Oppositional Defiant Disorder

Definition

The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) defines ODD as a childhood disorder characterized by an ongoing and persistent pattern of hostile, noncompliant, and resistant behaviors manifested toward authority figures. In order to attain a diagnosis of ODD, behaviors must consistently occur for at least 6 months. Individuals with ODD are often described as stubborn, easily angered, argumentative, verbally aggressive, quickly annoyed by others, externally blameful for personal mistakes, deliberately annoying, and physically aggressive. In addition, such children easily lose their temper on a consistent basis and may demonstrate vindictive behavior. Often, children with ODD possess a low frustration tolerance and have difficulty controlling impulses. Last, individuals with ODD typically procrastinate and dawdle when expected to comply with a command. They commonly lack insight into their behavior and view their noncompliant behavior as an acceptable response to overdemanding situations.

ODD can cause significant difficulties in many areas of a child's life, including the family and school environment. Typically children with ODD have a difficult time getting along with family members (i.e., siblings, parents) and may find it hard to initiate or maintain peer relationships. Although children with ODD often have difficulty forming positive relationships with individuals of authority (i.e., teachers, coaches), defiant behaviors are sometimes solely present with individuals with whom the child has a close relationship.

Prevalence and Onset of Symptoms

Although studies differ in reported statistics, an estimate of the prevalence rate for ODD ranges from 2% to 16%. In addition, the DSM-IV states that ODD tends to be more common in males prior to puberty, but prevalence rates even out between males and females following puberty. ODD is typically noticeable before the age of 8 and is not commonly evident soon after adolescence commences. Onset of symptoms is not sudden, and behaviors tend to slowly manifest over the course of several months or years. As younger children develop more sophisticated verbal capabilities, defiance may advance from simple refusals to more sophisticated oppositionality (i.e., negotiations).

Associated Difficulties

Problems commonly associated with ODD include low self-esteem, substance use or abuse, and frequent mood fluctuations. In addition, ODD may be an early indicator of a more severe psychopathology but does not necessarily precede a more severe condition. In some cases, ODD may progress into conduct disorder (CD), a disorder characterized by socially inappropriate (i.e., law breaking) and destructive behaviors. Children with ODD were 4 times more likely to develop CD than were children without ODD, although the risk of development from ODD to CD in females is somewhat unclear. Longitudinal research conducted by Hinshaw, Lahey, and Hart has shown that half of children with ODD progress to CD, 25% maintain the ODD diagnosis, and 25% eventually discontinue showing clinically significant levels of externalizing behavior. Last, attention deficit hyperactivity disorder (AD/HD), learning disabilities, and mood disorders commonly coexist with ODD, and interventions targeting these conditions may reduce oppositional behavior.

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