Oppositional Defiant Disorder

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KEY POINTS

• Oppositional defiant disorder is a pattern of being repeatedly disobedient and hostile for 6 months or more. The problem behaviors happen more and are worse than other children of the same age and sex.
• The best treatment is firm limits with clear rules, consistent results, and immediate rewards for good behavior. Therapy may also be helpful.

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What is oppositional defiant disorder?

Oppositional defiant disorder is a pattern of being repeatedly disobedient and hostile for 6 months or more. The problem behaviors happen more and are worse than other children of the same age and sex.

If a child's behavior has gotten to the point of dangerous anger or violence, destroying property, and stealing and has been this way for a year or more, the problem may be a more serious condition called conduct disorder. Some children with oppositional defiant disorder develop conduct disorder or antisocial personality disorder as they grow up.

What is the cause?

The exact cause of this disorder is not known. It tends to run in families, but it is not known if this is due to being born with the disorder, or if it is due to parenting. The disorder is more common in children with a parent who:

• Has a history of conduct disorder, substance abuse problems, or mood problems such as depression
• Has marriage troubles
• Uses harsh discipline
• Does not set predictable rules or limits for children
• Pays little attention to the children

Children with this disorder may have been fussy or colicky as infants. It is not known if this is in response to, or a result of their parents’ caregiving style. Children are also at greater risk if they have attention deficit/hyperactivity disorder (ADHD), speech and language problems, or a learning disability.

The disorder usually starts by age 8, but it may start as early as the preschool years. In young children, this disorder is more common in boys. In teens, it is equally common in boys and girls.

What are the symptoms?

Symptoms may include:

• Defying rules and authority at home and at school far more than what is usual for children of their age and sex
• Being angry, easily upset, and resentful
• Often trying to annoy adults and peers
• Blaming others for your child’s own mistakes
• Throwing severe temper tantrums and arguing with adults

How is it diagnosed?

Your child's healthcare provider or a mental health therapist will ask about your child's symptoms, medical and family history, and any medicines your child is taking. Your child’s provider will make sure that your child does not have a medical illness or drug or alcohol problem that could cause the symptoms. Your child may have tests or scans to help make a diagnosis.

How is it treated?

The best treatment is firm limits with clear rules, consistent results, and immediate rewards for good behavior. Be calm during discipline. Since children with this disorder seek to annoy, if you get angry and yell, it may increase how often they misbehave. Severe punishments may make your child’s behavior worse.

Therapy may also be helpful.

• Cognitive behavior therapy (CBT) is a good way to help your child identify and change views your child has of self, the world, and the future. CBT can make your child aware of unhealthy ways of thinking. It can also help your child learn new thought and behavior patterns even after your child stops going to therapy. It can help your child learn to manage stress and improve self-esteem.
• Social skills training to increase mental awareness, self-esteem, and confidence, and help your child make more friends.
• Behavior therapy helps your child recognize that the way your child acts affects others. This can help your child change problem behaviors.
• Family therapy is often helpful. Family therapy treats all members of the family rather than working with just your child. It helps the whole family to make changes.
• Parenting skills training to help with communication, stress, and other problems.

Medicines are not usually prescribed to treat this disorder.

What can I do to help my child?

• Be consistent. Set clear rules and tell your child what you expect. Notice your child's efforts to behave and reward good behaviors. Do not use anger or yell when you discipline your child.
• Help your child learn to manage stress. Teach children and teens to practice deep breathing or other relaxation techniques when feeling stressed. Help your child find ways to relax, for example take up a hobby, listen to music, watch movies, or take walks. Help your child learn to handle conflicts and cooperate with others.
• Take care of your child’s health. Make sure your child eats a variety of healthy foods and gets enough sleep and physical every day. Teach children and teens to avoid alcohol, caffeine, nicotine, and drugs.
• Contact your child’s healthcare provider or therapist if you have any questions or your child’s symptoms seem to be getting worse.

Get emergency care if your child has thoughts of suicide or self-harm, violence, or harming others.

For more information, contact:

• National Alliance on Mental Illness (NAMI)
  800-950-6264
  https://www.nami.org
• Mental Health America
  800-969-6642
  https://www.mhanational.org