II. Epidemiology
- Prevalence: 3.3%
- Slightly more common in males until adolescence (then equal between genders)
III. Pathophysiology
- Behavior disorder in children with onset in preschool or elementary school
- On spectrum of behavior continuum
- Children
- Normal defiance in childhood (exercising autonomy)
- Oppositional Defiant Disorder (develops in 1-16% of children, 3.3% on average)
- Conduct Disorder (develops in 33-42% of Oppositional Defiant Disorder children)
- Adults
- Antisocial Personality Disorder (develops in 40% of Conduct Disorder children)
- Children
IV. Risk Factors
- Poverty
- Parental Nicotine use
- Prenatal nutritional deficiency
- Developmental Delay
- Detached or unresponsive parenting
- Maternal aggression
- Harsh punishment or abuse
- Inconsistent Discipline
- Lack of structured environment
- Community Violence
V. Symptoms
- Children and adolescents with disobedience and difficulty controlling their temper
- Usual onset by early elementary school
VI. Diagnosis: DSM V Criteria
- Six month or more of negative, hostile, argumentative, vindictive or defiant behavior
- Occurs during interaction with at least one person who is not a sibling
- Criteria: Requires 4 or more behaviors (any category) that the child demonstrates frequently
- Angry irritable Mood
- Loses temper
- Easily annoyed by others ("touchy")
- Angry and resentful
- Argumentative or defiant behavior
- Argues with authority figures (includes adults when occurring in children)
- Actively defies or refuses to comply with authority figure's requests or rules
- Deliberately annoys people
- Blames others for the child's own mistakes or Misbehavior
- Vindictiveness
- Spiteful or vindictive at least twice in the last 6 months
- Angry irritable Mood
- Severity: Related to number of settings affected (home, school, work, peers)
- Mild: 1 setting
- Moderate: 2 settings
- Severe: 3 or more settings
- Behaviors occur on most days in age <5 years, and at least weekly in age >5 years
- Behaviors are not consistent with typical behavior (esp. <5 years old), developmental level, gender, culture
- Results in distress in patient or others or signficantly impairs social, academic or occupational functioning
- Behaviors not limited to Psychosis, Substance Abuse, Bipolar Disorder or Mood Disorder episodes
- Does not meet criteria for disruptive mood dysregulation disorder (DMDD)
- References
- (2013) DSM V, APA, Washington D.C., p. 462-3
VII. Diagnosis: Screening Tools
- Free scales
- NICHQ Vanderbilit Assessment Scale
- SNAP-IV Teacher and Parent Rating Scale (Swanson, Nolan, Pelham)
- Commercial scales (fee charged for use)
- Child behavior checklist
- Connors 3
VIII. Associated Conditions
- Attention Deficit Disorder (up to 40%)
- Conduct Disorder (42%)
- Anxiety Disorder (14%)
- Major Depression (9%)
IX. Differential Diagnosis
- Difficulty following rules or oppositional behavior
- Irritability or negative affect
- Anger outbursts
- Disruptive mood dysregulation disorder (DMDD)
- Intermittent explosive disorder
X. Management
- Treat comorbid Attention Deficit Disorder
- Stimulant Medications and Clonidine improve both Attention Deficit Disorder and comorbid ODD
- Treat comorbid Mood Disorders
- Fluoxetine has been shown effective for comorbid depression and ODD
- Atypical Antipsychotics (esp. Risperidone) may be effective for aggression and conduct problems
- Mental health referral (often group therapy, see programs below)
- Child therapy (including CBT)
- Problem solving skill training
- Collaborative problem solving (child problem solves with parents)
- Parent Training (parent management therapy)
- Teaches more positive and less harsh responses to child
- Disruptive behavior management
- Avoiding reinforcement of behaviors
- Timely and appropriate consequences
- Child therapy (including CBT)
XI. Prevention
- See Parenting Resources
- Preschool programs such as Head Start
- Parent Management Strategy programs
- Triple-P-Positive Parenting Program
- Incredible Years
- Parenting Through Change
XII. Complications
- See pathophysiology above
- Conduct Disorder (children)
- Antisocial Personality Disorder (adults)
- Substance Use Disorder
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Definition (NCI) | A behavior disorder characterized by a persistent pattern of defiant, disobedient, and hostile behavior towards authority figures, manifested by a frequent loss of temper, arguing, becoming angry or vindictive, or other negativistic behaviors. |
Definition (PSY) | A psychopathological disorder, usually beginning in childhood, consisting of negativism, disobedience, and hostile behavior toward authority figures. |
Definition (CSP) | recurrent pattern of negativistic, defiant, disobedient, and hostile behavior toward authority figures that persists for at least 6 months and is characterized by frequent occurrence of at least four of the following behaviors: losing temper, arguing with adults, actively defying or refusing to comply with requests or rules of adults, deliberately annoying others, blaming others for own mistakes, easily annoyed, angry or resentful; frequently attention deficit disorders and learning disorders are associated with this disorder. |
Concepts | Mental or Behavioral Dysfunction (T048) |
MSH | D019958 |
ICD9 | 313.81 |
ICD10 | F91.3 |
SnomedCT | 192601006, 18941000 |
DSM4 | 313.81 |
English | Defiant Disorder, Oppositional, OPPOSITIONAL DEFIANT DIS, oppositional defiant disorder of childhood (diagnosis), oppositional defiant disorder of childhood, Opposition defiant disor, defiant disorders oppositional, defiant disorder oppositional, disorder oppositional defiant, oppositional defiant disorder, Oppositional defiant disorder of childhood or adolescence, Oppositional defiant disorder, Oppositional defiant disorder (disorder), behavioral disorder; oppositional defiance, disorder; oppositional defiance, oppositional defiance; behavioral disorder, oppositional defiance; disorder, Oppositional Defiant Disorder |
Italian | Disturbo da disobbedienza oppositiva, Disturbo oppositivo provocatorio |
Japanese | 反抗挑戦性障害, ハンコウチョウセンセイショウガイ |
Czech | porucha s opozičním vzdorem, Porucha s opozičním vzdorem |
Portuguese | Transtorno Desafiador de Oposição, Doença oposicional (ODD) |
Spanish | Trastorno Provocador de Oposición, trastorno negativista desafiante (trastorno), trastorno negativista desafiante, trastorno oposicionista desafiante, Trastorno negativista desafiante |
French | Trouble oppositionnel avec provocation, TOP (Trouble Oppositionnel avec Provocation) |
German | Oppositionelles Problemverhalten, Stoerung des Sozialverhaltens mit oppositionellem, aufsaessigem Verhalten, abweisendes Trotzverhalten |
Korean | 도전적 반항적 장애 |
Hungarian | Dacos ellenkezéses zavar |
Norwegian | Opposisjonell atferdsforstyrrelse |
Dutch | gedragsstoornis; oppositioneel opstandig, oppositioneel opstandig; gedragsstoornis, oppositioneel opstandig; stoornis, stoornis; oppositioneel opstandig, oppositioneel-opstandige gedragsstoornis, Oppositioneel-opstandige gedragsstoornis |