- Last edited on March 3, 2021
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
- 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
Angry/Irritable Mood
- Often loses temper.
- Is often touchy or easily annoyed.
- Is often angry and resentful.
Vindictiveness
- Has been spiteful or vindictive at least
twice
within the past6
months.
Mnemonic
The mnemonicREAL BADS
can be used to remember the symptoms of ODD:
R
- ResentfulE
- Easily annoyedA
- Argues with adultsL
- Loses temperB
- Blames othersA
- Annoys people deliberatelyD
- Defies rules or requestsS
- Spiteful
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.
Specifiers
Severity Specifier
Specify current severity:
- Mild: Symptoms are confined to only
1
setting (e.g. - at home, at school, at work, with peers). - Moderate: Some symptoms are present in at least
2
settings. - Severe: Some symptoms are present in
3
+ settings.
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