Oppositional Defiant Disorder: Signs, Symptoms, & Treatment

Another fact to keep in mind is that 16% to 22% of normal school-age children engage in oppositional

behavior. Thus, oppositional behavior may be developmentally normal in early children. It is when the

oppositional behavior is significantly greater than what would normally be expected in other children of the

same age that a diagnosis of Oppositional Defiant Disorder is appropriate.

To diagnose Oppositional Defiant Disorder, the disturbed behavior must cause a significant impairment in

social, academic, or occupational (related to working) functioning. For oppositional defiant disorder to be

diagnosed, the behaviors cannot occur only during the course of a mood disorder (such as Major

Depressive Disorder) or a psychotic disorder. A psychotic disorder is one in which there is an impairment

in dealing with reality and coping with the demands of everyday life.

Oppositional defiant disorder should not be diagnosed if the child meets the criteria for Conduct Disorder.

Conduct Disorder is a more serious behavioral and emotional disorder, which includes problems such as

setting fires, physically harming animals, and physically harming people. If the person is under age 18,

Conduct Disorder should not be diagnosed if the child meets the criteria for Antisocial Personality

Disorder. Antisocial Personality Disorder is a more serious behavioral and emotional disorder that

involves a pattern of disregarding the rights of others since age15.

WHAT ARE SOME EXAMPLES OF THE CRITERIA FOR DIAGNOSING OPPOSITIONAL DEFIANT

DISORDER MENTIONED ABOVE?

Examples of negative and defiant behavior are stubbornness, not following directions, arguing with adults,

and not being willing to compromise with adults or children of the same age or grade. Some children with

Oppositional Defiant Disorder may purposely try to push the limits of others by ignoring orders, arguing,

and not accepting responsibility for doing something wrong.

Examples of hostility directed at adults or children of the same age or grade are temper tantrums,

purposely annoying others, and verbal aggression, such as teasing (usually without serious physical

aggression). Most children with Oppositional Defiant Disorder do not believe that their oppositional

behavioral and emotional responses are problematic. Rather, they find them to be appropriate responses

to the unreasonable demands of others or of certain situations.

The behavioral and emotional problems that are part of Oppositional Defiant Disorder usually occur with

someone the individual knows well. This means that it may be difficult for someone (such as a

psychologist) evaluating the individual to see the behavioral and emotional problems in person.

WHAT ARE COMMON CHARACTERISTICS OF PEOPLE WITH OPPOSITIONAL DEFIANT DISORDER?

Common characteristics of Oppositional Defiant Disorder are different depending on the child's age and

the seriousness of the problem. Most children with this disorder have adequate intelligence. For males,

this disorder has been found to occur more among those who, in the preschool years (usually ages 3 to

5), tend to have problematic emotional responses such as being overly sensitive or having a difficult time

being comforted.

For school age children with Oppositional Defiant Disorder, they tend to have unstable moods, low self-

esteem, a tendency to curse, and are easily frustrated. They also tend to use illegal drugs, alcohol, and

tobacco earlier than most people who use such substances. They have many conflicts with teachers,

parents, and children of the same age or grade. The behavior of children with Oppositional Defiant

Disorder may upset the parents, who may then respond by engaging in behavior that upsets the child. This

can lead to a vicious cycle that lasts for a long time.

Many children with Oppositional Defiant Disorder come from families in which there are too many different

caregivers, or from families in which strict, inconsistent, or neglectful behavior is present. Neglect refers

to when a parent or guardian fails or is unable to provide the minimal level of physical and emotional care

for someone dependent on him/her, in this case a child. It is common for children with Oppositional Defiant

Disorder to have Attention-Deficit/Hyperactivity Disorder. Oppositional Defiant Disorder is also

associated with Learning Disorders and Communication Disorders.

WHAT ARE COMMON CONSEQUENCES FOR PEOPLE WITH OPPOSITIONAL DEFIANT DISORDER?

One obvious consequence of Oppositional Defiant Disorder is poor relationships with others and/or a lack

of friends. In addition, children with this disorder often have difficulty in school. Poor school performance

in children with this disorder is usually not due to poor intelligence. Rather they have difficulty relating to

teachers (authority figures), refuse to obey teachers, do not participate in class, and refuse to let others

help them solve problems. The consequence of the child's poor school performance can be low self-

esteem, low frustration, depressed mood, and temper tantrums. Adolescents may abuse alcohol, tobacco,

and illegal drugs. Oppositional Defiant Disorder often develops into a more serious behavior disorder

known as Conduct Disorder. It also commonly develops into a Mood Disorder.

HOW MANY PEOPLE HAVE OPPOSITIONAL DEFIANT DISORDER?

Studies estimated that anywhere between 2% and 16% of people have Oppositional Defiant Disorder.

These ranges depend on the sample of people studies and the methods used in the study.

WHEN DOES OPPOSITIONAL DEFIANT DISORDER BEGIN?

Oppositional Defiant Disorder can begin as early as age three. It usually is detectable by age 8 and

usually does not occur any later than early adolescence (about age 11 to 13). This disorder usually begins

slowly, over the course of months or years. The problems in Oppositional Defiant Disorder usually are

seen at home but can occur in other places such as school or in the local community. In many cases,

Oppositional Defiant Disorder occurs before Conduct Disorder, a more serious pattern of problems

discussed above.

ARE MALES MORE LIKELY TO DEVELOP OPPOSITIONAL DEFIANT DISORDER THAN FEMALES?

Yes and no. Before puberty, males are more likely to develop Oppositional Defiant Disorder. After puberty,

males and females have about the same likelihood of developing this disorder. Puberty is the period of life

in which the ability to reproduce begins. Puberty usually begins between the ages of 11 and 13. The

symptoms of Oppositional Defiant Disorder are generally the same in males and females, although males

may be more confrontational and have symptoms that last longer.

WHAT CAUSES OPPOSITIONAL DEFIANT DISORDER?

No one knows for sure what the cause of Oppositional Defiant Disorder is. A biological factor is possible,

considering that many of these children tend to have problematic emotional responses as infants, such as

being overly sensitive or having a difficult time being comforted. In addition, many of these children have

been reported to be very assertive, have strong preferences, and a strong will before the behavioral and

emotional pattern of Oppositional Defiant Disorder becomes apparent.

Many parents may unknowingly strengthen oppositional behavior by reacting to their child in certain ways.

An example would be when a parent lets a child have a piece of candy after having a temper tantrum. This

behavior (the temper tantrum) is now strengthened because the child got what he/she wanted. The

chances have now been increased that the next time the child wants a piece of candy, he/she will have a

temper tantrum as a means to get it. Increased attention from parents is another way that oppositional

behavior is reinforced.

In late childhood, problems such as trauma, illness, or mental retardation may lead to the development of

Oppositional Defiant Disorder as a way to defend against feelings of helplessness, nervousness, and low

self-esteem. Other potential causal factors listed in response to the question below are also thought to

contribute to the development of Oppositional Defiant Disorder. Please keep in mind that what leads to the

development of Oppositional Defiant Disorder may not be one of these factors, but a combination of them.

DO CHILDREN IN CERTAIN TYPES OF FAMILIES DEVELOP OPPOSITIONAL DEFIANT DISORDER?

Many families of children with Oppositional Defiant Disorder are too controlling of the child and/or

overreact to normal oppositional behavior. This is problematic because it is a normal part of the

developmental process for a young child (and a teenager) to assert his/her independence. If the child is

not allowed to assert this independence, he/she can become defensive and oppositional. If Oppositional

Defiant Disorder develops, it appears to cause more stress to those around the child than to the child with

the disorder.

In some cases, the child with Oppositional Defiant Disorder is simply unwanted. Also, parents who engage

in strong verbal and physical punishment of their child increase the risk of oppositional behavior occurring,

such as aggression. Many families have several stubborn children, and this increases the chances of a

child developing Oppositional Defiant Disorder.

Some research has suggested that mothers with a history of a Depressive Disorder are more likely to

have children who engage in oppositional behavior. However, the relationship between the mother's

depression and the oppositional behavior of the child is unclear at this time. That is, it is not clear to what

degree a mother's depression causes oppositional behavior in children or if oppositional behavior in

children results from the mother's depression. Parents who are having serious marriage problems are

more likely to have children with Oppositional Defiant Disorder.

Oppositional Defiant Disorder seems to be more common in families in which at least one parent who has

a history of Oppositional Defiant Disorder, a Mood Disorder, Attention-Deficit Hyperactivity Disorder, a

Substance(drug)-Related Disorder, Conduct Disorder, and Antisocial Personality Disorder. See the end of

the answer to the 2nd question for a brief explanation of Conduct Disorder and Antisocial Personality

Disorder. As one can imagine, when one or two parents have one or more of the above problems, life at

home is likely going to be more abnormal for a child in that environment.

HOW IS OPPOSITIONAL DEFIANT DISORDER TREATED?

The main way that Oppositional Defiant Disorder is treated is through individual psychotherapy (a

psychological therapy done through talking). Psychotherapy is also done with the parents of the individual

with Oppositional Defiant Disorder so that they are better trained at managing their child's problems. A

type of psychotherapy called behavior therapy involves teaching the parents how to change their child's

problematic behavior and how to encourage better behavior. This is done by strengthening and praising

appropriate behavior and ignoring or not strengthening poor behavior. Psychotherapy is usually done by a

psychologist.

It is very important for the child to have a good relationship with the treating therapist in order for strict

and difficult family patterns to change. One of the keys is for the child to see the therapist as a non-

controlling person. If this occurs, the child can express him/herself more directly and can learn how his/her

behavior is self-destructive. In the child's relationship with the therapist, he/she can learn new ways to

develop a sense of mastery and success in social situations with family and with individuals of the same

age and grade. It is important for self-esteem to be raised during psychotherapy.

It is also important for harsh punishment of the child to be eliminated and replaced with more positive

parent-child interactions, such as talking. The parents should also increase their involvement in the child's

life in a positive way.

WHAT EVENTUALLY HAPPENS TO CHILDREN WITH OPPOSITIONAL DEFIANT DISORDER?

What eventually happens to children with Oppositional Defiant Disorder depends on the seriousness of

the disorder, the willingness of the family to change, the presence of other existing mental disorders, and

whether they receive treatment. Generally, about 25% of children who are diagnosed with Oppositional

Defiant Disorder do not meet the criteria for this diagnosis within the next several years after being

diagnosed. For patients in whom the diagnosis continues, many go on to have more serious behavioral

problems.

WHAT ELSE IS OPPOSITIONAL DEFIANT DISORDER KNOWN AS?

Oppositional defiant disorder is also known as oppositional disorder.

HOW CAN I FIND MORE INFORMATION ON OPPOSITIONAL DEFIANT DISORDER?

An excellent source of information on Oppositional Defiant Disorder is Internet Mental Health, where you

will find information on treatment, relevant research, booklets, and magazine articles.