Any parent can recount instances where their child misbehaved or did not obey the rules. This can be just a common phase in children’s development as they push limits and demonstrate autonomy. But what if these defiant acts continue beyond what’s typical? What if they happen so frequently that they take over family life, put pressure on relationships, and interfere with school performance? In such situations, we might be dealing with something more than just misbehaviour.
What is Oppositional Defiant Disorder (ODD)?
ODD is an impulse control behaviour problem that starts in childhood, usually in the preschool years, and rarely appears for the first time in adolescence. Some children grow out of it in their early adulthood, but if it is present in adolescence, it can persist past their twenties and beyond. According to the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition, ODD’s symptoms fall into three main categories.
Individuals diagnosed with ODD need to have a pattern of exhibiting at least four symptoms from any of the above categories, and the behaviours need to last at least six months. We don’t know the exact causes of ODD, as they could be related to genes, temperament, and upbringing. There are some associations between harsh, neglectful parenting and children developing ODD, but that’s still not the entire picture.
| Categories | 1. Angry or Irritable mood | 2. Argumentative or Defiant behaviour | 3. Vindictiveness |
| Symptoms | – Frequently lose temper – Be touchy or easily annoyed – Often angry and resentful | – Often argue with authority figures – Question or refuse to comply with rules – Intentionally annoy people – Blame others for their own mistakes | – Seek revenge or be spiteful |
How ODD Manifests in Boys vs. Girls
ODD affects around 3.3% of the general population. Before adolescence, it is more commonly observed in boys than in girls. However, the male predominance of ODD is not consistent in samples of adolescents or adults. The existence of a gender discrepancy in ODD has been called into question due to a potential bias of the diagnostic criteria. ODD symptoms can manifest in a physical (e.g. hitting others) way or a relational way (e.g. speaking negatively about others). Aggression is manifested differently in boys than in girls: while boys tend to display it more physically, girls prefer to express it more through manipulating social relationships. Some covert behaviours can easily go unnoticed, which makes it difficult to detect ODD in girls. Since the symptoms of ODD may present differently for different genders, one cannot conclude that girls are less at risk of developing ODD.
Can ODD Worsen During Adolescence?
Yes. Adolescents’ increasing need for autonomy manifests oppositional behaviours, accompanied by more conflicts with parents and authorities. In adolescence, a significant number of behaviours associated with ODD become more frequent and intense. Some signs of ODD, such as being irritable and argumentative, could be challenging to distinguish from common developmental behaviours. The prevalence of ODD tends to decrease with advancing age. Nevertheless, the decline in the prevalence of ODD in late adolescence may be attributed to the increased diagnosis of Conduct Disorder, which is highly linked to ODD but more destructive, or Antisocial Personality Disorder, which is considered more an adulthood disorder. Adolescents may not necessarily “grow out” of the impact of ODD. Instead, they may display other types of disruptive behaviours that fall under different classifications.
How Does ODD Affect Family, School, and Future Life?
Young people with ODD who frequently exhibit challenging behaviour towards their parents tend to create more tension in the family. Parents who are raising a child with ODD may face a variety of emotional, physical, and even financial difficulties, i.e. the high costs of treatment. Almost 50% of children and adolescents with ODD are diagnosed with ADHD, making it the most prevalent co-occurring condition. The coexistence of ODD and ADHD can negatively impact academic and occupational functioning, resulting in significant deficits in educational attainment. Individuals who continue to demonstrate ODD into adulthood may experience significant disruption in relationships through conflicts with parents, teachers, peers, and partners. Persistent irritability and heightened levels of anger may cause individuals with ODD to develop certain internalising disorders, such as anxiety and depression. Individuals with ODD are also more prone to develop addiction and substance-related disorders.
How to Intervene When Your Child Has ODD?
There are many available interventions and treatments for children and adolescents with ODD. Besides talk therapies and social skills training, they may draw support from a range of family and school-based interventions. Children and adolescents exhibit the best response towards treatment that incentivises good behaviour and imparts skills to deal with bad behaviour. Research indicates that early intervention and treatment can help adolescents prevail over the condition and minimise the risk of developing comorbidities.
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References:
1. Aggarwal, A., & Marwaha, R. (2022). Oppositional defiant disorder. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK557443
2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). American Psychiatric Publishing. https://doi.org/10.1176/appi.books.9780890425596
3. Ghosh, A., Ray, A., & Basu, A. (2017). Oppositional defiant disorder: Current insight. Psychology Research and Behavior Management, 10, 353–367. https://doi.org/10.2147/PRBM.S120582
4. Hawes, D. J., Gardner, F, Dadds, M. R., Frick, P. J., Kimonis, E. R., Burke, J. D., & Fairchild, G. (2023). Oppositional defiant disorder. Nature Reviews, Disease Primers, 9(1), 31–31. https://doi.org/10.1038/s41572-023-00441-6
5. Martel, M. M. (2019). The clinician’s guide to oppositional defiant disorder. Elsevier Science & Technology. https://doi.org/10.1016/B978-0-12-815682-7.00002-1