Oppositional defiant disorder (ODD) is a childhood behavioural problem characterised by constant disobedience and hostility. Around one in 10 children under the age of 12 years are thought to have ODD, with boys outnumbering girls by two to one. ODD is one of a group of behavioural disorders known collectively as disruptive behaviour disorders which include conduct disorder (CD) and attention deficit hyperactivity disorder (ADHD). Early intervention and treatment is important, since children with untreated ODD may continue to be difficult and anti-social into their adult years. This can impact on their relationships, career prospects and quality of life. Some children with ODD will develop the more serious conduct disorder (CD) which is characterised by aggressive criminal and violent behaviours.

Characteristics of ODD

ODD behaviours usually surface when the child is at primary school but the disorder can be found in children as young as three years of age. Some of the behaviours of a child with ODD may include:

Is easily angered, annoyed or irritated

Has Frequent temper tantrums

Argues frequently with adults, particularly the most familiar adults in their lives, such as parents

Refuses to obey rules

Seems to deliberately try to annoy or aggravate others

Has low self esteem

Has low frustration threshold

Seeks to blame others for any misfortunes and misdeeds.

The link to conduct disorder

Without intervention and treatment, some children with ODD progress to develop conduct disorder (CD) which is characterised by aggressive and delinquent behaviours including:

Lying

Being sadistic or cruel to animals and people

Physically or sexually abusing others

Criminal behaviours like deliberately lighting fires, vandalism or stealing.

Family life is an important risk factor

The cause of disruptive behaviour disorders is unknown but the quality of the child's family life seems to be an important factor in the development of ODD. Some studies have found that certain environmental factors in the family increase the risk of disruptive behaviour disorders, including:

Poor parenting skills

Domestic violence

Physical abuse

Sexual abuse

Neglect

Poverty

Substance abuse by parents or carers.

Diagnosis

ODD needs to be professionally diagnosed by a child psychologist, child psychiatrist or paediatrician specialising in behavioural disorders. Diagnosis involves detailed interviews with the child (if they are old enough), parents and teachers, and comparing the child's behaviour with a checklist for ODD contained in the Diagnostic and Statistical Manual of Mental Disorders from the American Psychiatric Association.

Treatment options

Treatment options may include:

Parental training - to help the parents to better manage and interact with their child, including behavioural techniques that reinforce good behaviour and discourage bad. This is the primary form of treatment and the most effective. Social support is increased if the parents are trained in groups with other parents who have children with ODD.

Functional family therapy - to teach all family members to communicate and problem-solve more effectively.

Consistency of care - all carers of the child (including parents, grandparents, teachers, child care workers and so on) need to be consistent in the way they behave towards and manage the child.

Where to get help

Your doctor

Child psychologist

Child psychiatrist

Paediatrician

The Specialist Children's Services, Department of Human Services Tel. (03) 9616 7777

Child Health Information Centre, Royal Children's Hospital Tel. (03) 9345 6429

Association for Children with a Disability Tel. (03) 9500 1232 or Freecall 1800 654 013

Things to remember

Oppositional defiant disorder (ODD) is a childhood behavioural problem characterised by constant disobedience and hostility.

The quality of parenting seems to be an important factor in the development of ODD.

Treatment options include parent management training and family therapy.