Oppositional Defiant Disorder

Definition of Oppositional Defiant Disorder

The Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-V) (American Psychiatric Association, 2013), is a handbook that is used by professionals around the world to diagnose a range of mental disorders.The DSM–V describes ODD as a pattern of angry/irritable mood, argumentative/defiant behaviours or vindictiveness towards authority figures. The first symptoms of ODD usually appear during preschool years and rarely later than early adolescence.

Most children, adolescents and young adults have at least once argued with authority figures, refused to comply with a rule or request, or annoyed someone on purpose and blamed the other person for their behaviour. However, for these individuals, it is not their normal pattern of behaviour. These behaviours may be in response to overwhelming stresses in their lives or a developmental phase they are going through. Hence, this negative behaviour pattern is generally short-lived and tends to disappear as the individual adjusts to the new circumstance or matures. However, for some individuals with persistent oppositional and defiant behaviours or with a diagnosis oppositional defiant disorder (ODD), this is not the case.

Causes of ODD

The exact cause is currently unknown, rather the interaction between the risk factors may contribute to its development. They include:

• Genetic factors: a predisposition to ODD is inherited in families with a history of attention deficit hyperactivity disorder (ADHD), substance use disorders, or mood disorders such as depression or bipolar disorder.
• Physiological factors: abnormal functioning of certain types of brain chemicals or neurotransmitters lead to abnormalities in brain functioning.
• Temperamental factors: the child has a difficult temperament (e.g. poor frustration tolerance, intense and high reactive responding and difficulty being soothed).
• Environmental factors: the influence of the family is a strong risk factor for many individuals with ODD. 

Some of the family level risk factors include:

• Parental lack of supervision.
• Parental rejection and neglect.
• Parental discipline is too harsh or too relaxed or inconsistent.
• Parental inconsistent child rearing practices.
• Parental criminality.
• Parental disharmony.
• Lack of parental monitoring.
• Parents with a mental health problem.
• Parents with a substance abuse problems.
• Parents involved in criminal behaviour.
• Individual has been physically or sexually abused.
• Individual lives in institutionalised care.
• Individual has frequent changes of caregivers.
• Individual is part of a large family.

Types of ODD

There are two types of oppositional defiant disorder:

• Childhood-onset ODD (i.e. the child showed at least one symptom characteristic of ODD before the age of 10 years).
• Adolescent-onset ODD (i.e. the child showed no symptom characteristic of ODD before the age of 10 years).

Symptoms of ODD

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

Angry/Irritable Mood 

1. Often loses temper. 
2. Is often touchy or easily annoyed. 
3. Is often angry and resentful. 

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. 

Vindictiveness 

1. Has been spiteful or vindictive at least twice within the past 6 months.

For support with the symptoms of ODD, see:

• Teaching Emotional Regulation
• Effects of Family Conflicts on Children
• Managing Anger, a guide for Parents and Teachers

References

American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).