Oppositional defiant disorder (ODD) is part of a cluster of diagnoses called the disruptive, impulse-control, and conduct disorders. Disruptive, impulse control and conduct disorders are a group of psychiatric conditions that include:
These disorders are characterized by the presence of difficult, aggressive, or antisocial behavior. It is often associated with physical or verbal injury to the self, others, or objects or with violating the rights of others (e.g., destruction of property). These behaviors can appear in several forms and can be defensive, premeditated or impulsive. Individuals with disruptive, impulse control and conduct disorders may have an irritable temperament, be impulsive or inattentive, be defiant towards adults, be aggressive towards peers, and lack problem solving skills. They may also have a coercive interaction style and lack social skills.
Oppositional defiant disorder is defined as defiant, hostile, and disobedient behavior, usually directed at authority figures. Intermittent explosive disorder is explosive outbursts of anger, often to the point of rage, that are disproportionate to the situation at hand. Conduct disorder is repetitive and persistent aggression toward others in which the basic rights of others are violated. Disruptive, impulse control and conduct disorders appear to have addictive properties as they tend to have strong aspects of compulsion, craving, loss of control, and hedonistic release.
ODD is a psychiatric disorder that affects approximately 3.3% of children. Although ODD affects both males and females, the disorder appears to be more prevalent in males prior to adolescence. ODD is characterized by three main symptoms:
Children with ODD are often verbally aggressive toward authority figures and peers. Some of the common behaviors children with ODD exhibit include:
Children who develop a stable pattern of oppositional behavior during their preschool years are at a greater risk to have oppositional defiant disorder during their elementary school years. The first symptoms of oppositional defiant disorder usually appear during the preschool years and rarely later than early adolescence. Children with oppositional defiant disorder are at greater risk of developing conduct disorder and antisocial personality disorder during adulthood.
Oppositional defiant disorder often precedes the development of conduct disorder, especially for those with the childhood-onset type of conduct disorder. However, many children and adolescents with oppositional defiant disorder do not subsequently develop conduct disorder. Children with ODD may have difficulty with interpersonal relationships, particularly with their parents, teachers, and peers. There is an increased risk for the development of anxiety disorders and major depressive disorders, even in the absence of conduct disorder. Children whose profile is predominantly defiant, argumentative, and vindictive symptoms carry most of the risk for conduct disorder, whereas angry and/or irritable profiles carry most of the risk for emotional disorders. Children and adolescents with oppositional defiant disorder are at increased risk for a number of problems in adjustment as adults, including antisocial behavior, impulse-control problems, substance abuse, anxiety, and depression. Coexisting conditions include attention-deficit/hyperactivity disorder and mood disorders.
Children with high levels of emotional reactivity and poor frustration tolerance may have problems related to emotional regulation. This emotional profile is common in children with ODD. Parents of children with ODD have been shown to exhibit less effective problem solving skills and negative parenting styles (e.g, uninvolved, rejecting, harsh). Thus, ODD could be a child's response to the parent-child interaction. Neurobiological markers such as skin conductance reactivity, lower heart rate, reduced basal cortisol reactivity and abnormalities in the prefrontal cortex and amygdala have been investigated in their role with ODD. No single neurotransmitter or neurologic pathway has been identified as the root cause. Oppositional defiant disorder appears to be familial, but research has yet to determine what role genetics play because studies on the genetics of the disorder have produced inconsistent result.
ODD is treatable. Published treatment guidelines for OCD include those from the Society of Clinical Child and Adolescent Psychology, the American Academy of Child and Adolescent Psychiatry, and the National Institute for Clinical Excellence.
First Line Treatments
Second Line Treatments
In cases of nonresponse to first-line treatment, alternative treatments with reasonable evidence of efficacy include:
Third Line Treatments
When patients do not respond adequately to the first- and second-line treatments described above, other strategies might include:
First Line Treatments
Second Line Treatments
In cases of nonresponse to first-line treatment, alternative treatments with reasonable evidence of efficacy include:
Third Line Treatments
When patients do not respond adequately to the first- and second-line treatments described above, other strategies might include: