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Oppositional defiant disorder

Definition

Oppositional defiant disorder is a pattern of disobedient, hostile, and defiant behavior toward authority figures.

Causes, incidence, and risk factors

This disorder is more common in boys than in girls. Some studies have shown that it affects 20% of school-age children. However, most experts believe this figure is high due to changing definitions of normal childhood behavior, and possible racial, cultural, and gender biases.

This behavior typically starts by age 8, but it may start as early as the preschool years. This disorder is thought to be caused by a combination of biological, psychological, and social factors.

Symptoms

• Actively does not follow adults' requests
• Angry and resentful of others
• Argues with adults
• Blames others for own mistakes
• Has few or no friends or has lost friends
• Is in constant trouble in school
• Loses temper
• Spiteful or seeks revenge
• Touchy or easily annoyed

To fit this diagnosis, the pattern must last for at least 6 months and must be more than normal childhood misbehavior.

The pattern of behaviors must be different from those of other children around the same age and developmental level. The behavior must lead to significant problems in school or social activities.

Signs and tests

Children with symptoms of this disorder should be evaluated by a psychiatrist or psychologist. In children and adolescents, the following conditions can cause similar behavior problems and should be considered as possibilities:

• Anxiety disorders
• Attention-deficit /hyperactivity disorder (ADHD)
• Bipolar disorder
• Depression
• Learning disorders
• Substance abuse disorders

Treatment

The best treatment for the child is to talk with a mental health professional in individual and possibly family therapy. The parents should also learn how to manage the child's behavior.

Medications may also be helpful, especially if the behaviors occur as part of another condition (such as depression, childhood psychosis, or ADHD).

Support Groups

Expectations (prognosis)

Some children respond well to treatment, while others do not.

Complications

In many cases, children with oppositional defiant disorder grow up to have conduct disorder as teenagers or adults. In some cases children may grow up to have antisocial personality disorder.

Calling your health care provider

Call your health care provider if you have concerns about your child's development or behavior.

Prevention

Be consistent about rules and consequences at home. Don't make punishments too harsh or inconsistent.

Model the right behaviors for your child. Abuse and neglect increase the chances that this condition will occur.

References

Steiner H, Remsing L, Work Group on Quality Issues. Practice parameter for the assessment and treatment of children and adolescents with oppositional defiant disorder. J Am Acad Child Adolesc Psychiatry. 2007;46:126-141.