Oppositional defiant disorder is a pattern of disobedient, hostile, and defiant behavior toward authority figures.
Causes, incidence, and risk factors
This disorder is more common in boys than in girls. Some studies have shown that it affects 20% of school-age children. However, most experts believe this figure is high due to changing definitions of normal childhood behavior, and possible racial, cultural, and gender biases.
This behavior typically starts by age 8, but it may start as early as the preschool years. This disorder is thought to be caused by a combination of biological, psychological, and social factors.
Actively does not follow adults' requests
Angry and resentful of others
Argues with adults
Blames others for own mistakes
Has few or no friends or has lost friends
Is in constant trouble in school
Spiteful or seeks revenge
Touchy or easily annoyed
To fit this diagnosis, the pattern must last for at least 6 months and must be more than normal childhood misbehavior.
The pattern of behaviors must be different from those of other children around the same age and developmental level. The behavior must lead to significant problems in school or social activities.
Signs and tests
Children with symptoms of this disorder should be evaluated by a psychiatrist or psychologist. In children and adolescents, the following conditions can cause similar behavior problems and should be considered as possibilities:
Call your health care provider if you have concerns about your child's development or behavior.
Be consistent about rules and consequences at home. Don't make punishments too harsh or inconsistent.
Model the right behaviors for your child. Abuse and neglect increase the chances that this condition will occur.
Steiner H, Remsing L, Work Group on Quality Issues. Practice parameter for the assessment and treatment of children and adolescents with oppositional defiant disorder. J Am Acad Child Adolesc Psychiatry. 2007;46:126-141.
Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine; and Michelle Benger Merrill, MD, Instructor in Clinical Psychiatry, Department of Psychiatry, Columbia University Medical Center, New York, NY. Also reviewed byDavid Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.