Oppositional defiant disorder (ODD) is primarily diagnosed in children — but adults can have it, too.
Anyone can have feelings of negativity and hostility occasionally, especially when life presents setbacks.
However, for some people, the urge to be oppositional happens more often than usual.
Someone who has trouble containing their emotions and has regular outbursts may have oppositional defiant disorder (ODD). Other signs of this condition include spitefulness, verbal aggression, and defiance.
If left untreated or misdiagnosed in childhood, ODD can lead to issues with anxiety, mood changes, and conduct in adulthood.
Fortunately, there are treatments that can help. You can manage ODD, prevent it from getting worse, and even reduce symptoms. The first step is to get a correct diagnosis.
To diagnose ODD, medical professionals draw on their clinical experience to assess symptoms and behaviors. They use questionnaires to gather information from various sources, such as parents and teachers.
Healthcare professionals look at three categories of behaviors:
- Anger and irritability: loses temper, acts resentful, is easily annoyed
- Defiance and argumentativeness: argues with authority figures, refuses to comply with authority or rules, deliberately annoys others, blames others for mistakes
- Vindictiveness: seeks revenge for perceived wrongdoings
To qualify for a diagnosis, the child or adult should have at least four symptoms from any category. In addition, the symptoms must:
- be recurring for at least 6 months
- be disruptive to social, occupational, or educational experiences
Different settings, like home or school, can trigger symptoms. Healthcare professionals categorize ODD severity based on the number of settings involved.
- Mild: one setting
- Moderate: two settings
- Severe: three or more settings
Healthcare professionals also look for other conditions that may cause similar symptoms. Examples of these include:
- anxiety disorders
- attention deficit hyperactivity disorder (ADHD)
- conduct disorder
- learning disorders
- mood disorders, such as depression and bipolar disorder
Sometimes, these conditions can occur along with ODD. Conditions that exist together are called “comorbid.” Treating comorbid conditions can help ease ODD symptoms.
Behaviors with other causes can mimic ODD. For example, autistic people may experience rigid thinking that creates defiance or irritability. However, they’re rarely vindictive.
To avoid a misdiagnosis, it’s important for medical professionals to have a complete medical history when identifying ODD. The right diagnosis can lead to the most effective treatment.
Therapy is the first-line treatment for oppositional behavior. When a child has an ODD diagnosis, it’s helpful for parents to participate in therapy to learn supportive behavior management strategies.
Cognitive behavioral therapy (CBT)
CBT works for many mental health conditions by teaching you to replace challenging thoughts and behaviors with those that are positive and constructive. CBT works as ODD treatment by replacing symptoms like defiance and irritability with calming thoughts and positive strategies.
Common CBT objectives include:
- identifying outburst triggers and consequences
- learning strategies to regulate emotion
- self-monitoring changes in emotion
- using relaxation techniques to remain calm
- learning socially appropriate reactions to anger-provoking situations
Parent management training (PMT)
PMT treats ODD in children by changing parent response patterns that reinforce unwanted behaviors. Parents are taught to ignore attention-seeking behavior and reward appropriate behavior.
For example, if a tantrum has worked to get a child something they want, PMT training teaches the parent not to give in when faced with the next tantrum.
Parent-child interaction therapy (PCIT)
This therapy for kids with ODD is real-time parenting coaching provided by a therapist watching participants in a playroom from behind one-way glass.
The therapist speaks to the parent using a wireless in-ear speaker. In this setting, the therapist can monitor the parent-child interaction as it happens, without relying on the parents’ memories of previous events.
Collaborative problem solving (CPS)
CPS recognizes that people with ODD don’t lack the desire to get along; instead, they lack the skills. Rather than force their will on others or walk away completely, CPS participants are taught a middle ground based on communication and compromise.
Peer group therapy
This type of social skills therapy teaches people with ODD better ways to interact with peers. The goal is to foster interactions that are positive, rather than combative. This therapy is most successful when it’s done in a natural setting, like school.
In people with ODD, medication can help to address coexisting conditions. For example, stimulant medication can ease the frustrations caused by ADHD symptoms, which in turn can reduce ODD symptoms.
Medications that can help people with ODD include:
Stimulant medication is usually used to treat ADHD, and several studies have connected these medications to improving ODD symptoms in children with ADHD.
Examples of stimulants used include methylphenidate (MPH) and mixed amphetamine salts (MAS).
ATX is a nonstimulant ADHD medication that can result in a reduction of ODD symptoms. It’s not clear if ATX works for ODD or if it improves ODD symptoms indirectly when it reduces ADHD symptoms.
Risperidone (Risperdal) is a type of atypical antipsychotic that’s used sparingly to reduce ODD aggression.
Doctors may prescribe it in cases where therapy and stimulant medication hasn’t worked, and the person with ODD is experiencing significant side effects because of ODD symptoms.
Risperidone is considered a last resort treatment since it can result in potentially harmful metabolic, hormonal, and neurological changes.
While therapy is the main treatment for ODD and medication can sometimes help, there are also self-care strategies that can help to reduce symptoms.
Mindfulness is a very powerful tool to regulate emotion and find calm. Mindfulness is the practice of turning your attention to the present moment and allowing your thoughts to pass by without engaging in them. Meditation is one of many ways to practice mindfulness.
Try stress reduction strategies to help ODD symptoms. Some ideas include:
- listening to music
- talking to a friend
- eating a nutritious diet
- exercising regularly
- having a good laugh
- prioritizing sleep
Living with ODD can be manageable with the right support. If you think you may have ODD, consider consulting with a healthcare or mental health professional to rule out other causes for your symptoms.
Next, try one of these locator tools to find an oppositional defiant disorder specialist:
- American Psychology Association
- American Academy of Child and Adolescent Psychiatry
- Association for Behavioral and Cognitive Therapies
You can also try Psych Central’s Find a Therapist tool.
Seeking help can be challenging since people with ODD can be wired to resist authority. It’s worth making the effort, though.
Once you connect with your support team, managing ODD gets much easier.