Overview

Even the best-behaved children can be difficult and challenging at times. But if your child or teenager has a frequent and persistent pattern of anger, irritability, arguing, defiance or vindictiveness toward you and other authority figures, he or she may have oppositional defiant disorder (ODD).

As a parent, you don't have to go it alone in trying to manage a child with ODD. Doctors, mental health professionals and child development experts can help.

Behavioral treatment of ODD involves learning skills to help build positive family interactions and to manage problematic behaviors. Additional therapy, and possibly medications, may be needed to treat related mental health disorders.

Source: http://www.mayoclinic.com

Symptoms

Sometimes it's difficult to recognize the difference between a strong-willed or emotional child and one with oppositional defiant disorder. It's normal to exhibit oppositional behavior at certain stages of a child's development.

Signs of ODD generally begin during preschool years. Sometimes ODD may develop later, but almost always before the early teen years. These behaviors cause significant impairment with family, social activities, school and work.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, lists criteria for diagnosing ODD. The DSM-5 criteria include emotional and behavioral symptoms that last at least six months.

Angry and irritable mood:

• Often and easily loses temper
• Is frequently touchy and easily annoyed by others
• Is often angry and resentful

Argumentative and defiant behavior:

• Often argues with adults or people in authority
• Often actively defies or refuses to comply with adults' requests or rules
• Often deliberately annoys or upsets people
• Often blames others for his or her mistakes or misbehavior

Vindictiveness:

• Is often spiteful or vindictive
• Has shown spiteful or vindictive behavior at least twice in the past six months

ODD can vary in severity:

• Mild. Symptoms occur only in one setting, such as only at home, school, work or with peers.
• Moderate. Some symptoms occur in at least two settings.
• Severe. Some symptoms occur in three or more settings.

For some children, symptoms may first be seen only at home, but with time extend to other settings, such as school and with friends.

When to see a doctor

Your child isn't likely to see his or her behavior as a problem. Instead, he or she will probably complain about unreasonable demands or blame others for problems. If your child shows signs that may indicate ODD or other disruptive behavior, or you're concerned about your ability to parent a challenging child, seek help from a child psychologist or a child psychiatrist with expertise in disruptive behavior problems.

Ask your primary care doctor or your child's pediatrician to refer you to the appropriate professional.

Source: http://www.mayoclinic.com

Causes

There's no known clear cause of oppositional defiant disorder. Contributing causes may be a combination of inherited and environmental factors, including:

• Genetics — a child's natural disposition or temperament and possibly neurobiological differences in the way nerves and the brain function
• Environment — problems with parenting that may involve a lack of supervision, inconsistent or harsh discipline, or abuse or neglect

Source: http://www.mayoclinic.com

Diagnosis

To determine whether your child has oppositional defiant disorder, the mental health professional will likely do a comprehensive psychological evaluation. Because ODD often occurs along with other behavioral or mental health problems, symptoms of ODD may be difficult to distinguish from those related to other problems.

Your child's evaluation will likely include an assessment of:

• Overall health
• Frequency and intensity of behaviors
• Emotions and behavior across multiple settings and relationships
• Family situations and interactions
• Strategies that have been helpful — or not helpful — in managing problem behaviors
• Presence of other mental health, learning or communication disorders

Source: http://www.mayoclinic.com

Complications

Children and teenagers with oppositional defiant disorder may have trouble at home with parents and siblings, in school with teachers, and at work with supervisors and other authority figures. Children with ODD may struggle to make and keep friends and relationships.

ODD may lead to problems such as:

• Poor school and work performance
• Antisocial behavior
• Impulse control problems
• Substance use disorder
• Suicide

Many children and teens with ODD also have other mental health disorders, such as:

• Attention-deficit/hyperactivity disorder (ADHD)
• Conduct disorder
• Depression
• Anxiety
• Learning and communication disorders

Treating these other mental health disorders may help improve ODD symptoms. And it may be difficult to treat ODD if these other disorders are not evaluated and treated appropriately.

Source: http://www.mayoclinic.com

Prevention

There's no guaranteed way to prevent oppositional defiant disorder. However, positive parenting and early treatment can help improve behavior and prevent the situation from getting worse. The earlier that ODD can be managed, the better.

Treatment can help restore your child's self-esteem and rebuild a positive relationship between you and your child. Your child's relationships with other important adults in his or her life — such as teachers and care providers — also will benefit from early treatment.

Lifestyle and home remedies

At home, you can begin chipping away at problem behaviors of oppositional defiant disorder by practicing these strategies:

• Recognize and praise your child's positive behaviors. Be as specific as possible, such as, "I really liked the way you helped pick up your toys tonight." Providing rewards for positive behavior also may help, especially with younger children.
• Model the behavior you want your child to have. Demonstrating appropriate interactions and modeling socially appropriate behavior can help your child improve social skills.
• Pick your battles and avoid power struggles. Almost everything can turn into a power struggle, if you let it.
• Set limits by giving clear and effective instructions and enforcing consistent reasonable consequences. Discuss setting these limits during times when you're not confronting each other.
• Set up a routine by developing a consistent daily schedule for your child. Asking your child to help develop that routine may be beneficial.
• Build in time together by developing a consistent weekly schedule that involves you and your child spending time together.
• Work together with your partner or others in your household to ensure consistent and appropriate discipline procedures. Also enlist support from teachers, coaches and other adults who spend time with your child.
• Assign a household chore that's essential and that won't get done unless the child does it. Initially, it's important to set your child up for success with tasks that are relatively easy to achieve and gradually blend in more important and challenging expectations. Give clear, easy-to-follow instructions.
• Be prepared for challenges early on. At first, your child probably won't be cooperative or appreciate your changed response to his or her behavior. Expect behavior to temporarily worsen in the face of new expectations. Remaining consistent in the face of increasingly challenging behavior is the key to success at this early stage.

With perseverance and consistency, the initial hard work often pays off with improved behavior and relationships.

Source: http://www.mayoclinic.com

Coping and support

It's challenging to be the parent of a child with oppositional defiant disorder. Ask questions and try to effectively communicate your concerns and needs to the treatment team. Consider getting counseling for yourself and your family to learn coping strategies to help manage your own distress. Also seek and build supportive relationships and learn stress management methods to help get through difficult times.

These coping and support strategies can lead to better outcomes for your child because you'll be more prepared to deal with problem behaviors.

Source: http://www.mayoclinic.com

Risk factors

Oppositional defiant disorder is a complex problem. Possible risk factors for ODD include:

• Temperament — a child who has a temperament that includes difficulty regulating emotions, such as being highly emotionally reactive to situations or having trouble tolerating frustration
• Parenting issues — a child who experiences abuse or neglect, harsh or inconsistent discipline, or a lack of parental supervision
• Other family issues — a child who lives with parent or family discord or has a parent with a mental health or substance use disorder
• Environment — oppositional and defiant behaviors can be strengthened and reinforced through attention from peers and inconsistent discipline from other authority figures, such as teachers

Source: http://www.mayoclinic.com