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Oppositional Defiant Disorder


Josephine Elia

, MD, Nemours/A.I. duPont Hospital for Children

Reviewed/Revised May 2023

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 Conduct Disorder A conduct disorder involves a repetitive pattern of behavior that violates the basic rights of others. Children with a conduct disorder are selfish and insensitive to the feelings of others... read more . 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 of Oppositional Defiant Disorder

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 of Oppositional Defiant Disorder

  • A visit with a doctor or behavioral health specialist

  • Description of child's behavior (such as by a parent or teacher)

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 Symptoms Depression includes a feeling of sadness (or, in children and adolescents, irritability), and/or loss of interest in activities. In major depression, these symptoms last 2 weeks or more and... read more and anxiety disorders Symptoms Anxiety disorders are characterized by fear, worry, or dread that greatly impairs the ability to function and is out of proportion to the circumstances. There are many types of anxiety disorders... read more 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.

Treatment of Oppositional Defiant Disorder

  • 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.

medications used to treat depressive or anxiety disorders sometimes help.

Even without treatment, most children gradually improve over time.

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