A degree of opposition to authority is developmentally appropriate in the teen years. This is the age at which young people establish their independence and begin to develop adult identities. In the process, rebellion against authority and defiance of adult rules is to be expected. However, when such typical opposition evolves into a prolonged pattern of excessive rule-breaking and defiance that results in difficulties at school, at home or with peers, the teen may be diagnosed with oppositional defiant disorder.
What Is Oppositional Defiant Disorder?
Oppositional defiant disorder is a behavioral disorder diagnosed in children and teens. Teens with ODD are, as the name suggests, oppositional and defiant toward authority figures, including their parents. According to the American Psychiatric Association, these teens will exhibit behaviors that include often losing their temper, arguing with adults, defying or refusing to comply with rules, purposefully annoying other people and blaming others for their mistakes or misdeeds. In addition, they are often touchy, annoyed, angry, resentful, spiteful or vindictive. To be diagnosed with ODD, these behaviors must have been present for six months and must have caused problems for the teen at school, with peers, at work or at home.
ODD and Other Disorders
Diagnosing and treating ODD can be difficult because, as the American Academy of Child and Adolescent Psychiatry, or AACAP, points out, ODD often co-occurs with other mental disorders. It is especially common among teens with attention-deficit hyperactivity disorder, or ADHD. It also commonly co-occurs with obsessive compulsive disorder and mood disorders such a major depression, anxiety disorder and bipolar disorder. According to the Substance Abuse and Mental Health Services Administration, or SAMHSA, teens with ODD may go on to develop a similar behavioral disorder known as conduct disorder, which is characterized by actively aggressive, destructive and illegal acts. However, teens cannot carry a diagnosis of ODD and conduct disorder at the same time.
The cause of ODD is not known. According to the AACAP, the disorder may originate in combative parent-child behavioral patterns established early in childhood. S. Sutton Hamilton, M.D., and John Armando, L.C.S.W., writing in the American Family Physician journal, suggest that the disorder may result from a cognitive deficit that causes the teen to become overwhelmed and react emotionally to simple requests and demands from authority figures.
Parent Training Programs
Among the primary treatments for ODD are parent training programs. As described by the AACAP, these classes provide parents with practical advice and techniques for managing their defiant teens. “Parents are taught negotiating skills, techniques of positive reinforcement, and other means of reducing the power struggles and establishing more effective and consistent discipline.”
Various types of therapy are also effective at helping teens with ODD and their families, the AACAP reports. In individual psychotherapy, the therapist can help the teen explore his feelings and develop anger management strategies. Cognitive-behavioral therapy techniques can help teens develop problem-solving skills in order to effectively handle situations that may otherwise overwhelm them. In family therapy, the therapist can involve the whole family at once in order to address dysfunctional family dynamics and improve intrafamily communication.
Medications are only used in teens with OCD who have co-occurring mental disorders such as ADHD, obsessive-compulsive disorder or anxiety disorder, Hamilton and Armando report. Several studies have shown that patients with both ODD and ADHD who are treated with ADHD medications such as Ritalin, Adderall or Strattera experience improvement in their symptoms of ODD. However, a study led by Mark E. Bangs, M.D., and published in the journal Pediatrics in 2008, reported that one such drug, Strattera, had no beneficial effects on ODD symptoms.
- “Diagnostic Criteria from DSM-IV”; American Psychiatric Association; 1994
- “American Family Physician”: Oppositional Defiant Disorder
- “Pediatrics”: Atomoxetine for the Treatment of Attention-Deficit/Hyperactivity Disorder and Oppositional Defiant Disorder