Oppositional Defiant Disorder (ODD)

 

Introduction

While most children will occasionally be oppositional, especially when tired or stressed, children with oppositional defiant disorder have an ongoing pattern of disobedience and hostility towards parents, teachers, and other authorities and refuse to comply with adults' requests.  They are also often easily annoyed and frequently lose their temper.  ODD and other conduct problems are the greatest reasons for referral to children's mental health services.

 

DSM criteria

Oppositional Defiant Disorder is defined in the DSM as a pattern of negativistic, hostile, and defiant behavior towards authority figures,lasting at least 6 months.  The behavior disturbance must causes clinically significant impairment in social, academic, or occupational functioning and four of the following characteristics must be present for a diagnosis:

  • Often loses temper
  • Often argues with adults
  • Often actively defies or refuses to comply with adults' requests or rules
  • 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

ODD shares many similarities with conduct disorder but lacks the violation of societal norms that is characteristic of conduct disorder.

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Prevalence

Prevalence of ODD in children under 18 is thought to be between 5-16%.

  • Boys > girls before puberty, rates become equal after puberty
  • 67% of cases have resolved 3 years later.
  • 30% of cases progress to conduct disorder.

Most children with ODD will show signs of the problem before age 9.

 

Comorbidities

  • Many other psychiatric illnesses have been found to occur with more frequency in children with ODD.  These include:
  •  ADHD (50-65%)
  • Mood disorders (35%)
  • Learning disabilities (20-30%)

 

Etiology

The cause of ODD is unknown.  There is evidence for biological and genetic factors.  Studies have shown abnormalities in the prefrontal cortex, altered neurotransmitter function in the serotonergic, noradrenergic, and dopaminergic systems, low cortisol, and elevated testosterone levels.  Family members of children with ODD may have higher than expected rates of not only ODD, but also ADHD, substance abuse, and mood disorders.  Inconsistent and harsh discipline may also play a role.

 

Treatment

Treatment of ODD focuses on behavioral management, especially by parents.  Parent management training (PMT) is recommended for parents of children with ODD to change the pattern of negative interactions between parents and child that typically occur in these families.  PMT involves training parents to recognize their child's positive behaviors and reinforce them, and to use brief negative consequences for poor behavior.  Studies have demonstrated that about 65% of families show significant improvement with PMT.  Pharmacotherapy may also be used for co-morbid ADHD and mood disorders.

 

References:

  1. Boylan et al.  Comorbidity of internalizing disorders in children with oppositional defiant disorder. European Child and Adolescent Psychiatry. Dec 2007; 16(8): 484-494
  2. Tynan, Douglas. Oppositional Defiant Disorder. eMedicine. Feb 2008 http://www.emedicine.com/ped/TOPIC2791.HTM
  3. Burke JD, Loeber R, Birmaher B. Oppositional defiant disorder and conduct disorder: a review of the past 10 years, part II. J Am Acad Child Adolesc Psychiatry. Nov 2002;41(11):1275-93.
  4. Steiner H, Remsing L. Practice parameter for the assessment and treatment of children and adolescents with oppositional defiant disorder. J Am Acad Child Adolesc Psychiatry. Jan 2007;46(1):126-41.

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