Oppositional Defiant Disorder

What is ODD?

It is common for children to defy adults sometimes. For example, they may argue, refuse to do what they are told or talk back.

If your child has negative, hostile and defiant behavior that lasts more than 6 months and is worse than typical for their age, they may have oppositional defiant disorder (ODD). ODD is a behavior disorder that often happens along with other disorders, such as attention disorder, learning problems, conduct disorders, anxiety and mood disorders.

ODD is fairly common in children and teens. This and other behavior problems are the most common reason children are referred to mental health care.

About 1 in 6 children and teens are struggling with ODD at any time. It may start in early childhood and then improve or go away, or it may begin as a child gets older. Boys are more likely than girls to have ODD.

ODD at Seattle Children’s

Seattle Children’s Psychiatry and Behavioral Medicine providers specialize in evaluating children who might have ODD or a related disorder. Then we develop a treatment plan to fit your child’s needs. We work with you to get support and care to help your child succeed at home, at school and in the community.

  • The experts you need are here
    • At Seattle Children’s, your child is cared for by a team that includes psychiatrists, psychologists, advanced registered nurse practitioners, pediatricians and mental health therapists, plus trainees from many areas of healthcare.
    • We start with a consultation or evaluation to get a complete picture of your child’s behavior and challenges, and then we talk with you about recommendations and next steps. Based on your child’s age, this visit could be with our Early Childhood Clinic or Behavior and Attention Management Program.
    • Our team offers evidence-based treatments. Treatments include a range of options, like parenting groups through the Behavior and Attention Management Program to teach you skills for dealing with your child’s behavior, medicines for attention or mood disorders and referrals to other Seattle Children’s clinics and community resources.
  • Care from birth through young adulthood
    • Everyone on our team is specially trained to understand and meet the specific needs of children and teens. Our pediatric experts tailor care to your child’s age and developmental stage.
    • The Early Childhood Clinic sees children age 4 or younger who have behavior issues, anxiety, sleep problems, neurodevelopmental problems or prenatal (before birth) exposure to alcohol or drugs. We also see children who have other medical conditions along with a behavior or emotional problem.
    • The Behavior and Attention Management Program sees children and teens ages 5 to 15 with disruptive behavior or attention problems, like ODD, and their families. We offer consultation and diagnostic evaluations. We also offer classes, group training for caregivers, groups for caregivers and children or teens together, Disruptive Behavior Crisis Clinic and 1-on-1 therapy for caregivers of children with the most serious defiant or aggressive behavior.
  • Resources for your child and family

What are the symptoms of ODD?

The signs and symptoms of ODD in children and teens include frequent:

  • Loss of temper
  • Arguing with adults
  • Refusing to do what adults ask or to follow rules
  • Annoying other people on purpose
  • Blaming others for their own mistakes
  • Being touchy or easily annoyed by others
  • Anger and resentment
  • Spitefulness or vindictiveness (being unkind or mean)

ODD can cause social, academic and family problems. Your child’s ODD will likely improve over time, but it does put them at greater risk for more serious behaviors or disorders. Due to the long-term risks, you are right to take ODD seriously and seek treatment.

What causes ODD?

Healthcare providers believe ODD develops from a mix of biological, psychological and environmental factors, including:

  • The nature or temperament your child was born with
  • A child learning and testing out ways to get their needs met or influence adults
  • Difficulty processing and coping with feelings
  • Discipline that varies over time or is overly harsh or overly lax
  • Abuse, neglect or exposure to violence or trauma

Family stress can worsen ODD symptoms.

How is ODD diagnosed?

A healthcare provider may diagnose ODD after an evaluation that includes talking with you and your child about your child’s thoughts, feelings and behavior.

Often, it’s helpful to check for other problems that may go along with challenging or defiant behavior, such as attention deficit hyperactivity disorder (ADHD) or reading disabilities.

How is ODD treated?

Children with ODD often benefit when their parents and teachers get training in how to shape a child’s behavior (behavior modification).

Because ODD often happens along with other disorders, it is important to have a complete evaluation and make a treatment plan to care for your whole child. Medicine may help treat related disorders, such as attention or mood disorders. It is often helpful to work with your child’s school on any learning difficulties and peer problems.

Is treatment helpful for ODD?

Teaching parents how to use effective discipline strategies can greatly reduce behavior problems in children.

Medicines may be helpful for treating your child’s ODD symptoms if they also have ADHD.

What should I do if I think my child has ODD?

If you’re concerned about your child’s behavior, talk to your child’s primary care provider about first steps. Treatment is more effective with younger children.

How to Get Services

We often have more requests from new patients than we have openings. To make an appointment for the Early Childhood Clinic or the Behavior and Attention Management Program, you need a referral from your child’s primary care provider. Learn more about how to get mental health services at Seattle Children’s.

If you have a referral, call 206-987-2164.

Providers, see how to refer a patient.

Related Links

In crisis?

If you, your child, family or friend needs help right away, call or text 988. Chat is another option. The 988 Suicide & Crisis Lifeline provides free and confidential support for people in distress, as well as prevention and crisis resources. The Lifeline is available 24 hours a day, 7 days a week in the United States.

Hotlines for Youth (PDF) provides other options for immediate help for children and teens. (Also available in Amharic, Arabic, Russian, Simplified Chinese, Somali, Spanish, Ukrainian and Vietnamese.)