Oppositional Defiant Disorder

Oppositional Defiant Disorder is a childhood condition typically characterized by:

• A pattern of negativistic, hostile, and defiant behavior lasting at least 6 months, during which four (or more) of the following are present:

  • Often loses temper

  • Often argues with adults

  • Often defies or refuses to comply with adults requests

  • Often deliberately annoys people

  • Often blames others for his or her mistakes or misbehavior

  • Is often touchy or easily annoyed by others

  • Is often angry and resentful

  • Is often spiteful or vindictive

• The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.

• The behaviors do not occur exclusively during the course of a Psychotic or Mood Disorder.

• Criteria are not met for Conduct Disorder, and, if the individual is age 18 years or older, criteria are not met for Antisocial Personality Disorder.

Associated Features

In males, the disorder has been shown to be more prevalent among those who, in the preschool years, have problematic temperaments (e.g., high reactivity, difficulty being soothed) or high motor activity. During the school years, there may be low self-esteem (or overly inflated self-esteem), mood lability, low frustration tolerance, swearing, and the precocious use of alcohol, tobacco, or illicit drugs. There are often conflicts with parents, teachers, and peers. There may be a vicious cycle in which the parent and child bring out the worst in each other. Oppositional Defiant Disorder is more prevalent in families in which child care is disrupted by a succession of different caregivers or in families in which harsh, inconsistent, or neglectful child-rearing practices are common. Attention-Deficit/Hyperactivity Disorder is common in children with Oppositional Defiant Disorder. Learning Disorders and Communication Disorders also tend to be associated with Oppositional Defiant Disorder.

Course

Oppositional Defiant Disorder usually becomes evident before age 8 years and usually not later than early adolescence. The oppositional symptoms often emerge in the home setting but over time may appear in other settings as well. Onset is typically gradual, usually occurring over the course of months or years. In a significant proportion of cases, Oppositional Defiant Disorder is a developmental antecedent to Conduct Disorder. Although Conduct Disorder, Childhood-Onset Type is often preceded by Oppositional Defiant Disorder, many children with Oppositional Defiant Disorder do not subsequently develop Conduct Disorder.

Diagnostic criteria summarized from:

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, fourth edition. Washington, DC: American Psychiatric Association.