Overview
Oppositional Defiant Disorder is a behavioral disorder that presents with a pattern of persistent anger or irritability, argumentative and defiant behavior, or vindictiveness.
The onset of these behavioral patterns usually occur between childhood and adolescence, and can be a cause of significant distress to the individual as well as those around them, and hinder functionality in various areas of life, particularly across interpersonal interactions.ย
There is a male preponderance in the prevalence of the disorder during childhood, and the gender gap continues to diminish with progress in age.
The presentation of the disorder in childhood may mark the occurrence of conduct disorder, major depression, or anxiety disorders in later life in some cases.
Genetic, neurobiological, temperamental, and psychosocial environmental risk factors are associated with the presentation of the disorder. ADHD is a common comorbidity observed alongside Oppositional Defiant Disorder.ย
Modes of treatment for Oppositional Defiant Disorder are largely based in psychosocial and behavioral therapy, and stresses parental roles, multisystemic interventions, and addressing various areas of functionality.
Signs and Symptoms
Oppositional Defiant Disorder may present with any of the following symptoms:
- Persistent irritation or angry mood
- Losing temper often
- Constantly being argumentative with others, especially authority figures
- Blaming others for own mistakes
- Engaging in defiant behavior
- Vindictiveness
- Having poor social interactions
In many cases, the symptoms of Oppositional Defiant Disorder are shown when among family members in the home setting.
Risk Factors
Oppositional Defiant Disorder is observed to have a male preponderance from childhood to adolescence, but the difference in prevalence is considered to diminish over time, and there is no significant difference in a lifetime occurrence between males and females.
The onset of the symptoms of the disorder is usually in childhood, specifically during pre-school, and may precede the onset of childhood-onset conduct disorder or major depressive disorder or anxiety disorders.ย
Biological factors associated with Oppositional Defiant Disorder include genetic components, with a considerable heritability involved.
However, genes identified to be attributable to the occurrence of the disorder are found to be shared by other psychopathologies as well, such as Conduct Disorder. Neuroanatomical abnormalities have also been observed, and neuropsychological factors have been considered.
Emotion dysregulation is attributed to a temperamental risk factor. Environmental correlates including familial aspects such as presence of psychopathology among family members, inadequate or hostile parenting styles, maltreatment and maladjustment, as well as external factors such as trauma or life stressors, peer rejection, and so on, have also been identified.ย
Oppositional Defiant Disorder is also considered to be significantly comorbid with ADHD.
Diagnosis
A thorough clinical assessment, inclusive of clinical interviews and the administration of effective diagnostic tools, is required to be carried out in order to confirm the diagnosis of Oppositional Defiant Disorder.
The overlap of symptoms with other behavioral disorders, as well as the common occurrence of symptoms associated with the disorder as behavioral patterns during childhood and adolescence may make the initial detection of the disorder difficult from the caregiverโs point of view.
The frequency and persistence of the behaviors is an important factor in differentiating it from the expected threshold of problematic behavior.ย
The DSM-5 marks the following diagnostic criteria for Oppositional Defiant Disorder:
A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months as evidenced by at least four symptoms from any of the following categories, and exhibited during interaction with at least one individual who is not a sibling.
- Angry/Irritable Mood
- Often loses temper
- Is often touchy or easily annoyed
- Is often angry and resentful
- Argumentative/Defiant Behavior
- Often argues with authority figures or, for children and adolescents, with adults
- Often actively defies or refuses to comply with requests from authority figures or
- with rules
- Often deliberately annoys others
- Often blames others for his or her mistakes or misbehaviour
- Vindictiveness
- Has been spiteful or vindictive at least twice within the past 6 months
Diagnostic criteria for the disorder highlight the prerequisite that these symptoms cause distress within the individual and those associated with them, as result in an interference with adequate functionality. Moreover, these symptoms should not be the effect of other underlying disorders, or the use of psychotic substances.
The disorder is specified in terms of severity. In the case of symptoms being limited to one setting, the occurrence of the disorder is considered to be mild. Moderate and severe classifications of the disorder are made when symptoms appear in two, and three or more settings respectively.
Due to the possibility of symptoms being limited to only one setting, commonly the home, the diagnostic process should take into account a possible variance among the accounts given by any informants.
Treatment
Treatment options for Oppositional Defiant Disorder tend to focus on the behavioral component of the disorder rather than the affective component.
Parent-centric approaches include Parental Management Technique, which reinforces parenting skills and prioritizes quality time spent with the child. Parent-Child Interaction Therapy makes the use of direct instruction and gives parents insight into effectively motivating children, as well as helping children implement problem-solving skills.
Functional Family Therapy may be effective when symptomatic behavior influences and is influenced by the composition and functioning of the family as a whole.ย
Peer and social interventions, as well as family units, school, and individual-level intervention is incorporated together in Multisystemic Therapy, in order to take into consideration every possible problem area in the individualโs life.
In older children, Cognitive Behavioral Therapy can be of considerable efficacy for management of symptoms.ย
Psychosocial and behavior therapy based interventions are the preferable course of treatment for Oppositional Defiant Disorder, and pharmacological treatment is usually implemented in order to treat any comorbid disorders.
Differential Diagnosis
1. 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. The behaviors of oppositional defiant disorder are less severe in nature than those of conduct disorder and do not include aggression toward people or animals, destruction of property, or a pattern of theft or deceit. And, oppositional defiant disorder includes problems of emotional dysregulation that are not included in the definition of conduct disorder.
2. Attention-deficit/hyperactivity disorder: ADHD is often comorbid with oppositional defiant disorder. To make the diagnosis of oppositional defiant disorder, it is important to determine that the individual’s failure to conform to requests is not solely in situations that demand attention or demand that the individual sit still.
3. Depressive and bipolar disorders: Depressive and bipolar disorders often involve negative affect and irritability. As a result, a diagnosis of oppositional defiant disorder should not be made if the symptoms occur only during the course of a mood disorder.
4. Intermittent explosive disorder: Intermittent explosive disorder also involves high rates of anger. However, individuals with this disorder show serious aggression toward others that is not part of the definition of oppositional defiant disorder.
5. Disruptive mood dysregulation disorder: Oppositional defiant disorder shares with disruptive mood dysregulation disorder the symptoms of chronic negative mood and temper outbursts. However, the severity, frequency, and chronicity of temper outbursts are more severe in disruptive mood dysregulation disorder than in oppositional defiant disorder.
6. Intellectual disability: A diagnosis of oppositional defiant disorder is given only if the oppositional behavior is greater than commonly observed among individuals of comparable mental age and with comparable severity of intellectual disability.
7. Language disorder: Oppositional defiant disorder must also be distinguished from a failure to follow directions that is the result of impaired language comprehension.
8. Social anxiety disorder: Oppositional defiant disorder must also be distinguished from defiance due to fear of negative evaluation associated with social anxiety disorder.
Comorbidity
Oppositional Defiant Disorder is comorbid with ADHD, conduct disorder, anxiety disorders and major depressive disorder and substance use disorders.
Specialist
The diagnosis of Oppositional Defiant Disorder may be carried out by a qualified psychiatrist or clinical psychologist. Mental health practitioners including behavior therapists with adequate expertise in the treatment of behavior disorders may be involved in the treatment process.
In Conclusion
The oppositional defiant disorder cannot be entirely prevented. Positive parenting techniques and prompt medical attention, however, can aid in behavior improvement and stop things from getting worse. It is better to treat ODD as soon as possible.
The right kind of treatment can repair your child’s self-confidence and your bond with them. Early intervention will help improve your child’s interactions with other significant adults in his or her life, such as teachers and caregivers.
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