World Library  
Flag as Inappropriate
Email this Article

Oppositional defiant disorder


Oppositional defiant disorder

Oppositional defiant disorder
Classification and external resources
Specialty Psychiatry
ICD-10 F91.3
ICD-9-CM 313.81
MedlinePlus 001537
MeSH D019958

Oppositional defiant disorder (ODD) is defined by the DSM-5 as "a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least six months as evidenced by at least four symptoms from any of the [defined] categories and exhibited during interaction with at least one individual who is not a sibling".[1] Unlike children with conduct disorder (CD), children with oppositional defiant disorder are not aggressive towards people or animals, do not destroy property, and do not show a pattern of theft or deceit.[2] A diagnosis of ODD is also no longer applicable if the individual is diagnosed with Reactive Attachment Disorder (RAD).


  • Signs and symptoms 1
  • Causes 2
    • Genetic influences 2.1
    • Prenatal factors and birth complications 2.2
    • Neurobiological factors 2.3
    • Social-cognitive factors 2.4
    • Environmental factors 2.5
  • Diagnosis 3
  • Management 4
  • Epidemiology 5
  • History 6
  • See also 7
  • References 8
  • Further reading 9
  • External links 10

Signs and symptoms

The fourth revision of the Diagnostic and Statistical Manual (DSM-IV-TR) (now replaced by DSM-5) stated that the child must exhibit four out of the eight signs and symptoms to meet the diagnostic threshold for oppositional defiant disorder.[3] Furthermore, they must be perpetuated for longer than six months and must be considered beyond normal child behavior to fit the diagnosis.[4] Signs and symptoms were: actively refuses to comply with majority's requests or consensus-supported rules;[5] performs actions deliberately to annoy others;[5] is angry and resentful of others;[4] argues often;[4] blames others for their own mistakes;[6] frequently loses temper;[6] is spiteful or seeks revenge;[6] and is touchy or easily annoyed.[6]

These patterns of behavior result in impairment at school and/or other social venues.[4]


The cause of ODD is unknown, but it is believed that a combination of biological, environmental, and genetic factors may contribute to the condition.

Genetic influences

Research indicates that parents pass on a tendency for externalizing disorders to their children that may be displayed in multiple ways, such as inattention, hyperactivity, or oppositional and conduct problems. This heritability can vary by age, age of onset, and other factors. Adoption and twin studies indicate that 50% or more of the variance causing antisocial behavior is attributable to heredity for both males and females. ODD also tends to occur in families with a history of ADHD, substance use disorders, or mood disorders, suggesting that a vulnerability to develop ODD may be inherited. A difficult temperament, impulsivity, and a tendency to seek rewards can also increase the risk of developing ODD. New studies into gene variants have also identified possible gene-environment (G x E) interactions, specifically in the development of conduct problems. A variant of the gene that encodes the neurotransmitter metabolizing enzyme monoamine oxidase-A (MAOA), which relates to neural systems involved in aggression, plays a key role in regulating behavior following threatening events. Brain imaging studies show patterns of arousal in areas of the brain that are associated with aggression in response to emotion-provoking stimuli.[7]

Prenatal factors and birth complications

Many pregnancy and birth problems are related to the development of conduct problems. Malnutrition, specifically protein deficiency, lead poisoning, and mother’s use of nicotine, marijuana, alcohol or other substances during pregnancy may increase the risk of developing ODD. Although pregnancy and birth factors are correlated with ODD, strong evidence of direct biological causation is lacking.[7]

Neurobiological factors

Deficits and injuries to certain areas of the brain can lead to serious behavioral problems in children. Brain imaging studies have suggested that children with ODD may have subtle differences in the part of the brain responsible for reasoning, judgment and impulse control. Children with ODD are thought to have an overactive behavioral activation system (BAS), and underactive behavioral inhibition system (BIS). The BAS stimulates behavior in response to signals of reward or nonpunishment. The BIS produces anxiety and inhibits ongoing behavior in the presence of novel events, innate fear stimuli, and signals of nonreward or punishment. Neuroimaging studies have also identified structural and functional brain abnormalities in several brain regions in youths with conduct disorders. These brain regions are the amygdala, prefrontal cortex, anterior cingulate, and insula, as well as interconnected regions.[7]

Social-cognitive factors

As many as 40 percent of boys and 25 percent of girls with persistent conduct problems display significant social-cognitive impairments. Some of these deficits include immature forms of thinking (such as egocentrism), failure to use verbal mediators to regulate his or her behavior, and cognitive distortions, such as interpreting a neutral event as an intentional hostile act.[7]

Environmental factors

Negative parenting practices and parent–child conflict may lead to antisocial behavior, but they may also be a reaction to the oppositional and aggressive behaviors of children. Factors such as a family history of mental illnesses and/or substance abuse as well as a dysfunctional family and inconsistent discipline by a parent or guardian can lead to the development of behavior disorders.

Insecure parent–child attachments can also contribute to ODD. Often little internalization of parent and societal standards exists in children with conduct problems. These weak bonds with their parents may lead children to associate with delinquency and substance abuse. Family instability and stress can also contribute to the development of ODD. Although the association between family factors and conduct problems is well established, the nature of this association and the possible causal role of family factors continues to be debated.[7]

Low socioeconomic status is associated with poor parenting, specifically with inconsistent discipline and poor parental monitoring, which are then associated with an early onset of aggression and antisocial behaviors.[7]

Externalizing problems are reported to be more frequent among minority-status youth, a finding that is likely related to economic hardship, limited employment opportunities, and living in high-risk urban neighborhoods.[7]


For a child or adolescent to qualify for a diagnosis of ODD, behaviors must cause considerable distress for the family or interfere significantly with academic or social functioning. Interference might take the form of preventing the child or adolescent from learning at school or making friends, or placing him or her in harmful situations. These behaviors must also persist for at least six months. Effects of ODD can be greatly amplified by other disorders in comorbidity such as ADHD. Other common comorbid disorders include depression and substance use disorders.[8]


Approaches to the treatment of ODD include parent management training, individual psychotherapy, family therapy, cognitive behavioral therapy, and social skills training.[9][10] According to the American Academy of Child and Adolescent Psychiatry, treatments for ODD are tailored specifically to the individual child, and different treatment techniques are applied for pre-schoolers and adolescents.[9] Several preventative programs have had a positive effect on those at high risk for ODD. Both home visitation and programs such as Head Start have shown some effectiveness in preschool children. Social skills training, parent management training, and anger management programs have been used as prevention programs for school-age children at risk for ODD. For adolescents at risk for ODD, cognitive interventions, vocational training and academic tutoring have shown preventative effectiveness.[8]


ODD has an estimated lifetime prevalence of 10.2% (11.2% for males, 9.2% for females).[8]


Oppositional defiant disorder was first defined in the DSM-III (1980). Since the introduction of ODD as an independent disorder, the field trials to inform the definition of this disorder have included predominantly male subjects. Some clinicians have debated whether the diagnostic criteria presented above would be clinically relevant for use with females. Furthermore, some have questioned whether gender-specific criteria and thresholds should be included. Additionally, some clinicians have questioned the preclusion of ODD when CD is present.[3] According to Dickstein, the DSM-5 attempts to:

“redefine ODD by emphasizing a ‘persistent pattern of angry and irritable mood along with vindictive behavior,’ rather than DSM-IV's focus exclusively on ‘negativistic, hostile, and defiant behavior.’ Although DSM-IV implied, but did not mention, irritability, DSM-5 now includes three symptom clusters, one of which is 'angry/irritable mood' —defined as ‘loses temper, is touchy/easily annoyed by others, and is angry/resentful.’ This suggests that the process of clinically relevant research driving nosology, and vice versa, has ensured that the future will bring greater understanding of ODD”.[8]

See also


  1. ^ Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Diagnostic Criteria 313.81 (F91.3): American Psychiatric Association. 
  2. ^ Nolen-Hoeksema, Susan (2014). (ab)normal psychology. New York, NY: McGraw Hill. p. 323.  
  3. ^ a b Pardini DA, Frick PJ, Moffitt TE (November 2010). "Building an evidence base for DSM-5 conceptualizations of oppositional defiant disorder and conduct disorder: introduction to the special section". J Abnorm Psychol 119 (4): 683–8.  
  4. ^ a b c d Kaneshiro, Neil. "Oppositional Defiant Disorder". A.D.A.M. Medical Encyclopedia. Retrieved 5 November 2011. 
  5. ^ a b "Oppositional Defiant Disorder: Symptoms". Psych Central. Retrieved 5 November 2011. 
  6. ^ a b c d
  7. ^ a b c d e f g Mash EJ, Wolfe DA (2013). Abnormal Child Psychology (5th ed.). Belmont, CA: Wadsworth Cengage Learning. pp. 182–191. 
  8. ^ a b c d Dickstein DP (May 2010). "Oppositional defiant disorder". J Am Acad Child Adolesc Psychiatry 49 (5): 435–6.  
  9. ^ a b "FAQs on Oppositional Defiant Disorder". Retrieved 2015-01-28. 
  10. ^ Steiner H, Remsing L; Work Group on Quality Issues (January 2007). "Practice parameters for the assessment and treatment of children and adolescents with oppositional defiant disorder". J Am Acad Child Adolesc Psychiatry 46 (1): 126–41.  

Further reading

  • Latimer K, Wilson P, Kemp J, et al. (September 2012). "Disruptive behaviour disorders: a systematic review of environmental antenatal and early years risk factors". Child Care Health Dev 38 (5): 611–28.  
  • Matthys W, Vanderschuren LJ, Schutter DJ, Lochman JE (September 2012). "Impaired neurocognitive functions affect social learning processes in oppositional defiant disorder and conduct disorder: implications for interventions". Clin Child Fam Psychol Rev 15 (3): 234–46.  

External links

This article was sourced from Creative Commons Attribution-ShareAlike License; additional terms may apply. World Heritage Encyclopedia content is assembled from numerous content providers, Open Access Publishing, and in compliance with The Fair Access to Science and Technology Research Act (FASTR), Wikimedia Foundation, Inc., Public Library of Science, The Encyclopedia of Life, Open Book Publishers (OBP), PubMed, U.S. National Library of Medicine, National Center for Biotechnology Information, U.S. National Library of Medicine, National Institutes of Health (NIH), U.S. Department of Health & Human Services, and, which sources content from all federal, state, local, tribal, and territorial government publication portals (.gov, .mil, .edu). Funding for and content contributors is made possible from the U.S. Congress, E-Government Act of 2002.
Crowd sourced content that is contributed to World Heritage Encyclopedia is peer reviewed and edited by our editorial staff to ensure quality scholarly research articles.
By using this site, you agree to the Terms of Use and Privacy Policy. World Heritage Encyclopedia™ is a registered trademark of the World Public Library Association, a non-profit organization.

Copyright © World Library Foundation. All rights reserved. eBooks from Project Gutenberg are sponsored by the World Library Foundation,
a 501c(4) Member's Support Non-Profit Organization, and is NOT affiliated with any governmental agency or department.