Oppositional Defiance

Oppositional defiant disorder is defined in the DSM-5 by eight possible symptoms.  Any four of these are needed for the diagnosis.


  1. Loses temper
  2. Argues excessively
  3. Breaks rules
  4. Disobedient
  5. Annoying to others
  6. Blames others for his/her own mistakes
  7. Touchy or easily annoyed
  8. Angry and resentful
  9. Spiteful or vindictive


How to diagnose/assess it?

Diagnoses are made from clinical interviews with caregivers.  Information from teachers and schools is also helpful, whether obtained directly from the school or related through the caregivers.

Information from and observation of youths is also valuable but oppositional behaviors may be completely absent during a brief visit to an office.

Severity is best measured with a standardized checklist that rates each symptom on a Likert-style scale.

A free, public domain checklist is the SNAP, which stands for the Swanson, Nolan, and Pelham checklist.  If the sum of items 21-30 is 18 or greater, this indicates a probable diagnosis of ODD.

What causes it?

Oppositional defiance is one of the most common problems that brings children to clinics but we know relatively little about what causes it compared to other disorders.  Because the behaviors are so often directed at authority figures and parents, it has been theorized that faulty parenting practices are the cause, but this is more folk tale than scientific fact. The causes are likely due largely to genetics just like the majority of other psychiatric disorders.

When to Refer/Seek Help

When the severity of the problems prevent normal functioning at home or school on a frequent basis (i.e., almost daily), it is time to seek help.  If problems have been present for at least one month, these are unlikely to resolve on their own.  Parents tend to wait to seek help until day cares or schools take disciplinary action, and by then the problems have been present typically for months or years.


Milder cases can respond to low-level interventions such as more structured discipline plans implemented by parents when guided by self-help books.  This might be simple and clear plans to target behaviors with rewards.  Wise use of time-outs can also be helpful.

More often, cases require structured interventions with licensed clinicians.  There are multiple evidence-based interventions.  One of the most well-studied, is Parent Child Interaction Therapy (PCIT), best for 2-7 year-old children.  PCIT uses a novel technique of coaching parents in real time with an ear piece.  The Triple P – Positive Parenting Program is another proven intervention. 

There are no medications approved by the FDA for ODD.

Additional Resources

In 2019, Healthy Blue, one of the five Louisiana managed care organizations for Medicaid, funded a training program to increase the number of therapists trained in PCIT.  About 15 therapists began the training in March 2019.  They ought to complete their training by the end of 2019, at which time Healthy Blue will hopefully post a roster of these clinicians.

General information about PCIT can be found at http://www.pcit.org/

General information on Triple P is available at http://www.triplep-america.com/glo-en/home

-Updated July 3, 2019