Do You Have a Moody Kid, or Is It Oppositional Defiant Disorder?

It’s normal for children to be cranky, moody, and downright obstinate sometimes. However, the term “oppositional defiant disorder” (ODD) is becoming more well-known, and many parents want to know whether their child has ODD or whether their defiance falls in the normal realm of child behavior. It is important to note that ODD in children is a proper, diagnosable condition that affects their behavior significantly. It is not the same as typical defiance, not listening, losing their temper, or moodiness.¹ So, what is the difference, and how can you support your child if you believe they might have ODD?

Oppositional defiant disorder is a disruptive behavior disorder that occurs in childhood and typically involves challenges with being able to control and regulate emotions and behaviors. First, however, it’s essential to understand the meaning of defiant, which is crucial in understanding ODD. Defiance is described as being openly resistant or disobedient, particularly against authority.²

Now, you might be thinking, “Yup, that’s my child. They are disobedient!” However, for children diagnosed with oppositional defiant disorder, it’s not simply about talking back or refusing to comply with requests or instructions on occasion. It is a frequent and regular pattern of these behaviors over a long period.³ For children with ODD, their behavior can cause difficulties in many areas, including performance at school, everyday life, and the ability to make and maintain friendships and relationships with family members.⁴

The main feature of ODD is a pattern of behaviors in children or teens who are irritable, argumentative, and defiant. You might witness aggression or tantrums that are inappropriate for the child’s age and developmental level. Some children may also display a level of vindictiveness toward other people.⁴ Other behaviors to look out for can include:³

• Using unkind words
• Having an angry attitude
• Blaming others for their behavior/misbehavior
• Refusing to comply with instructions or requests
• Questioning rules
• Feeling easily annoyed by others
• Seeking revenge

It’s also important to understand that oppositional defiant disorder coexists with other diagnoses. There can be some crossover or similarity in symptoms, so it is vital to seek support from an appropriately skilled mental health professional if you are considering getting your child support or a diagnosis. Other diagnoses that may co-occur with ODD are anxiety and mood disorders.⁵ While other conditions that might have overlapping symptoms include attention deficit hyperactivity disorder (ADHD) and autism.^5,6

ODD Causes and Risk Factors

Unfortunately, there is no apparent cause for ODD. However, some research indicates there is a high chance it is hereditary because ODD or other conduct/behavioral disorders can cluster or occur together in families.⁷ Although researchers don’t know exactly what causes it, research tends to look at risk factors linked with disruptive behaviors (not ODD specifically) and identify these as mostly being biological or environmental.⁸

A risk factor doesn’t necessarily mean someone will develop a disorder/condition, but it does indicate an increase in the chances of it developing. Some risk factors associated with ODD may include:^8,9

• Prenatal nutritional deficiencies
• Prenatal substance use
• Nicotine use by parents
• Developmental delays
• Insecure attachment or unresponsive parenting, including a lack of structure (however, it should also be noted that supportive environments and secure/responsive parenting styles can be a protective factor for ODD)
• Parental mental health or psychological issues, particularly maternal aggression or harsh punishment
• Social issues like poverty and community violence
• Problems with peers, like rejection or bullying

ODD can be pretty complicated to diagnose because many of the symptoms cross over with other diagnoses, which is why it is vital to engage a professional’s support if you are considering seeking a diagnosis for your child. ODD is diagnosed using the Diagnostic and Statistical Manual (fifth edition), and criteria include at least four symptoms, which need to have been present for most days over at least six months. They need to demonstrate a pattern of anger, irritable mood, argumentative or defiant behavior, or being vindictive. Symptoms include the following:¹

• Often losing their temper
• Is touchy or gets annoyed easily
• Feels angry and resentful
• Argues with authority figures
• Actively refuses or defies rules or requests from authority figures/adults
• Deliberately annoys others
• Blames others for their mistakes
• Has demonstrated spiteful or vindictive behavior at least twice in the past six months

A diagnosis must include some evidence of impairment or distress (including in the person themselves, their family, peers, etc.) or that a negative impact occurs in social, educational, or other areas of functioning. A diagnosis will also be rated in terms of severity:¹

• Mild (the symptoms only occur in one setting)
• Moderate (symptoms occur in at least two settings)
• Severe (symptoms occur in three or more settings)

It is important to note that while there aren’t any apparent gender differences in terms of how often ODD is diagnosed in girls versus boys, the way they express their symptoms can be different. Boys typically present with symptoms like blaming others or deliberately annoying others and tend to have coexisting conditions like ADHD and issues in school. Girls are more likely to present with symptoms or diagnoses associated with anxiety and depression.¹⁰

When pursuing treatment for your child, remember that their behaviors are a symptom of their diagnosis, and they aren’t challenging on purpose. If your child has ODD (or suspected ODD), it is essential to seek professional guidance because they can look at how your child’s behaviors impact areas of your child’s life and provide disorder-specific treatment recommendations or support. Typical treatment, which has been well-researched as being effective, include:¹¹

• Therapy — including cognitive behavioral therapy, dialectical behavior therapy, and family therapy
• Emotional regulation and coping skills — including practical strategies to help them manage anger, irritation, frustration, and other strong emotions and learn to cope with challenges
• Parent training and support — which focuses on how to parent a child with ODD and includes things like supporting their child consistently, establishing boundaries, coping with tantrums or disruptive behavior, and developing a positive parent-child relationship
• Social skills training
• Medication — which isn’t usually the first option but may be prescribed if your child has other co-occurring diagnosis that are best treated with it

Supporting your child with oppositional defiant disorder can be challenging. While they aren’t engaging in these behaviors on purpose, it doesn’t make it easy on you. So, it’s essential to reach out for support from health professionals to explore a diagnosis and treatment plan. But don’t forget to look after yourself, too. Make sure you have your support (self-care, eating well, keeping fit and healthy, social support, or even seeking counseling or more formal support from your health professional) so that you can be in the best space possible to support your child with ODD.