OPPOSITIONAL DEFIANT DISORDER-understanding and treating

Oppositional Defiant Disorder Basics*

Children with oppositional defiant disorder (ODD) display extreme resistance to authority, conflict with parents, outbursts of temper and spitefulness with those close to them such as family and/ or those perceived and stationary helping persons. In other words, persons with whom they are sure that the display of outbursts will not have long lasting consequences. There may be a fear of peers (who can shame the ODD child) or those seen as having more power such as teachers, school authorities, etc.


ODD: What Is It?

Oppositional defiant disorder (ODD) is a persistent behavioral pattern of angry or irritable mood; argumentative, defiant behavior towards authority figures; and vindictiveness. In some children with ODD, these behaviors are only in evidence in one setting—usually at home. In more severe cases they occur in multiple settings. For a diagnosis of ODD, the frequency and intensity of these behaviors must be outside the typical range for a child’s developmental level, gender and culture.

ODD: Diagnosis

To distinguish symptoms of ODD from normal childhood or adolescent rebellion, professionals depend on a detailed history of behaviors in various situations. For children younger then 5, the behaviors should occur on most days for at least 6 months; for those who are 5 or older, they should occur once a week for 6 months. Since children with ODD may show symptoms only in one setting—usually at home—and are more likely to be defiant in interactions with adults and peers they know well, the symptoms may not be in evidence in the clinician’s office.

ODD: Risk For Other Disorders

ODD is often diagnosed alongside ADHD. Children with ODD often have co-occurring mood disorders like depression, anxiety disorders, or learning or communication disorders. Professionals warn that ODD that goes untreated early in life is often linked to more severe disorders later, including conduct disorder and substance use disorder.

ODD: Treatment

ODD is treatable, usually with behavioral therapy or a combination of behavioral intervention and medication. Behavioral therapy must be employed consistently and across all environments: home, school, community.

Psychotherapeutic: A popular evidence-based treatment is a type of behavior therapy called parent-child interaction therapy. The parent and child work together through a set of exercises while a therapist coaches parents through an ear bud. Parents learn to increase positive interactions with the child and to set consistent consequences for undesirable behavior. Children learn to rein in behavior and enjoy a more supportive relationship with parents.

Pharmacological: Medicines are not specifically indicated for ODD. However, as many children with ODD have co-occurring conditions such as ADHD, they may be on medications for those other disorders. In addition, some children are so troubled by their own aggression, and their difficulties managing their painfully low frustration tolerance, that a clinician may recommend medication—to help them control those responses and benefit more from behavioral therapy.



  • Diffuse: do not try to address everything at once pick one issue and combine it with something that is easier to do
  • Distract: Put issue/task aside and go onto something familiar
  • De-escalate: limit talking do not get “sucked into fighting/answering” when child is in an aggravated state. “Do this (familiar and or pleasant activity) I will be back” think of it as “hit and run”. DO NOT try to coax child out of rage. DO NOT try to negotiate, offer rewards, etc.

Teach coping skills when child is calm. Learn “triggers” and prepare child that we are going to practice coping with those triggers when they “don’t matter”, i.e. base calm.


REFERRAL Suggestion:

Dr. Michelle L. Green, PhD

Address18 Lenox Pointe NE # B, Atlanta, GA 30324

Phone(404) 840-4403


*Sources: Child Mind Institute

Scott. D. Walls, MA, LIPC, CCMHC—PSEI Institute

Compiled by: Susan N. Schriber Orloff, OTR/L, FAOTA

Children’s Special Services, LLC, ATL., GA