Oppositional Defiant Disorder (ODD)

Primer

Epidemiology
Prognosis
Comorbidity
Risk Factors

Diagnostic Criteria

Criterion A

A pattern of angry/irritable mood, argumentative/defiant behaviour, or vindictiveness lasting at least 6 months as evidenced by at least 4 symptoms from any of the following categories, and exhibited during interaction with at least 1 individual who is not a sibling.

Argumentative/Defiant Behaviour
  1. Often argues with authority figures or, for children and adolescents, with adults.
  2. Often actively defies or refuses to comply with requests from authority figures or with rules.
  3. Often deliberately annoys others.
  4. Often blames others for his or her mistakes or misbehaviour
Angry/Irritable Mood
  1. Often loses temper.
  2. Is often touchy or easily annoyed.
  3. Is often angry and resentful.
Vindictiveness
  1. Has been spiteful or vindictive at least twice within the past 6 months.
Note: The persistence and frequency of these behaviours should be used to distinguish a behaviour that is within normal limits from a behaviour that is symptomatic. For children younger than 5 years, the behaviour should occur on most days for a period of at least 6 months unless otherwise noted (Criterion A8 - Vindictiveness). For individuals 5 years or older, the behaviour should occur at least once per week for at least 6 months, unless otherwise noted (Criterion A8 - Vindictiveness). While these frequency criteria provide guidance on a minimal level of frequency to define symptoms, other factors should also be considered, such as whether the frequency and intensity of the behaviours are outside a range that is normative for the individual’s developmental level, gender, and culture.
Criterion B

The disturbance in behaviour is associated with distress in the individual or others in his or her immediate social context (e.g., family, peer group, work colleagues), or it impacts negatively on social, educational, occupational, or other important areas of functioning.

Criterion C

The behaviours do not occur exclusively during the course of a psychotic, substance use, depressive, or bipolar disorder. Also, the criteria are not met for disruptive mood dysregulation disorder.

Severity

Mild: Symptoms are confined to only one setting (e.g., at home, at school, at work, with peers). Moderate: Some symptoms are present in at least two settings. Severe: Some symptoms are present in three or more settings.

Mnemonic

The mnemonic REAL BADS can be used to remember the symptoms of oppositional defiant disorder

  • R - Resentful
  • E - Easily annoyed
  • A - Argues with adults
  • L - Loses temper
  • B - Blames others
  • A - Annoys people deliberately
  • D - Defies rules or requests
  • S - Spiteful

Screening Tools and Scales

Pathophysiology

Differential Diagnosis

Investigations

Hold the blood tests and medications! A biopsychosocial “investigation” to understanding aggressive behaviour is important. A child diagnosed with ODD or ADHD may all have these factors contribute to their symptoms:

  • Parenting and family factors:
    • Parenting behaviour
    • Parent-child attachment
  • Peer relationships:
    • Peer rejection
    • Deviancy “training” (getting trained to be “unliked” by others)
  • Child-level mental processes:
    • Callous-unemotional traits (degree of empathy in the child)
    • Emotional regulation
    • Executive functions and language (think learning disorders)
    • Social cognition
  • Predisposing Factors:
    • Trauma
    • Raised up in the orphanage
  • Precipitating Factors:
    • Recently punched by student
    • Recently moved
    • Recent death in family
  • Perpetuating Factors:
    • Recurring social/family/school conflicts

Treatment

Prognosis

Resources

For Patients

For Providers

Articles
Research