Defiant behavior is a hallmark of both oppositional defiant disorder (ODD) and pathological demand avoidance (PDA), but the two conditions differ in causes, characteristics, and co-occurring conditions.
People with ODD are hostile toward authority figures like parents and teachers, while PDA behaviors are driven by anxiety related to everyday demands and routines.
Managing ODD or PDA often requires an individualized approach to care, including close collaboration from family, mental health professionals, and teachers.
Oppositional defiant disorder (ODD) and pathological demand avoidance (PDA) are both conditions that involve frequent defiance and challenges with emotional regulation. The key difference is that ODD often shows up as anger and hostility toward authority figures, while PDA is driven more by anxiety and a strong need to stay in control.
Recognizing the signs and risk factors of each can help caregivers seek the right support and treatment.
Understanding ODD
(ODD) causes kids and teens to often challenge or disrespect authority figures like parents, teachers, and other adults. It’s usually diagnosed in childhood but can continue into adulthood without treatment.
Common signs of ODD include:
Being unusually angry, irritable, or vindictive
Throwing frequent temper tantrums
Arguing excessively with adults
Refusing to follow rules
Deliberately annoying or upsetting people
Blaming others for their own mistakes or misbehaviors
The care you need, when you need it
Learn how Rula can support your mental health journey
Understanding PDA
While oppositional defiant disorder (ODD) involves choosing to disobey authority, pathological demand avoidance (PDA) is driven by anxiety and a strong need for independence. People with PDA strongly resist everyday demands, like getting dressed or following routines. This can cause fear and frustration in children and feel exhausting or overwhelming for adults.
Other common signs of PDA include:
Having a strong need for control over their environment
Engaging in compulsive behavior, often focused on other people
Being prone to mood swings and impulsivity
Resisting or avoiding activities of daily living
Using social strategies to avoid demands
Having trouble understanding social cues
Key differences between ODD and PDA
ODD is recognized as an official mental health diagnosis. PDA is not an official diagnosis but is a set of traits and behaviors that’s often considered part of the autism spectrum profile.
A few other key differences between ODD and PDD include:
Motive: ODD involves deliberate attempts to annoy or defy other people, while PDA stems from an intense desire for personal control.
Frequency of symptoms: ODD is often limited to specific people or places, like at home or at school, while PDA is typically all encompassing and pervasive.
Duration of symptoms: Some children will outgrow ODD with access to early intervention and treatment, but PDA is considered a lifelong condition.
Co-existing conditions: People with ODD often meet criteria for mood disorders, anxiety disorders, impulse control disorders, and substance use disorders. PDA most frequently co-occurs with autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD).
Dig deeper:
Finding the right diagnosis for you or a loved one
ODD and PDA are both defined by demand avoidance, as well as impulsivity, mood swings, and other shared symptoms. Because PDA isn’t an official, diagnosable condition, it’s thought that many people who show signs of PDA never receive treatment for it. In fact, some experts believe that it’s often misdiagnosed as other conditions, including ODD, conduct disorders, and ADHD.
To be diagnosed with ODD, a person must consistently show four or more symptoms of defiance, argumentativeness, anger, irritable mood, or vindictiveness over a six-month period. There’s no official diagnostic criteria for PDA, but the Extreme Demand Avoidance Questionnaire’ (EDA-Q) can help identify traits associated with the condition.
Treatment and support strategies for ODD and PDA
If you think you might have PDA or ODD, it’s important to meet with a mental health professional to better understand your symptoms and how to manage your well-being moving forward. Your exact treatment plan will depend on your age, severity of symptoms, and any co-occurring mental health conditions. For children and teens, treatment typically involves a collaborative effort from caregivers, teachers, and mental health professionals.
When managing ODD, many people benefit from individual therapy, which may include cognitive behavioral therapy (CBT) or some type of family therapy, like parent-child interaction therapy. Treatment typically also includes parent management therapy (PMT) to show parents how to encourage healthy behavior change in their children. Children may also benefit from school-based interventions to improve academic performance, peer relationships, and problem-solving skills.
Talk therapy is also considered a first-choice treatment approach for PDA. The exact technique depends on the person and their therapist but may include cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), or acceptance and commitment therapy (ACT).
Support strategies for caregivers
Caring for someone with ODD or PDA can be challenging at times, but your support can make a meaningful difference. Here are some strategies caregivers can use to create a supportive, understanding environment:
Focus on solutions. Take a proactive and collaborative approach to addressing and solving problems.
Encourage healthy coping mechanisms. Mindfulness, journaling, and other relaxation techniques can help people manage stress, anger, and frustration.
Provide positive feedback. Offer recognition and encouragement when someone demonstrates flexibility, cooperation, or other positive behaviors.
Promote calm whenever possible. Pick your battles to avoid creating additional power struggles or anxiety.
Use flexible language. Avoid non-negotiable words or rigid demands. For example, people with ODD may resist the word “no,” and people with PDA may have difficulty with words like “need,” “will,” or “can’t.”
Support healthy routines. Eating a balanced diet, getting enough sleep, and spending quality time with family and friends can support their mental health.
Build new skills together. Help them practice communication, emotional regulation, and social skills in low-pressure settings so they feel safe learning.
With ODD, defiance often stems from anger and frustration. With PDA, refusal is driven by intense anxiety and fear of losing control — what looks like defiance is really panic in disguise.
Brandy Chalmers, LPC
Clinical reviewer
Find care with Rula
If you or someone in your life is showing defiant attitudes and behaviors, know that balance and peace are possible. Getting an accurate diagnosis is the first step in learning to manage symptoms, improve behaviors, and create a more positive future.
With Rula, you have access to a diverse network of therapists who understand your symptoms and how to help you feel your best. In as little as three minutes, you can find a therapist who takes your insurance and offers the specialized treatment you deserve. And our convenient online appointments means that you can connect with your therapist at a time and place that works for you.
Alex Bachert
Alex Bachert is a freelance copywriter and mental health advocate. Since earning her masters degree in public health, she has focused her career on creating informative content that empowers people to prioritize their health and well-being. Alex has partnered with organizations like Ro, WellTheory, and Firsthand, and her work has been recognized by the Digital Health Association.
When she’s not writing about mental health, Alex is usually playing pickleball, meeting with her local board of health, or enjoying time with her three kids.
Adrienne Duhon, LCSW
Adrienne has worked in the mental health field for over 10 years across a variety of settings including hospitals, nursing homes, and telehealth. In her current role as a Clinical Quality Specialist at Rula, she supports therapists by providing clinical guidance, documentation support, and peer consultation, with a focus on improving quality of care. She is trained in CBT and specializes in working with people experiencing anxiety, depression, and ADHD.
Adrienne is passionate about mental health because she believes everyone deserves access to compassionate, evidence-based care that helps them thrive and feel supported. Outside of work, she enjoys spending time with her family and taking long walks with her dog.
Rula's editorial process
Rula's editorial team is on a mission to make science-backed mental health insights accessible and practical for every person seeking to better understand or improve mental wellness.
Members of Rula’s clinical leadership team and other expert providers contribute to all published content, offering guidance on themes and insights based on their firsthand experience in the field. Every piece of content is thoroughly reviewed by a clinician before publishing.
