NewYork-Presbyterian. The University Hospital of Columbia and Cornell.

Oppositional Defiant Disorder

What is ODD?

ODD is a persistent pattern (lasting for at least six months) of negativistic, hostile, disobedient, and defiant behavior in a child or teen without serious violation of the basic rights of others.

What are the symptoms of ODD?

Symptoms of ODD may include the following behaviors when they occur more often than normal for your age group:

• losing your temper
• arguing with adults; defying adults or refusing adult requests or rules
• deliberately annoying others
• blaming others for your own mistakes or misbehavior
• being touchy or easily annoyed
• being angry and resentful
• being spiteful or vindictive
• swearing or using obscene language
• having a low opinion of yourself

The person with ODD is moody and easily frustrated, has a low opinion of him or herself, and may abuse drugs.

What causes ODD?

The cause of Oppositional Defiant Disorder is unknown at this time. The following are some of the theories being investigated:

• It may be related to the child's temperament and the family's response to that temperament.
• A predisposition to ODD is inherited in some families.
• There may be problems in the brain that cause ODD.
• It may be caused by a chemical imbalance in the brain.

What happens to people who have ODD?

The course of Oppositional Defiant Disorder is different in different people. It is a disorder of childhood and adolescence that usually begins by age 8, if not earlier. In some children it changes into a conduct disorder or a mood disorder. Later in life, it can develop into Passive Aggressive Personality Disorder or Antisocial Personality Disorder. With treatment, reasonable social and occupational adjustment can be made in adulthood.

What is the treatment of Oppositional Defiant Disorder?

Treatment of ODD usually consists of group, individual and/or family therapy and education, keeping a consistent daily schedule, support, limit-setting, discipline, consistent rules, having a healthy role model to look up to, training in how to get along with others, behavior modification, and sometimes residential treatment, day treatment and/or medication.

What can I do to deal with my ODD?

• Attend therapy sessions.
• Use self time-outs.
• Identify what increases anxiety.
• Talk about feelings instead of acting on them.
• Find and use ways to calm yourself.
• Remind yourself often of your goals.
• Get involved in tasks and physical activities that provide a healthy outlet for your energy.
• Learn how to talk with others.
• Develop a predictable, consistent, daily schedule of activity.
• Figure out ways to have fun and feel good.
• Learn how to get along with other people.
• Find ways to avoid getting too riled up.
• Learn to admit mistakes in a matter-of-fact way.

What can I do to keep the symptoms from coming back once they're under control?

During a period of good adjustment, the patient and his family and the therapist should plan what steps to take if signs of relapse appear. The plan should include what specific symptoms are important warnings of relapse. Make an agreement to call the therapist right away when those specific symptoms occur, and at the same time to notify friends and other people who can help. Plan ahead for specific ways to limit stress and stimulation and to make the daily schedule more predictable and consistent if warning signs of relapse appear.

Where can I get more information about ODD?

There are some good books about ODD and its treatment

Russell Barkley Defiant Children, second edition. Guilford Press, 1997.

Rex Forehand and Nicholas Long Parenting the Strong-Willed Child. NTC Publishing Group, 1996.

Ross W. Greene The Explosive Child. Harper Collins, 1998.

Robert L. Hendren (editor) Disruptive Behavior Disorders in Children and Adolescents. In Review of Psychiatry, vol. 18, American Psychiatric Press, 1999.

Harold Koplewicz. Its Nobodys Fault: New Hope and Help for Difficult Children and Their Parents. Random House, 1997.

Carol W Peschel et. al., (editors) Neurobiological Disorders in Children and Adolescents. Jossey-Bass, 1992.

The following organizations can provide help, information and support:

American Academy of Child and Adolescent Psychiatry
A professional organization that provides many publications for the layperson. Call 202-966-7300 or reach them online at www.aacap.org

Family Self-Help Group for Parents of Children and Adolescents
Sponsored by the National Alliance for the Mentally Ill (NAMI). Offers support, information and advice for parents of children with psychiatric disorders. To see if there is a group in your area, call NAMI at 1-800-950-NAMI or reach them online at www.nami.org

Family Ties
A self-help group for parents of children with psychiatric or behavior problems. Call your local self-help clearinghouse for information about meetings near you, or call the National Self-Help Clearinghouse at 1-212-817-1822. Not available in all areas.

Toughlove
Provides mutual support for parents whose children are having trouble. A self-help group. You can find their number in your local telephone book, or reach them online at www.toughlove.com