Oppositional defiant disorder
Classification and external resources
ODD develops in childhood and is often directed at parents, authority figures, and other caregivers
ICD-10	F91.3
ICD-9	313.81
MeSH	D019958

Oppositional defiant disorder (ODD) is a diagnosis described by the Diagnostic and Statistical Manual of Mental Disorders (DSM) as an ongoing pattern of anger guided disobedience, hostilely defiant behavior toward authority figures which goes beyond the bounds of normal childhood behavior. People may appear very stubborn and often angry. A diagnosis of ODD cannot be given if the child presents with conduct disorder (CD).^[1]

  Behavioral features

Common features of oppositional defiant disorder (ODD) include excessive, often persistent anger, frequent temper tantrums or angry outbursts, as well as disregard for authority. Children and adolescents with ODD often purposely annoy others, blame others for their own mistakes, and are easily disturbed. Parents often observe more rigid and irritable behaviors than in siblings.^[2] In addition, these young people may appear resentful of others and when someone does something they don't like they prefer taking revenge more than sensitive solutions.^[3]

For a child or adolescent to qualify for a diagnosis of ODD these behaviors must cause considerable distress for the family and/or interfere significantly with academic or social functioning. Interference might take the form of preventing the child or adolescent from learning at school or making friends, or placing him or her in harmful situations. These behaviors must also persist for at least six months. Effects of ODD can be greatly amplified by other disorders in comorbidity such as ADHD.^[4]

  Signs and Symptoms

Some signs and symptoms that must be perpetuated for longer than 6 months and must be considered beyond normal child behavior to fit the diagnosis are:^[5][6]

The child must exhibit 4 out of the 8 signs and symptoms listed below in order to meet the DSM-IV-TR diagnostic threshold for oppositional defiant disorder^[7]

• Actively refuses to comply with majority's requests or consensus supported rules^[8]

• Performs deliberate actions to annoy others^[8]

• Angry and resentful of others^[6]

• Argues often^[6]

• Blames others for his or her own mistakes

• Has few or no friends or has lost friends

• Is causing constant trouble at school

• Spiteful or seeks revenge

• Touchy or easily annoyed

Generally, these patterns of behavior will lead to problems at school and other social venues.^[6]

  Causes

Children of alcoholic parents, or whose parents have "been in trouble with the law" run a 18% chance of developing ODD, beginning very early in age.^[4] This could suggest that the development of ODD concerning symptoms of dis-cooperativeness may be influenced by the behavior of the parents.

  Prognosis

According to a 1992 article, if left untreated, about 52% of children with ODD will continue to meet the DSM-IV criteria up to three years later and about half of those 52% will progress into conduct disorder.^[9] This strong correlation between strong defiance in childhood and adulthood may suggest similar mechanisms for hostility towards established authority by children and by adults.

  Psychosocial treatments

One of the key factors in the development and maintenance of the negative behaviors associated with ODD symptoms is reinforcement, whether intentional or not, of the unwanted behaviors. The most effective way of treating disruptive behavior disorders is behavioral therapies.^[10] Behavioral therapy for children and adolescents focuses primarily on how to prevent problematic thoughts or behaviors from accidentally getting reinforced unknowingly within a young person's environment.

Positive reinforcement often unintentionally contributes to an increase in the frequency of ODD behaviors. Behavior therapies can be applied to a wide range of psychological symptoms among children, adolescents, and adults with ODD. Behavior therapists encourage children and adolescents to try new behaviors and not to allow unwanted reinforcement to dictate the ways in which they act. Furthermore, therapists may work with parents to discontinue ways in which they are unintentionally reinforcing unwanted behaviors. An example of how positive reinforcement can occur is when the patient is rewarded with attention when performing ODD behaviors. Attention is reinforcing itself and the reinforcing attention could be accidentally given, ironically, when trying to create a negative consequence to their behavior.^[11] Positive Punishment occurs when the patient is inadvertently punished by aversive stimuli for not performing the ODD behaviors (of revenge, dis-cooperation, and frequent anger). These aversive stimuli that punish patients for not performing ODD behaviors can include: humiliation, isolation, not being told the reason of rules (e.g. being told "the reason you should is because I said so"), not having opinions taken seriously, as well as "being pushed around".

Researchers have found that the use of positive reinforcement and praise for appropriate behaviors are two key elements in effective interventions. By using praise and positive reinforcement, the focus is placed on the negative behaviors, creating a cycle of negative interactions. For example, if the majority of interactions with the child are focused around correcting their negative behaviors, a cycle has been created, where the child expects attention after misbehaving. However, with positive reinforcement and praise, it not only builds a child's self-esteem but also serves to strengthen the bond between a child and their caregiver. It is important to note that positive reinforcement should occur immediately after a child has exhibited an appropriate behavior. The behaviors outlined for the child to be reinforced should be easy to evaluate and have very clear and easy to understand instructions. The type of reinforcement used should always depend on the child and should be developed together with both the family and the therapist.^[12]

Other approaches to the treatment of ODD, include parent training programs, individual psychotherapy, family therapy, cognitive behavioral therapy, and social skills training.^[13][14] According to the American Academy of Child and Adolescent Psychiatry, treatments for ODD are tailored specifically to the individual child, and different treatment techniques are applied for pre-schoolers and adolescents.^[15]

An approach developed by Russell Barkley^[16][17][18] uses a parent training model and begins by focusing on positive approaches to increase compliant behaviours.

Non-profit organizations such as the Mayo Clinic and the American Academy of Child & Adolescent Psychiatry (AACAP) provide information and resource centers to the public through their respective websites regarding ODD, including tests and diagnosis, treatments and drugs, as well as advice on preparation for an initial meeting with a physician regarding concerns.

  Issues to address in the DSM-V

Oppositional defiant disorder was first defined in the DSM-III. Since the introduction of ODD as an independent disorder, the field trials to inform the definition of this disorder has included predominately male subjects. Some clinicians have debated whether or not the diagnostic criteria presented above would be clinically relevant for use with females. Furthermore, some have questioned whether or not gender-specific criteria and thresholds should be included. Additionally, some clinicians have questioned the preclusion of ODD when CD is present.^[19]

  See also

Psychiatry portal

• Antisocial personality disorder
• Counterdependency
• Parent Management Training
• Passive-aggressive behavior

  References

  External links

• What is ODD? – Society for Clinical Child and Adolescent Psychology (SCCAP)
• Oppositional defiant disorder (ODD) – Mayo Clinic
• ODD Resource Center – American Academy of Child & Adolescent Psychiatry