Oppositional Defiant Disorder

1. Pathophysiology
   1. Behavior disorder in children with onset in preschool or elementary school
   2. On spectrum of behavior continuum
      1. Children
         1. Normal defiance in childhood (exercising autonomy)
         2. Oppositional Defiant Disorder (develops in up to 16% of children)
         3. Conduct Disorder (develops in 33% of Oppositional Defiant Disorder children)
      2. Adults
         1. Antisocial Personality Disorder (develops in 40% of Conduct Disorder children)
2. Diagnosis: DSM IV Criteria
   1. Six month or more of negative, hostile or defiant behavior
   2. Criteria (requires 4 or more behaviors that the child demonstrates frequently)
      1. Loses temper
      2. Argues with adults
      3. Actively defies or refuses to comply with adults' requests or rules
      4. Deliberately annoys people
      5. Blames others for the child's own mistakes or Misbehavior
      6. Easily annoyed by others ("touchy")
      7. Angry and resentful
      8. Spiteful or vindictive
   3. Results in signficantly impaired social, academic or occupational functioning
   4. Behaviors not limited to Psychosis or Mood Disorder episodes
   5. Does not meet criteria for Conduct Disorder (children) or Antisocial Personality (adults)
3. Diagnosis: Screening Tools
   1. NICHQ Vanderbilit Assessment Scale
   2. SNAP-IV Teacher and Parent Rating Scale
4. Associated Conditions
   1. Attention Deficit Disorder (up to 40%)
   2. Anxiety Disorder (14%)
   3. Major Depression (9%)
5. Management
   1. Psychology
   2. Treat comorbid Attention Deficit Disorder
      1. Stimulant medications improve both Attention Deficit Disorder and comorbid ODD
   3. Treat comorbid Mood Disorders
   4. Parent Training
      1. Teaches more positive and less harsh responses to child
6. Prevention
   1. Preschool programs such as Head Start
   2. Parent Management Strategy programs
      1. Triple-P-Positive Parenting Program
      2. Incredible Years
      3. Parenting Through Change
7. Complications ( See pathophysiology above)
   1. Conduct Disorder (children)
   2. Antisocial Personality Disorder (adults)
8. References
   1. Hamilton (2008) Am Fam Physician 78:861-8
   2. Maughan (2004) J Child Psychol Psychiatry 45(3): 609-21
   3. Steiner (2007) J Am Acad Child Adolesc Psychiatry 46(1):126-41