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Oppositional Defiant Disorder ˌäp-ə-ˈzish-nəl-di-ˈfī-ənt-, -ən-ᵊl-

By Josephine Elia, MD, Professor of Psychiatry and Human Behavior, Professor of Pediatrics;Attending Physician, Sidney Kimmel Medical College of Thomas Jefferson University;Nemours/A.I. duPont Hospital for Children

Oppositional defiant disorder is a recurring pattern of negative, defiant, and disobedient behavior, often directed at authority figures.

Children with oppositional defiant disorder are stubborn, difficult, disobedient, and irritable without being physically aggressive or actually violating the rights of others. Oppositional defiant disorder is sometimes thought of as a milder form of conduct disorder. However, the two disorders have distinct differences. Children with conduct disorder seem to lack a conscience and, unlike those with oppositional defiant disorder, repeatedly violate the rights of others, sometimes without any sign of irritation.

Many preschool and early adolescent children occasionally display oppositional behaviors, but oppositional defiant disorder is diagnosed only if behaviors persist for 6 months or more and are serious enough to interfere with social or academic functioning.

What causes oppositional defiant disorder is unknown. It is probably more common among children from families in which adults have loud arguments. This disorder indicates underlying problems that may require further investigation and treatment.

Symptoms

Symptoms of oppositional defiant disorder often begin in the time period from preschool through middle school.

Typical behaviors of these children include the following:

  • Arguing with adults

  • Losing their temper easily and often

  • Actively defying rules and instructions

  • Deliberately annoying people

  • Blaming others for their own mistakes

  • Being angry, resentful, and easily annoyed

  • Being spiteful and vindictive

These children do know the difference between right and wrong and feel guilty if they do anything that is seriously wrong. Many of them lack social skills.

Diagnosis

  • Symptoms and behavior

Doctors diagnose oppositional defiant disorder based on the child's symptoms and behavior, which must have been present for at least 6 months and be serious enough to interfere with the child's ability to function.

When oppositional defiant disorder is suspected, doctors carefully evaluate all children for signs of depression, such as sleep or appetite disturbances, as well as anxiety. In children, depression and anxiety disorders can cause some of the same symptoms as oppositional defiant disorder. For example, sometimes the main symptom of depression is irritability, and extreme anxiety can cause children with an anxiety disorder to disobey or behave defiantly. Doctors must distinguish these disorders from oppositional defiant disorder, often based on other symptoms the disorders cause.

Doctors must also distinguish oppositional defiant disorder from untreated attention-deficit/hyperactivity disorder (ADHD), which can also cause similar symptoms. These symptoms often lessen when ADHD is adequately treated.

Treatment

  • Behavior management techniques

  • Possibly group therapy

Problems that may be contributing to symptoms (such as dysfunction in the family or ADHD) should be treated if possible.

Oppositional defiant disorder is best treated through behavior management techniques, which include a consistent approach to discipline and appropriate reinforcement of desired behavior (with rewards). Parents and teachers can be instructed in these techniques by the child’s counselor or therapist.

Children may benefit from group therapy that helps them improve their social skills.

Drugs used to treat depressive or anxiety disorders sometimes help.

Even without treatment, most children gradually improve over time.