Oppositional Defiant Disorder (ODD) is a common mental disorder seen in childhood and adolescence. The incident of ODD is, on the average, about 10% but fluctuates from study to study depending on the population and the methodology used to determine the diagnosis. ODD is seen more often in males until adolescence when the male/female ratio becomes more even. ODD is also more likely to be present in families where mental disorders are present. A substantial number of children with ODD develop Conduct Disorder. The latter is a disorder that often leads to delinquency and substance abuse. Early evaluation and intervention is desirable because the treatment for associated (comorbid) conditions and relief from a stressful life situation can often improve the behavior of the child with ODD.
The Diagnostic and Statistical Manual of the American Psychiatric Association, fourth edition (DSM-IV) defines ODD as a pattern of negativistic, hostile and defiant behavior, lasting at least 6 months, during which four or more of the following symptoms are present:
1. Often loses tempern2. Often argues with adultsn3. Often actively defies or refuses to comply with adult’s requests or rulesn4. Often deliberately annoys peoplen5. Often blames others for his or her mistakes or misbehaviorsn6. Is often touchy or easily annoyed by othersn7. Is often angry or resentfuln8. Is often spiteful or vindictivennFurther, the symptoms listed must cause significant impairment in social academic or occupational function.
Other factors should be considered before entertaining the diagnosis of ODD. Children normally go through developmental phases where their “opposing choice” places them in opposition to adult requests. Differences in temperament might be mistakenly viewed as defiant where a child might simply be shy or slow to react. These normal developmental situations often resolve with a short passage of time and should not be considered as ODD.
While ODD is a diagnostic category unto itself, one should be certain that overlapping behavioral phenomena seen in other mental disorders do not lead to an inaccurate diagnosis. Disorders that may be confused with ODD or that frequently occur with ODD are as follows:nn Developmental Delay or Mental Retardationn Expressive/Receptive Language Disordern Pervasive Developmental Disorder (autistic spectrum disorder)n Medical Disorders of the Central Nervous System (including medication)n Mood Disordersn Adjustment Disordern Attention Deficit Hyperactivity Disordern Substance Use Disordern Psychosis and SchizophreniannThere are two additional disorders that should be discussed briefly because some experts believe these conditions can be treated successfully with mood stabilizers and or nantipsychotic drugs.
One condition listed in DSM IV, is termed Intermittent Explosive Disorder. Here, the affected child has relatively long periods of perfectly normal behavior only to suddenly become totally out of control with anger and aggressive behavior.
The second condition is one where a child is generally unhappy and irritable. With little provocation he or she becomes extremely agitated and rebellious even to the point of physical aggression towards others and/or destruction of property. The condition has been aptly described as a dysphoric conduct disorder.
Both conditions could possibly represent a slow and rapid cycling childhood
bipolar disorder.
Once other conditions have been considered the diagnosis of ODD can be entertained as a singular or comorbid condition. Where there is a comorbid condition with ODD the treatment should be prioritized.
The treatment for ODD is primarily behavioral. For the most part, this involves the parent or caregiver identifying factors that trigger the negative behaviors and develop strategies that abate or avoid them. This can often be accomplished by utilizing persuasion and negotiation along with guidance toward a more tranquil situation. The child with ODD should understand those behaviors that earn respect and those that are unacceptable. Treatment requires a cohesive and combined effort within the family.
Fortunately, the majority of children with ODD are eventually able to control their behavior and conform to societal norms. However, a high percentage goes on to develop Conduct Disorder and Personality Disorder. Therefore it is imperative that therapy be instituted early in the illness.
For more information about Oppositional Defiant Disorder and co morbidities see
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