ODD in Teens: Signs, Diagnosis & Available Treatment

What Is Oppositional Defiant Disorder (ODD)?

Oppositional Defiant Disorder (ODD) is a disruptive behavior disorder in childhood that deals mainly with the self-control of emotions and behaviors of children and teenagers.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for ODD focus on the consistent pattern of irritable or angry mood, or argumentative or defiant conduct, or spiteful (vengeful) behavior toward others.

Between 2% to 16% of children and teens have ODD. In younger children, this disorder is more common in boys. In teens, it happens about equally in boys and in girls. Symptoms generally emerge in the preschool years and are often diagnosed by early adolescence.

What Causes ODD in Teenagers?

It is difficult to identify a single cause for ODD. Many factors contribute to its development and the causes often interact across genetic, biological, environmental and psychosocial domains.

Genetic factors:

Genetic factors appear to play a role in the development of ODD in approximately 50% of cases. Many young people with ODD have mental health disorders in first degree relatives.

As well, many children and teens with ODD also have other mental health conditions, such as ADHD, learning differences, or depression and anxiety disorder. This suggests a genetic link between the conditions.

Biological factors:

Some research suggests that changes in particular brain regions can lead to behavior disorders, particularly related to emotion regulation and impulse control.

ODD has also been linked to issues concerning particular neurotransmitters that facilitate communication among nerve cells in the brain.

Environmental/Psychosocial factors:

Psychological and environmental events, such as chaotic family environment, child abuse and neglect, and inconsistent parenting, may also play a role in the development of ODD.

Furthermore, conditions such as peer exclusion, participation in delinquent peer circles, financial hardships, community violence, and other unsteady social or economic situations can also contribute to the development of ODD.

How Does ODD Affect Teens and Parents?

Oppositional and defiant behaviors are frequent and ongoing. They cause considerable problems in relationships, social activities, school endeavors, and work, affecting both the child and the family.

Signs linked to emotions and behavior connected to ODD usually last for at least six months.

Children and teens with ODD have an angry and irritable mood, argumentative and defiant behavior, and hurtful and revengeful behavior. Children with ODD may struggle academically, have difficulty maintaining friendships, and be at higher risk for other mental health issues such as ADHD, anxiety and depression.

Parents often feel overwhelmed by their child’s behavior and aren’t sure how to help them. 

In response to their children with ODD, parents may be pushed to react in extreme ways without meaning to. 

Parents may yell at their child because they are frustrated at the child’s refusal to cooperate. Or a parent might give in to whatever the child wants because they want them to stop throwing a tantrum.

Such reactions can reinforce the child’s behavior over time with the child learning that yelling is okay and that tantrums get them what they want. 

Signs of ODD in a Teenager

The main signs of ODD are:

Angry and irritable mood

• Often and easily loses temper
• Is frequently touchy and easily annoyed by others
• Have frequent outbursts of anger and resentment
• Be frequently angry and/or disrespectful

Argumentative and defiant behavior

• Excessively argues with adults or people in authority
• Often actively defies or refuses to follow adults’ requests or rules
• Deliberately try to annoy or upset others
• Often blames others for their own mistakes or misbehavior

Hurtful and revengeful behavior

• Says mean and hateful things when upset
• Tries to hurt the feelings of others and seeks revenge, also called being vindictive
• Being spiteful and seeking revenge.at least twice in the past six months

Oppositional Defiant Disorder Treatment for Teens

Treatment for ODD varies based on many factors, including:

• Your teen’s age
• The severity of their symptoms
• Your teen’s ability to take part in and tolerate specific therapies
• If your teen has other conditions, such as ADHD, learning differences and/or OCD

Treatment of ODD should involve your child, your family and their school.

Treatment usually consists of a combination of the following:

Parent Management Training Programs

The first priority is to improve the parent-child relationship as such parents play a major role in treatment.

Parent management therapy (PMT) is the main treatment for oppositional behaviors. It teaches parents ways to change their child’s behavior in the home by using positive reinforcement to decrease unwanted behaviors and promote healthy behaviors.

There are different types of training programs, which usually involve multiple sessions over several weeks. During the sessions, parents learn to identify problem behaviors, as well as positive interactions, and to apply punishment or reinforcement as appropriate.

PMT has been shown to decrease conduct problems in multiple contexts and family backgrounds significantly. It models how to:

• Set clear expectations 
• Use effective praise when kids meet expectations 
• Use effective consequences when they don’t 

Such techniques can teach children how to manage their emotions and improve their behavior.  

Parent training programs might include sessions with parents and children working together, or just parents alone. Some different programs include: 

• Parent-Child Interaction Therapy (PCIT) 
• Parent Management Training (PMT) 
• Defiant Teens 
• Positive Parenting Program (Triple P) 
• The Incredible Years 

Social Skills Training for Teens

Some children might also benefit from social skills training to improve their peer relationships.

Psychotherapy 

• Cognitive Behavioral Therapy (CBT): This is a structured, goal-oriented individual type of therapy that helps your teen take a close look at their thoughts and emotions. Your child will come to understand how their thoughts affect their actions.
• Family-Focused Therapy: This therapy is for teens with ODD and their caregivers. During this treatment, your teen and family will join together in therapy sessions of psychoeducation regarding ODD, communication improvement and problem-solving skills. It can help identify factors in your home life that may contribute to or worsen aggressive behaviors
• Dialectical Behavior Therapy (DBT): If your teen is struggling with extreme emotions 

School-based Interventions.

• Involving the teacher, parents and child
• Supportive interventions to improve school performance, peer relationships and problem-solving skills are very useful in the treatment of ODD
• Education and tools for your child’s teacher(s) to improve classroom behavior
• Techniques to prevent oppositional behavior or the worsening of such behavior
• Other methods that help your child follow classroom rules and acceptable social interactions

Medications

There is no FDA-approved medication for ODD. However, medication is sometimes used along with therapy. These include: 

• Antipsychotic medications, if a child is at risk of being removed from school or the home 
• Stimulant medications, if a child also has ADHD or is struggling with impulsivity 
• Antidepressant medications, if a child also has depression or anxiety 

Prevention

Although it might not be possible to prevent oppositional defiant disorder, recognizing and acting on symptoms when they first appear can minimize distress to your child and family. It can also help prevent many of the problems associated with the disorder. Family members can learn steps to take if signs and symptoms return, as well.

In addition, providing a nurturing, supportive and consistent home environment might help reduce symptoms and prevent episodes of defiant behavior.