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.