Stubborn Child

It’s not unusual for a child to argue against rules or try to get their way sometimes. Being a bit stubborn every now and then — refusing dinner or arguing about homework, for example — is typical childhood behavior. But for some children, that occasional stubbornness crosses the line into a behavioral issue known as oppositional defiant disorder (ODD).

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What Is Oppositional Defiant Disorder in Children?

ODD is a type of disruptive behavior disorder (DBD). Children with ODD are often hostile, defiant, angry, or uncooperative. This especially applies to authority figures, such as parents, caregivers, and teachers. And it’s common, affecting up to 16% of all school-age children and adolescents, according to the American Academy of Child & Adolescent Psychiatry.

ODD is usually diagnosed during childhood and adolescence. The Centers for Disease Control and Prevention says that ODD starts before age 8 and no later than age 12. For some, it can take until adolescence to get a diagnosis of ODD.

Symptoms of ODD

Not every child who argues with their parents or disobeys authority has ODD. Sometimes these reactions are situational, such as when they’re tired, hungry, or sick. But children with ODD show a frequent and consistent pattern of anger and verbal aggression toward their parents and other authority figures.

Knowing the symptoms of ODD in children can help your child get the treatment and services they need. Children with this disorder engage in these behaviors more often than other children their age. Symptoms of ODD in children often include:

  • Arguing with adults and other authority figures.
  • Refusing to accept rules or requests.
  • Questioning rules and limits.
  • Having temper tantrums.
  • Being quick to anger.
  • Blaming others for their own behavior or mistakes.
  • Being resentful or spiteful or seeking revenge for perceived wrongs.
  • Annoying or upsetting others or being quick to get annoyed or upset by others.
  • Having a bad attitude.
  • Using mean or hateful speech when upset.

ODD behaviors can disrupt a child’s daily functioning in school and at home.

Risk factors and causes of ODD

Why some children develop oppositional defiant disorder is unknown. Biological, psychological, and social factors may play a role.

Risk factors for oppositional defiant disorder in children include:

  • Being exposed to violence or criminal behavior.
  • Experiencing harsh treatment or inconsistent parenting.
  • Having parents with mental health issues, such as depression, substance use disorders, and attention-deficit/hyperactivity disorder (ADHD).

Treatment and Prevention for Oppositional Defiant Disorder in Children

If you suspect your child has ODD, they will need a comprehensive medical and mental health evaluation. This will help their doctor rule out other issues that could contribute to the child’s defiant and hostile behavior. Children struggling with learning disabilities, ADHD, mood disorders (depression or bipolar disorder), and anxiety disorders might present with symptoms very similar to ODD, so a thorough evaluation is essential to ensure appropriate treatment.

Treatment

The strongest evidence for treatment of ODD in children includes:

  • Parent behavior management training. This can help parents, caregivers, and teachers learn to manage the child’s behavior.
  • Individual child behavior therapy or cognitive behavioral therapy. This helps the child learn more effective anger management and skills to refrain from negative behavior.
  • Family therapy. This helps improve communication and understanding between children with ODD and their parents and other family members.
  • Social skills training. This helps the child with ODD learn to navigate social situations and peers in a healthier way.

There are no evidence based medications to treat ODD, specifically, but there are commonly coexisting disorders, such as ADHD or depression, that could benefit from medication management.

Prevention

It’s possible to reduce some of the risk factors that can lead to ODD. Protective factors against developing ODD include:

  • Following a positive parenting style with your children.
  • Focusing on adult mental health and psychiatric care for any mental health issues parents and other caregivers face.
  • Using high-quality child care that doesn’t involve harsh treatment or discipline.
  • Preventing and intervening in childhood bullying.
  • Engaging in youth violence prevention.

Children with ODD can get better if they get help and parental support. Talk to your doctor to get them — and you — started on a path to where constant hostility isn’t the norm.

Sources

ODD: A Guide for Families by the American Academy of Child & Adolescent Psychiatry. AACAP. Link.

Oppositional Defiant Disorder. AACAP. Link.

Behavior or Conduct Problems in Children. Centers for Disease and Prevention. Link.

Conduct Disorder. AACAP. Link.

Therapy to Improve Children's Mental Health. CDC. Link.

About Pediatrics

From nutrition to illnesses, from athletics to school, children will face many challenges growing up. Parents often will make important health care decisions for them. We hope to help guide both of you in that journey. UPMC Children’s Hospital of Pittsburgh is a national leader in pediatric care, ranking consistently on U.S. News & World Report’s Best Children’s Hospitals Honor Roll. We provide expert treatment for pediatric diseases, along well-child visits, urgent care, and more. With locations across Pennsylvania, Maryland, and West Virginia, you can find world-class care close to home. We also work closely with UPMC Magee-Womens Hospital, a national leader in care for newborns and their mothers. Our goal is to provide the best care for your children, from birth to adulthood and beyond. Visit our website to find a doctor near you.