Background
Oppositional defiant disorder (ODD) is defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) as a recurrent pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months. [1, 2] To fulfill the diagnosis, an individual must have at least 4 symptoms from the following categories:
Angry/Irritable Mood
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Often loses temper
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Often touchy or easily annoyed
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Often angry and resentful
Argumentative/Defiant Behavior
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Often argues with authority figures or with adults (if a child or adolescent)
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Often actively defies or refuses to comply with requests from authority figures
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Often deliberately annoys others
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Often blames others for his or her mistakes or poor behavior
Vindictiveness
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Has been spiteful or vindictive at least twice within the past 6 months
Symptoms are distinguished from behaviors that are developmentally normative for children of different ages: for children younger than 5 years, the behavior should occur on most days; for children 5 years or older, the behavior should occur at least once per week. Symptoms may be present at home, in the community, at school, or in all three settings.
Etiology
Oppositional defiant disorder (ODD) is associated with temperamental contributions including poor emotion regulation, high levels of emotional reactivity, and poor frustration tolerance. [29] Environmental risk factors include harsh or neglectful parenting, and highly authoritarian parenting.
Children with ADHD are particularly vulnerable. The child will react to the excessive control of the parent by becoming angry and wanting to assert himself or herself even more. The child will see the parent as inappropriately domineering and bossy, rather than helpful. The parent sees the child as unreasonable and disrespectful and is likely to try doubly hard to enforce his or her authority.
Interactional patterns betwen parents and children may develop that inadvertently promote and maintain the behaviors. For example, the child's negative behaviors may be rewarded by attention, which albeit negative, tends to maintain or even increase the undesired behaviors. [3] Both children and parents may become angry and increasingly rigid in their stances as they try to defend their self-esteem.
Epidemiology
Estimated prevalence ranges from 1% to 11% in the general population, with an average of 3.3%. Before puberty, the condition is more common in boys (1.4:1); however, after puberty, it is equally common in boys and girls. The disorder usually manifests by age 8 years. [1]
Roughly half the children with attention-deficit/hyperactivity disorder (ADHD) have oppositional defiant disorder (ODD).
Patient Education
Learning more effective parenting skills is a critical component of treatment for ODD. When parents are unable or unwilling to engage in treatment, due to their own emotional or other issues, treatment for their child will be compromised.
