Oppositional Defiant Disorder

Oppositional defiant disorder (ODD) is a childhood disorder that is characterized by undercontrolled, noncompliant, defiant, and socially disruptive behavior. ODD is classified as a disruptive behavior disorder along with attention deficit hyperactivity disorder (ADHD) and conduct disorder (CD). The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Text Revision (DSM-IV-TR) specifies that youth must exhibit four of the following behaviors for at least six months for a diagnosis of ODD to be made (American Psychiatric Association, 2000):

• Loses temper
• Argues with adults
• Defies or refuses to comply with rules or adult's requests
• Annoys others deliberately
• Blames others for mistakes
• Is easily annoyed by others
• Is often angry and resentful
• Is often spiteful and vindictive

The DSM-IV-TR also specifies that a diagnosis should only be made if oppositional and defiant behavior significantly impairs an individual's academic, social, and adaptive functioning.

According to the DSM-IV-TR, ODD typically manifests itself before the age of 8 and affects anywhere from 2% to 16% of youth, depending on the diagnostic tools used (American Psychiatric Association, 2000). Before puberty, the DSM-IV-TR reports higher prevalence rates of ODD in boys than girls; however, it is presumed that gender rates are equal after puberty (American Psychiatric Association, 2000). Research has not uncovered a direct link between any one risk factor and ODD, rather the interaction between multiple factors most likely influences the development of this disorder (Burke & colleagues, 2002). The search for causes of ODD is further complicated by the fact that most research has focused on aggression, delinquency, and CD rather than on ODD. Social and biological influences that continue to be explored as [Page 360]possible links to ODD include temperament of children and parents (Barkley, 1997; Burke & colleagues, 2002), inconsistent and harsh discipline (Frick & colleagues, 1992), response to chronic illness (Beratis, 1993), neuroanatomy, and the under-arousal of the autonomic nervous system (Burke & colleagues, 2002).

Research shows that ODD is frequently accompanied by other disruptive behavior disorders (e.g., ADHD, CD), developmental disorders (e.g., mental retardation), and affective disorders (e.g., depression). Wenning and colleagues (1993) found that 79% of their subjects originally diagnosed with ODD also had a diagnosis of depression or developmental disorder, leaving only 21% of their sample with a sole diagnosis of ODD. Some comorbid conditions that frequently occur with ODD include: ADHD; reading, writing, and math disorders; expressive and receptive language disorders; and depression. The comorbidity of ODD with other disorders increasingly complicates the accurate assessment and delivery of treatment to children with ODD because practitioners and teachers may unintentionally overlook affective or developmental disorders because they are focused on the overt, disruptive symptoms of ODD. Because hostile, defiant, and negative behaviors are challenging and frustrating to parents and teachers, there is a tendency to focus on these behaviors to the exclusion of social, academic, and language deficits. Teachers may attribute failure to comply with commands to the student's oppositional nature, rather than considering the possibility that a student may have difficulty in receptive language.

A thorough understanding of ODD by parents and professionals is critical because accurate diagnosis that leads to effective early intervention can diminish the negative impact this disorder has on a student's academic, adaptive, and social skills.

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