by Abby Sakovich M.S., CCC-SLP
As children grow and develop, they face opportunities to learn to respond appropriately to and identify
their feelings and emotions. When encountering new and/or stressful scenarios, children may “misbehave”
on occasion during this process. Children may talk back, act out, or refuse to follow directions. However,
when these behaviors begin repeatedly interfering with the home environment, social activities, and
school, it may be an indication something other than emotional growing pains is at play.
Oppositional Defiant Disorder (ODD) is a behavioral disorder exhibited by a pattern of disobedient, hostile,
and defiant behavior most often directed towards authority figures. Four emotional and behavioral
symptoms from the following categories must be present in order to diagnose (ODD):
Angry and Irritable Mood
- Frequently has difficulty controlling his/her temper.
- Often sensitive or easily irritated by others.
- Recurrently demonstrates angry or resentful behavior.
Argumentative and Defiant Behavior
- Annoys others frequently and deliberately.
- Regularly argues with adults or authority figures.
- Often actively refuses to comply with the request of adults or authority figures.
- Repeatedly blames others for personal mistakes or misbehavior.
- Frequently spiteful (acting out of malice) or vindictive (acting out of revenge.)
- Demonstrates malicious or vengeful behavior at least twice within a six-month period.
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), ODD occurs when the
pattern of behavior:
- Occurs with at least one individual who is not a sibling.
- Causes significant problems at home and/or school.
- Occurs independently of another mental health disorder (i.e., depression, bipolar disorder).
- Takes place on most days within a six-month period (children under 5 years old).
- Occurs at least one time per week in a six-month period (children over 5 years old).
What Causes ODD?
Experts have not determined a definitive cause of ODD, but they believe that a combination of genetic
and environmental factors may contribute to its development. Research suggests anywhere from 1-16% of
children and adolescents are affected by ODD. Symptoms range from Mild (occur in one setting), Moderate
(some occur across two settings), or Severe (some occur in three settings).
Experts agree that short-term or one-time treatment approaches are not successful in
treating children with ODD. Behavior boot camps, tough-love, and scare tactics may
do more harm than good by reinforcing aggressive behavior.
Similar to other behavioral disorders, it is best to individualize treatment to meet
the needs of a specific child. In addition to medication, treatment typically includes
Parent-Child Interaction Therapy (PCIT) for both the child and family, as well as
cognitive problem solving, parent, and social skills training. Early identification and
early intervention play an important role in determining treatment success.
While it is true that children “grow out” of some of the symptoms of ODD over time, research shows
that 67% of children struggling with ODD are symptom free following three years of treatment. If left
untreated, research suggests children are at a higher risk for substance abuse, delinquency or developing
a more serious form of disruptive behavior disorder. Empowering children with the tools to cope with
new and stressful situations appropriately will help them identify, express, and manage their feelings and
behaviors positively. This empowerment will provide children the best opportunity to grow up and lead
fulfilling and happy lives.