Frequently Asked Questions About Oppositional Defiant Disorder (ODD)

Q: What is Oppositional Defiant Disorder?

A: When a child is extremely uncooperative and/or disobedient, and defies authority figures, he or she may be suffering from Oppositional Defiant Disorder (ODD). ODD is a mental disorder that is usually diagnosed during childhood. According to the Diagnostic and Statistical Manual of Mental Disorders—Fourth Edition (DSM-IV), in order to meet disorder criteria, a child must exhibit a pattern of negative, hostile, and defiant behavior lasting at least six months, during which four or more of the following behaviors are present:

  1. Often loses temper
  2. Often argues with adults
  3. Often actively defies or refuses to comply with adult requests or rules
  4. Often deliberately annoys people
  5. Often blames others for his or her mistakes or misbehavior
  6. Is often touchy or easily annoyed by others
  7. Is often angry and resentful
  8. Is often spiteful or vindictive

All children exhibit behaviors that could be labeled as "oppositional" from time to time: They may talk back, throw tantrums, break rules, annoy others, become angry, etc. Children are more likely to have trouble controlling their behavior when they are tired, hungry, frustrated, stressed, etc. Also, children can act out when their environmental demands exceed their abilities. For example, expecting a five-year-old to sit quietly during a long airplane ride, or when an authority figure is inconsistent about rules and/or allowable behavior. A child’s behavior should not be considered abnormal unless it occurs much more frequently than is typically observed by other children of a comparable age and developmental level, or when it seriously affects the child's social, family, and academic life.1

Q: How common is ODD?

A: Surveys suggest that between 2 and 16 percent of school-aged children are diagnosed with ODD, with rates somewhat higher among preschool-aged children.2 ODD is usually diagnosed before the age of eight. If ODD persists into late childhood and adolescence it tends to be more severe, or may develop into Conduct Disorder. According to the DSM-IV, ODD is more prevalent among boys than girls before puberty, with rates being equal thereafter. However, other findings suggest that up to the age of eight, boys and girls are equally affected by ODD, but boys with ODD tend to be more disruptive than girls with ODD.2

Q: Do children outgrow ODD?

A: Children with ODD are not likely to simply "outgrow" the problem, at least not right away. Symptoms may improve over time as children and their families receive treatment or develop tools for coping with this disorder.

Q: What treatments are helpful for ODD?

A: Research suggests that parent training programs are effective for treating oppositional behavior in children.3, 4 Parent Management Training teaches new skills for dealing with oppositional and defiant behavior. Parents learn to consistently apply consequences (e.g. rewards and punishment) to shape obedient behavior in their children. Since behavioral problems that are characteristic of ODD are impacted by parent-child interactions, parents also learn their role in these transactions and how to respond more effectively.2 More

Behavioral Interventions and Behavior Therapy
A lot of problems experienced by young people can be helped or treated with behavioral interventions or a relatively quick dose of behavior therapy. More

The effectiveness of medication for the treatment of ODD has not received a lot of research to date. Children suffering with ODD are sometimes prescribed stimulant medications if they are also suffering from Attention Deficit Hyperactivity Disorder (ADHD). Talk to your doctor about recommended treatment.

Q: How do I locate professional to treat ODD?

A: You can contact any of the following organizations, which have referral capabilities:

Find a TRICARE Provider
Or call 1-888-TRIWEST.

Association for the Advancement of Behavior Therapy
Or call 1-212-647-1890.

American Psychological Association
Or call 1-800-964-2000.

National Association of Social Workers—Search Clinical Register

American Academy of Child and Adolescent Psychiatry

Q: Do I have to see a specialist in order to get help?

A: No. There are a number of steps you can take on your own to address ODD symptoms. Check out the self-help tools offered by this site. Caregivers and teachers can learn a number of tools on their own for managing child behavioral problems. Sometimes family, friends, or clergy can be excellent sources of support for families facing a challenging behavioral change. If your PCM believes it is necessary to seek specialty care, he or she will be able to assist you to that next level of care.

Q: Is ODD a covered TRICARE benefit?

A: TRICARE policy for reimbursement requires that services must be medically necessary for a diagnosed mental disorder. The disorder must be one referenced in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and must be of a severity not only to cause the patient distress but also to interfere with the patient’s usual activities.

TRICARE beneficiaries are eligible for eight behavioral health care visits per year without a referral or pre-authorization. Active duty military personnel always need a referral for care outside a military treatment facility. More

References:

1American Academy of Child and Adolescent Psychiatry (1999). Children with oppositional defiant disorder. Fact Sheets For Families, 72. Accessed 4/24/06

2Eyberg, S. M., O’Brien, K. A., & Chase, R. M. (in press). Oppositional defiant disorder and parent training.In J. E. Fisher & W. O’Donohue (Eds.). Practitioner’s guidelines for evidence based psychotherapy. Kluwer.

3Walter, H. I., & Gilmore, S. K. (1973). Placebo versus social learning effects in parent training procedures designed to alter the behavior of aggressive boys. Behavior Therapy, 4, 361-377.

4Wells, K. C., & Egan, J. (1988). Social learning and systems family therapy for childhood oppositional disorder: Comparative treatment outcome. Comprehensive Psychiatry, 29, 138-146.