Oppositional Defiant Disorder 465
Culture-Related Diagnostic Issues
The prevalence of the disorder in children an d adolescents is relatively consistent across
countries that differ in race and ethnicity.
Functional Consequences of 
Oppositional Defiant Disorder
When oppositional defiant disorder is pers istent throughout deve lopment, individuals
with the disorder experience frequent conflic ts with parents, teachers, supervisors, peers,
and romantic partners. Such problems often re sult in significant impairments in the indi-
vidual’s emotional, social, academ ic, and occupational adjustment. 
Differential Diagnosis
Conduct disorder. Conduct disorder and oppositional defiant disorder are both related
to conduct problems that  bring the individual in conflict  with adults and other authority
figures (e.g., teachers, work supervisors). Th e behaviors of oppositional defiant disorder
are typically of a less severe nature than those of conduct disorder and do not include ag-
gression toward people or anima ls, destruction of property, or a pattern of theft or deceit.
Furthermore, oppositional defian t disorder includes problems  of emotional dysregulation
(i.e., angry and irritable mood) that are not in cluded in the definition of conduct disorder. 
Attention-deficit/hyperactivity disorder. ADHD is often comorbid  with oppositional de-
fiant disorder. To make the additional diagnosis of oppositional defiant disorder, it is impor-
tant to determine that the indivi dual’s failure to conform to requ ests of others is not solely in
situations that demand sustained effort and attention or demand that the individual sit still. 
Depressive and bipolar disorders. Depressive and bipolar di sorders often involve neg-
ative affect and irritability. As a result, a di agnosis of oppositional defiant disorder should