Oppositional defiant disorder is described by the Diagnostic and Statistical Manual of Mental Disorders as an ongoing pattern of disobedient, hostile and defiant behavior toward authority figures which goes beyond the bounds of normal childhood behavior. People who have it may appear very stubborn.
DSM criteriaTo meet DSM-IV-TR criteria, certain factors must be taken into account. First, the defiance must interfere with the child’s ability to function in school, home, or the community. Second, the defiance cannot be the result of another disorder, such as the more serious conduct disorder, depression, anxiety, or a sleep disorder such as DSPS. Third, the child's problem behaviors have been happening for at least six months. The diagnostic criteria for this disorder are as follows:
- Diagnostic Criteria
- A pattern of negativistic, hostile, and defiant behavior lasting at least 6 months, during which four (or more) of the following are present:
Note: Consider a criterion met only if the behavior occurs more frequently than is typically observed in individuals of comparable age and developmental level.
- 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
- 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.
PrevalenceThe DSM-IV-TR cites a prevalence of 2-16%, "depending on the nature of the population sample and methods of ascertainment."
PrognosisChildhood oppositional defiant disorder is strongly associated with later developing conduct disorder. Untreated, about 52% of children with ODD will continue to meet the DSM-IV criteria up to three years later and about half of those 52% will progress into Conduct Disorder.
TreatmentThere are a variety of approaches to the treatment of oppositional defiant disorder, including parent training programs, individual psychotherapy, family therapy, cognitive behavioral therapy, and social skills training.According to the American Academy of Child and Adolescent Psychiatry, treatments for ODD are tailored specifically to the individual child, and different treatments are used for pre-schoolers and adolescents.
An approach developed by Russell Barkley uses a parent training model and begins by focusing on positive approaches to increase compliant behaviours. Only later in the program are methods introduced to extinguish negative or noncompliant behaviours.
One other type of treatment of this disorder is the prescription of risperidone.
ControversyAccording to The American Journal of Psychiatry, there are several sources of controversy around the diagnosis of ODD. One concerns the fact that the DSM-IV criteria differ slightly from those of the World Health Organization's criteria, as outlined in the ICD-10. Diagnosis of ODD is further complicated by the high occurrence of comorbidity with other disorders such as ADHD, though a 2002 study provided additional support for the validity of ODD as an entity distinct from Conduct disorder.
In another study, the utility of the DSM-IV criteria to diagnose preschoolers has been questioned because the criteria were developed using school-age children and adolescents. The authors concluded that the criteria could be used effectively when developmental level was factored into assessment.