The symptoms of oppositional defiant disord er can occur to some degree in individu-
als without this disorder. There are several ke y considerations for de termining if the be-
haviors are symptomatic of oppo sitional defiant disorder. First, the diagnostic threshold
of four or more symptoms within the preceding 6 months must be met. Second, the per-
sistence and frequency of the symptoms should  exceed what is normative for an individ-
ual’s age, gender, and culture. For example, it is not unusual for preschool children to
show temper tantrums on a weekly basis. Te mper outbursts for a preschool child would be
considered a symptom of oppositional defiant d isorder only if they occurred on most days
for the preceding 6 months, if they occurred with at least three other symptoms of the dis-
order, and if the temper outbursts contribu ted to the significant impairment associated
with the disorder (e.g., led to destruction of  property during outbursts, resulted in the
child being asked to leave a preschool). 
The symptoms of the disorder often are part  of a pattern of pr oblematic interactions
with others. Furthermore, individuals with this  disorder typically do not regard themselves
as angry, oppositional, or defian t. Instead, they often justify their behavior as a response to
unreasonable demands or circumstances. Thus, it can be difficult to disentangle the rela-
tive contribution of the individual with the disorder to the problematic interactions he or
she experiences. For example, children with oppositional defiant disorder may have ex-
perienced a history of hostile parenting, and it is often impossible to determine if the
child’s behavior caused the parents to act in a more hostile manner toward the child, if the