Oppositional Defiant Disorder (ODD) versus Bipolar Disorder
Oppositional defiant disorder (ODD) is not just typical childhood rebellion. All children are oppositional at times; it’s part of growing up and developing independence and personality. For most kids, rebellious behaviors respond fairly well to the usual carrot-and-stick parenting techniques, but oppositional kids exhibit a much more tenacious defiance.
Parents describe the child as being stubborn, strong-willed, or simply a pain in the neck. When this pattern creates significant problems in function — at school, at home, with friends, or during activities — a doctor or therapist may suggest a diagnosis of oppositional defiant disorder (ODD), which is described in the DSM-5 as:
A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months . . . and is not exclusively directed at siblings.
ODD’s irritable mood and behavioral difficulties — not doing as one’s told — can overlap with mania. Although this is often a confusing area, the child with ODD demonstrates these symptoms chronically and not episodically. Furthermore, ODD doesn’t include other manic symptoms such as energy changes and grandiosity as we describe in the previous section on ADHD.
ODD is a problematic diagnosis in many regards, because its core symptoms are nonspecific. Irritable mood and defiant behavior can be associated with a wide range of developmental and psychiatric conditions. Your child needs a careful medical and psychiatric evaluation to help understand the mechanisms underlying these difficult symptoms. Bipolar disorder/mania is one possible explanation, but others can include unipolar depression, ADHD, language disorders, autism spectrum disorder, and trauma, among others.