What is conduct disorder and oppositional defiant disorder (ODD)?

Many children and young people behave in a difficult or aggressive way from time to time. However, for some young people these behaviours can lead to problems at home, school or in the wider community.

Oppositional defiant disorder (ODD) and conduct disorder are not ‘character flaws’ and do not mean that children and young people with these diagnoses are ‘bad’ or ‘nasty’. Instead, ODD and conduct disorder are best thought of as mental health conditions where children and young people can be supported to improve their difficulties with behaviour.

What is oppositional defiant disorder?

Children with oppositional defiant disorder (ODD) often have difficulties with following rules and behave in a way that upsets other people. While many children and young people will behave like this sometimes, these behaviours are a lot more common for children with ODD compared to other children their age. Often, children with ODD might behave in a way that is challenging or argumentative and might have difficulties with anger and irritability. Sometimes these behaviours might only cause problems in specific places (e.g. at school), but other children with ODD might have these difficulties all the time.

ODD is usually first noticed in young children, although these difficulties often improve over time. For some children with ODD, their behaviour difficulties can persist into their teenage and adult years, with about 1 in 3 children with ODD later being diagnosed with conduct disorder.

What is conduct disorder?

Conduct disorder describes a pattern of more severe rule-breaking than ODD and can include problems with violence, stealing, vandalism, misuse of drugs or alcohol and lying. Children and young people who live in families where there is a lot of conflict or who have experienced abuse or neglect are more likely to be diagnosed with ODD and conduct disorder. Children with ODD or conduct disorder are also more likely to experience other difficulties, such as ADHD, learning difficulties (such as dyslexia) and emotional difficulties (such as depression).

Getting help

It will usually be your parents or carers who decide to ask for help because they are struggling to help you with your behaviour on their own. Sometimes your school might raise concerns about your behaviour and recommend that you and your parents or carers ask for some extra support. You might also decide that you want help with your behaviour, for example if it’s having an impact on your school work, you’re struggling with drugs or alcohol or you’re also experiencing emotional difficulties.

If conduct disorder has led to you to getting into trouble with the police then a Youth Offending Team might offer to support you and your family with your behaviour. Your parents or carers can also contact the youth offending team directly if they are worried that your behaviour might put you at risk of being in trouble with the police in the future.

Parenting support is widely available for parents or carers of children and young people who already have or are at risk of being diagnosed with ODD or conduct disorder. Parenting support involves your parents or carers attending classes and is often called ‘parent training’. Your parents or carers will usually be able to refer themselves for this kind of support, but you should also be able to ask for help through your school, local Family Hub, GP or social care service.

If you may also have other difficulties such as ADHD, a learning disability, autism, depression, substance misuse or alcohol misuse then you should be referred to child and adolescent mental health services (CAMHS). Sometimes you might be able to refer yourself, but your GP or school should also be able to help with a referral.

You can find more information about mental health referrals here and more information about local mental health services here.

What kind of support could I be offered?

Before starting treatment you should have an assessment to check whether you might be experiencing any other conditions as well as ODD or conduct disorder. For example, your professional might think about whether you could be experiencing:

  • learning difficulties
  • autism
  • ADHD
  • emotional problems
  • any difficulties at home, including abuse

Your assessment should also look at broader things that you might need to support your behaviour and the things your family might need to help them support you.

If you are having problems at school (especially if your behaviour difficulties only happen at school) then your school should look at whether you need any extra learning support. Your school may also have a behaviour support team who can help your teachers to support you and might ask to talk to your parents or carers.

Your support options will usually aim to improve your communication and behaviour, with some treatments seeing conduct problems as a form of communication that needs to be understood. As well as communication, interpersonal and social skills are an important part of most treatments to help you get along better with other people and deal with conflict in a less harmful way. For example, treatments could help you to think differently about solving problems so that you are better at managing tricky impulses like anger. They can also help with your family relationships to help you feel more supported at home. This type of support with relationships can help everyone in the family learn more about emotions and behaviour, which can help with communication.

Parent training will usually be recommended as a first step if your behaviour problems are mild or moderate and you do not have another mental health problem. If you have ADHD as well as ODD then parent training will still usually be suggested as a first step, or could be suggested alongside another treatment if you are experiencing another mental health condition as well as behaviour difficulties. Usually parent training involves group sessions, but your parents or carers could be offered individual or online sessions.

You could be referred to Child and Adolescent Mental Health Services (CAMHS) for a different type of support if:

  • you need more support after the parent training
  • your behaviour problems are severe
  • you have another mental health condition (as well as your behavioural difficulties).

The kind of support you are offered at CAMHS will depend on your age, whether you have any other mental health conditions and what help you and your family have tried before. Your professional should also listen to your preferences and your family’s views. Types of support offered by CAMHS include the following:

  • Individual parenting support for your parents or carers, which might also involve sessions with you.
  • Individual CBT or problem solving approaches if you are aged between 9 and 14. This option would usually involve some sessions with your parents or carers.
  • Family therapy, a specific type called Functional Family Therapy can be helpful for teenagers.
  • Intensive multi-component interventions which involve sessions with your parents, individual sessions with you, working with your school or college and helping with problems in your everyday life. The most commonly used multi-component intervention is called multi-systemic therapy.

If you have problems with severely aggressive behaviour and explosive anger which has not been helped by psychological treatments (e.g., CBT or family therapy), then you might be offered a medication called risperidone. Medication should not be used to treat more general behaviour problems, but if you also have ADHD then you might be offered medication specifically to help with your ADHD.

You can find more information about how treatment decisions are made here.

What about my parents or carers?

The most helpful treatments for ODD and conduct disorder include working with your parents or carers, so they will usually be involved in your treatment. This doesn’t mean that your parents or carers will know everything that happens in your individual sessions, you can find more information about confidentiality and privacy here.

The wellbeing of your parents or carers is important and they may need support and advice themselves. Your professional should offer support to your parents or carers, including:

  • an assessment of their needs for personal, social and emotional support
  • support in their role as a parent
  • emergency planning
  • practical advice on issues such as childcare, housing and finances
  • help with accessing this support.
Transitions between services

If you still have problems related to ODD or conduct disorder as you approach adulthood then any services you are in contact with should be able to advise you on where and how to seek help. For example, if your conduct disorder has led to involvement with the criminal justice system then your Youth Offending Team should arrange your transition to services for adults (if these services would still help).

If you have another mental health condition alongside your ODD or conduct disorder such as ADHD, substance misuse or depression and you want to continue treatment as an adult, then your care should be transferred to services for adults when you reach age 18.

You may also transition to another CAMHS service (e.g. if you move house). If this happens, your professional should work with you to make sure that your support can continue smoothly and that your new service has all the information they need.

For more information about transitioning between services, please see Moving on.

Additional support

The below organisations offer conduct disorder and ODD specific support for children, young people and their families:

  • AFC Crisis Messenger: a free, confidential, 24/7 text message support service for anyone who is feeling overwhelmed or is struggling to cope. If you need support, you text AFC to 85258
  • Childline: Childline is there to help anyone under 19 in the UK with any issue they’re going through. Whether it’s something big or small, their trained counsellors are there to support you
  • Supportline: charity offering helpline for people of all ages on a wide range of issues including anger, eating disorders, self-harm, depression, anxiety, panic attacks, and addictions
  • The Mix: support and advice for children and young people under 25
  • YoungMinds: young people’s mental health charity who offer resources to help children, young people and their families with anger

Treatments outlined on these webpages may not be available in every local area. It’s important that you discuss with your GP or mental health professional the treatment options available to you. You can also search for services near you on our Youth Wellbeing Directory and find out more about referral processes here.

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