We’ve all likely seen a child acting out in public while an adult spouts orders that go unheeded. It’s easy to write it off as normal child behavior, but what if there’s more to it? What if these acts of defiance are more than the norm?

A child’s excessive anger can be a sign that there’s an underlying problem pointing to oppositional defiant disorder.

Here, we’ll help you understand factors associated with ODD and how to get help for a child who struggles with defiant moods and behaviors.

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Since the roots of ODD first appeared in the second edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1968, and the first ODD diagnosis appeared in the manual in 1980, diagnostic criteria has evolved greatly.

Today, The American Academy of Child and Adolescent Psychiatry estimates that 1 percent to 16 percent of school-age children and adolescents have ODD. Though, some clinicians question or reject the diagnosis as a stigmatizing label that doesn’t address underlying causes of a child’s behavior (i.e., trauma).

So what causes ODD or its associated symptoms? There’s not a clear consensus.

Theories suggest a combination of physical, psychological, and social factors contribute to its development. It’s more common in families with a history of mood disorders, attention deficit hyperactivity disorder (ADHD), or substance use. Also, ODD is diagnosed most often in adolescent boys.

Other factors associated with ODD are:

  • differences in the part of the brain that uses reason, judgment, and controls impulses
  • trouble interpreting social cues
  • lack of structure at home
  • the presence of abuse
  • exposure to violence

“Anger externalized as avoidant behavior, which tend to get labeled as ODD, is a product of a child’s struggle to emotionally regulate while their nervous system is overwhelmed,” said Emily W. King, PhD, Child, Adolescent, and Family Psychologist.

“In this state, children go into fight or flight (in this context, fight) to defend themselves from a perceived threat. The perceived threat is specific to each child based on their experiences thus far in life.”

Behaviors associated with ODD usually begin before a child is 8 years old (and definitely before age 12). Children diagnosed with ODD might behave in these ways:

  • often losing their temper
  • arguing with adults over just about everything
  • showing resentment or spite
  • doing things to intentionally annoy others
  • blaming others when they get into trouble

A diagnosis of ODD means that the following symptoms are present for at least 6 months, are more frequent or severe than typical child behavior, and cause significant problems for the child:

  • defiance toward adults
  • anger
  • vengefulness
  • annoyance
  • trouble maintaining friendships
  • in trouble at school

Symptoms in adults who have been diagnosed with ODD are very similar to those in children, and overlap with other disorders like antisocial personality (aka sociopathy).

Symptoms of ODD often overlap with those found in other mental disorders, and could easily coexist with or mimic them.

ODD is also often associated with a diagnosis of conduct disorder.

“In my training 20 years ago, we were taught that ODD was a precursor to conduct disorder,” King said. “However, currently, pediatric mental health experts think of ODD as a diagnostic label for what is actually a trauma response in a young child.

“In addition to trauma being the underlying cause of behaviors presenting as oppositional or defiant, children with ADHD and Autism Spectrum Disorders (ASD) can be quite resistant to compliance of demands. But this is not a ‘disorder,’ it’s a stress response to demands being placed on them that are higher than their ability to cope with such demands.”

King sees an ODD diagnosis as a label that hints at trauma or stress that has impacted a child’s ability to cope with emotions.

“Many children with ADHD, ASD, and trauma histories may also get labeled as ODD because they impulsively respond to high emotion,” she says. “[This] appears oppositional but truly, it’s a stress response paired with a child’s inability to remain emotionally regulated while communicating their needs due to developmental weaknesses in impulse control or emotional regulation.

“Whenever I see a child with an ODD diagnosis, I think, ‘What has happened to this child that is causing such a high level of anxiety that they are not able to remain emotionally regulated and communicate their stress?’”

The first step in getting help for a child with ODD symptoms is to talk with their doctor about it. You may be referred to a mental health professional for more evaluation.

Two types of therapy are used to treat ODD:

  1. Individual therapy. To help the child develop problem-solving and coping skills.
  2. Family therapy. To help parents develop skills for managing their child’s behavior. Medication may also be prescribed.

“Since ODD is actually just a high level of stress and anxiety presenting as externalizing behavior, providers need to understand the origin of the anxiety,” noted King. “Many children benefit from medically treating their anxiety, but that alone is not the answer. We also need to look at a child’s history of relationships in their life thus far.

“Children learn to process emotions in the context of their relationships with caregivers. If they have not felt safe in their relationship with caregivers, children benefit from play therapy with a safe caregiver and a therapist to promote a healthy connection, which will then support the child during times of emotional dysregulation.”

Excessive anger and misbehavior in children could be a sign of a larger problem. A diagnosis of oppositional defiant disorder may be made if a child’s moods and behavior are outside the range of “normal” for at least 6 months and is causing them significant social and school-related problems.

An ODD diagnosis could be a clue to underlying trauma that makes the child unable to regulate their emotions. A doctor and therapist can help families get the best treatment for the child’s mental health.