diagnose ODD, the doctor may use various tests - such as X-rays and blood tests - to rule out physical illness or medication side effects as the cause of the symptoms. The doctor will also look for signs of other conditions that often occur along with ODD such as ADHD and depression.

If the doctor cannot find a physical cause for the symptoms, he or she may refer the child to a child and adolescent psychiatrist or psychologist, healthcare professionals who are specially trained to diagnose and treat mental health illnesses in children and teens. Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate a child for a mental illness. The doctor will base his or her diagnosis on reports of the child's symptoms and his or her observation of the child's attitude and behaviour. The doctor often must rely on reports from the child's parents, teachers and other adults because children often have trouble explaining their problems or understanding their symptoms.

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