Oppositional Defiant Disorder

Key Points

• The provider must establish a therapeutic alliance with both the child and the family to be successful in treating oppositional defiant disorder.

• The diagnosis of ODD is based on reports from the parents and child; carefully consider the possibility of comorbid conditions.

• The best treatment of ODD usually is parent training in behavior management techniques.

• Medication may be helpful in treating the symptoms of comorbid conditions.

The prevalence of oppositional defiant disorder (ODD) in children under 18 years old is widely reported as 2% to 16%. Before puberty, males outnumber females, but after puberty the rates are more equal. The disorder is usually evident by 8 years of age (APA, 2000). ODD is a chronic persistent disorder; however, approximately 67% of childhood cases have resolved 3 years later. About 30% of children with early-onset ODD develop conduct disorder (Connor et al., 2002).

The characteristics predisposing to ODD are biologic, social, and psychological, involving the parents and child. The parents usually employ poor, ineffective, inconsistent, and indiscriminate behavioral management methods, which are often combined with unusually harsh but inconsistent discipline and poor monitoring of activities. These children are usually temperamental, impulsive, active, and inattentive. The parents themselves are frequently immature, temperamental, and impulsive. The family members usually experience significant marital, financial, health, and personal distress (Barkley, 1997).

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