Oppositional Defiant Disorder in Children and Teenagers

If you have noticed that your child or teenager has a behavioural problem or if you have been advised to seek help for your child because there is concern that they may have ODD - Oppositional Defiant Disorder – we will be able to help.

What is ODD (Oppositional Defiant Disorder)?

ODD is a behavioural disorder and most commonly diagnosed in the under 10’s. ODD is a term used to describe children who display pervasive anger, irritability and seemingly cruel or vindictive behaviours which cause a significant impact on the young person’s life.

Children as young as 5 can be diagnosed with ODD - some would even say a diagnosis is possible as early as 3¹.
¹ Steiner, H., et al (2007)

Symptoms of ODD

There are several common symptoms that indicate your child may have ODD. These can be considered to fall within three categories².

1) Irritability
    Losing their temper
    Being easily annoyed or overly touchy
    Often being angry / having tantrums or meltdowns

2) Hurtful behaviour
    Deliberately annoying others / winding people up
    Blaming others for their mistakes
    Showing spiteful or vindictive behaviours

3) Being Headstrong
    Defying requests made by adults
    Arguing with people in authority/adults

Whilst all children will, at some stage, display some or all of the above behaviours (it’s a natural part of growing up), to meet the diagnostic criteria for ODD, a child or teenager needs to display these behaviours for 6 months or more.

Some children will display these behavioural signs daily, others on a weekly basis – what is important for the ODD diagnosis is that the behaviours persist and happen frequently (weekly as a minimum is a good guide). Another key element of the diagnosis of ODD is the degree of impact these behaviours have on the child’s life.

Some children with ODD will only display these behaviours in one setting – which is normally the home environment. This is because it is at home that they are most likely to achieve the desired outcome – often these behaviours are less prevalent at school because things are more out of their control.

Children with severe ODD will behave in these ways in a variety of settings and with a higher frequency.

² Hukkleberg, S., (2017)

Seeking help for ODD

We know that early intervention is the most effective way of preventing the behaviours of ODD from escalating. Many parents hope their child’s behaviour is just a phase or might be reluctant to seek help because of shame or embarrassment; however behavioural problems are very common, and treatment can make a real difference to your child’s life.

The benefits of seeking help for ODD:

1. Prevent future problems - we know that children who have behavioural difficulties in childhood are more likely to have a mood or anxiety disorder later in life. For instance, children who display signs of defiance and vindictiveness are more likely to have conduct disorder later on in life³.
2. Increase understanding - getting an assessment early will help parents understand what the best treatment is for their child and how to prevent future issues from escalating. You will be able to share this information with the child’s school which will help teachers know best how to support your child.
3. Improve family life - we know from helping thousands of families whose children have behavioural issues like ODD, that behavioural problems can play a real toll on family life.
   
   Marital discord (and even breakdown), constant arguments and tension within the home, poor parent-child relationships and in some cases, an inability to carry out normal family life (such as attending family events, birthday parties, shopping trips or days out) can all be a result of a child who has a conduct disorder or ODD.
4. Your child’s future - there can be serious consequences for the child who has ODD. Some children will grow out of the behaviours as they mature, but some will go on to develop a condition like antisocial personality disorder as an adult, which can have a real impact on their ability to hold down a job, relationship or even mean they are more likely to engage in criminal activity.
5. Your child’s mental health - we also know that around 50% of children with ODD will also have another mental health condition. The most common of these is ADHD, however depression, bipolar disorder and anxiety are also reasons why your child may have ODD. Treating the underlying condition can help with your child’s behaviour.

³ Whelan, Y., et al (2013)

What help is available for children and teenagers with ODD?

Assessment of ODD

It can be difficult to know if your child has ODD or another mental health condition that is causing their behavioural problems.

A Child and Adolescent Psychiatrist is the best person to assess your child and will spend time understanding if there are other underlying conditions.

As they are experts in child mental health, they will be able to formulate an effective treatment plan, which can significantly improve things for both your child and your whole family.

It might seem a bit scary getting a diagnosis, many of us are loathe to ‘label’ our children – however, we hear from parents every day who describe huge relief at having an explanation for their child’s behaviour and recommendations on how to help their child going forward.

A diagnosis can, therefore, be incredibly helpful in terms of both increased understanding, but also an ability to communicate to others why their child behaves as they do – which can ensure that children have the necessary provision put in place at school.

Read more about treatment options for behavioural issues

ODD is not just bad behaviour, it is a pervasive pattern of behaviours that challenge caused by a combination of biological and environmental factors. If ODD symptoms cause dysfunction, at school, at home or at leisure, it might be a good idea to request a specialist assessment.

Dr Dennis Ougrin

MBBS, MRCPsych, PGDip (Oxon), CCT, PhD

Consultant Child Psychiatrist

London

Dr Ougrin is a psychiatrist with nearly 10 years of clinical and academic experience specialising in child and adolescent psychiatry. He also has undertaken much research in the area of self-harm and has developed an effective intervention for...