toms carry most of the risk for emotional disorders. 
Manifestations of the disorder across de velopment appear consistent. Children and
adolescents with oppositional defiant disorder are at increase d risk for a number of prob-
lems in adjustment as adults, including anti social behavior, impu lse-control problems,
substance abuse, anxiety, and depression.
Many of the behaviors associated with oppositional defiant disorder increase in fre-
quency during the preschool period and in adol escence. Thus, it is especially critical dur-
ing these development periods that the freq uency and intensity of these behaviors be
evaluated against normative leve ls before it is decided that they are symptoms of opposi-
tional defiant disorder.
Risk and Prognostic Features
Temperamental. Temperamental factors related to problems in emotional regulation
(e.g., high levels of emotiona l reactivity, poor frustration to lerance) have been predictive
of the disorder.
Environmental. Harsh, inconsistent, or neglectful child-rearing practices are common in
families of children and adolescents with oppo sitional defiant disorder, and these parent-
ing practices play an important role in many causal theories of the disorder. 
Genetic and physiological. A number of neurobiological markers (e.g., lower heart rate
and skin conductance reactivity; reduced basal cortisol reactivity; abnormalities in the pre-
frontal cortex and amygdala) have been associated with oppositional defiant disorder.
However, the vast majority of studies have not separated children with oppositional de-
fiant disorder from those with conduct diso rder. Thus, it is unclear whether there are
markers specific to oppositional defiant disorder.