Oppositional defiant disorder

Assessment and diagnosis of ODD are performed by a specialist health professional, such as a paediatrician, child psychologist or child psychiatrist. Your general practitioner can make an initial assessment, however, they will usually refer your child for further assessment if they suspect ODD.

For a child to be diagnosed with ODD, symptoms and behaviours need to occur on a long-term basis (a minimum of six months). They must also behave in this way with at least one person who is not a sibling, although some children will only display these behaviours at home.

Assessment for ODD is complex and can include:

• A medical examination to rule out any underlying medical conditions;
• A mental health assessment;
• A developmental assessment to understand your child's overall development compared to milestones expected for their age;
• Assessment of your child's situation and needs including family, culture and education, and;
• Assessment of your child's behaviour.

In order for this assessment to be comprehensive, your specialist may ask to talk to other family members and teachers about your child's behaviour. They may also ask to review information, such as school reports, or for your child to be observed at home or school.

In Australia, guidelines and approaches to diagnosing ODD are evolving. Particularly with children who have mild symptoms, there can be different approaches to diagnosing the condition. If you have any concerns or questions about how ODD is diagnosed or your child's diagnosis, you can discuss them with your specialist.

Diagnosis of adults

As with children, while a general practitioner can make an initial assessment, most adults will be referred to a specialist, usually a psychiatrist, for a full assessment and diagnosis.

A full medical assessment helps to determine whether there are any underlying medical conditions that may be contributing to your symptoms. Your specialist will ask you about your symptoms and may also ask to speak with your partner or other family members.

ODD is only diagnosed if the symptoms create a serious disruption to your life.

Types of treatment

ODD cannot be cured, but the goal of treatment is to:

• Reduce and manage disruptive behaviours so that they have less impact on the child's wellbeing and development, and;
• Support parents, carers and other family members.

It is helpful for children with ODD if everyone who cares for them (for example, teachers, child-care workers, grandparents and other family members, as well as parents or primary carers) are consistent in the way they deal with them. So, a management plan for ODD may involve family, school and other people who care for the child.

Family education and support

It can be very challenging to care for a child with ODD. Disruptive behaviours can cause stress for parents and other family members.

The main form of management for ODD is to help parents and carers understand ODD and learn techniques to reduce and better manage disruptive behaviour. Information and counselling are available. Support groups with other families of children with ODD may also help.

Psychological management

Family counselling that helps family members communicate and solve problems more effectively may be helpful.

Counselling can help with understanding and managing oppositional defiant disorder. 

Medication

There are currently no medications recommended for the treatment of ODD. However, many children with ODD are also diagnosed with attention deficit hyperactivity disorder (ADHD). Medications for ADHD, such as methylphenidate and dexamphetamine sulphate, may help to improve behaviour in children who have both disorders.

Treatment of adults

Following diagnosis, you can discuss options with your specialist for psychological management of your symptoms.

Potential complications

ODD and other developmental and mental disorders

There is a wide range of behaviour and mental health disorders that can cause similar symptoms to ODD. Part of the assessment procedure is to identify the pattern of symptoms and provide an accurate diagnosis, so that the most effective management can be recommended.

In some cases, a person with ODD may also be diagnosed with another disorder:

• Children with ODD are frequently also diagnosed with attention deficit hyperactivity disorder (ADHD);
• Both children and adults with ODD are at increased risk of anxiety and depression, and;
• Adults and adolescents with ODD are at increased risk of substance abuse.

Conduct disorder

Conduct disorder is a more severe behaviour disorder than ODD. Conduct disorder involves a persistent pattern of behaviour that includes:

• Bullying, threatening and committing violence against people or animals;
• Deliberately destroying property;
• Theft, lying to or deceiving others, and;
• Disobeying essential rules (such as school attendance or night curfews).

Children with ODD can go on to develop conduct disorder.

Prognosis

Early intervention and management involving both the family and the child has been shown to help prevent the development of more serious behaviour disorders and mental health issues. ODD is a relatively new diagnosis, so research into therapies and ways to manage the condition are ongoing.

Prevention

Dealing with family difficulties and developing positive parenting practices may help to reduce a child's risk of developing ODD.