Introduction to Oppositional Defiant Disorder
Children with Oppositional Defiant Disorder repeatedly engage in a pattern of defiant, disobedient, and hostile behavior toward authority figures. This behavior goes beyond acceptable misbehavior for the given child's age and the behavior has been continued for at least six months.
Children with Oppositional Defiant Disorder tend to display the following symptoms:
- Persistent resistance towards taking direction from others
- Stubbornness or non-compliant behavior
- An unwillingness to compromise
- Frequent arguing with, talking back to, or challenging of authority
- Irritability, resentfulness, or negativity
- Deliberate provocation of others which comes across as mean, spiteful, or rude
- Temper tantrums or outbursts
- Externalization of blame (it's always someone else's fault). Always blaming others or denying responsibility
- Repeated testing of other people's limits (ignoring orders, arguing with directions)
- Repeated trouble at school
- Few or no friends
The symptoms of Oppositional Defiant Disorder are almost always evident at home. However, ODD children will sometimes compartmentalize their bad behavior so that it does not occur in other environments. Other children will display ODD symptoms across multiple environments including school, home and while out in the community.
Generally, ODD children are symptomatic when in the presence of adults or peers they know well. They may not display obvious symptoms in front of strangers. This tendency to reserve ODD behavior for family and friends (or home settings) can make diagnosing ODD difficult. Symptoms may simply not be displayed when ODD children are being interviewed by a strange therapist.
According to the DSM, Oppositional Defiant Disorder is fairly common, occurring in between 2 and 16% of children and adolescents. ODD usually begins prior to age 8 and is only rarely diagnosed after early adolescence has begun. Before puberty, males are more likely to develop ODD; following puberty this disorder occurs at the same rate across genders.
Diagnosis of Oppositional Defiant Disorder
Clinically diagnosable oppositional behavior must be distinguished from typical childhood misbehavior (e.g., occasionally talking back or hitting a sibling). The DSM lists 8 diagnostic criteria indicative of ODD. At least 4 of these behaviors must be present for at least 6 months in order to diagnose a child with ODD:
1) Frequently loses his/her temper
2) Frequently argues
3) Frequent defies or refuses to comply with rules and requests
4) Frequently annoys people on purpose
5) Frequently blames other people for mistakes or poor behavior
6) Is frequently very sensitive to other's comments, or is easily annoyed by others
7) Frequently angry or resentful
8) Frequently cruel or retaliative
Assessment of Oppositional Defiant Disorder takes place in much the same manner as the process used to diagnose Conduct Disorder. The assessing clinician will typically conduct interviews with the child, parents and family members and teachers, examine school records, and ask people familiar with the child to complete behavior rating forms similar or identical to those used for Conduct Disorder. To return to our section on Conduct Disorder, please click here.
Conduct Disorder and Oppositional Defiant Disorder share features in common. For instance, both conduct disordered and oppositional defiant children are highly irritable and have poor social skills. However, children with ODD simply do not show the serious behavioral problems that are present in Conduct Disorder (e.g., behaviors that violate the rights of others such as destruction of property). Children who meet criteria for both Conduct Disorder and Oppositional Defiant Disorder at the same time are diagnosed solely with Conduct Disorder, as the diagnosis of CD takes precedence over the diagnosis of ODD (due to its greater severity).