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Oppositional Defiant Disorder ˌäp-ə-ˈzish-nəl-di-ˈfī-ənt-, -ən-ᵊl-

by Josephine Elia, MD

Oppositional defiant disorder is a recurring pattern of negative, defiant, and disobedient behavior, often directed at authority figures.

Children with oppositional defiant disorder are stubborn, difficult, disobedient, and irritable without being physically aggressive or actually violating the rights of others, as occurs in conduct disorder (see Conduct Disorder). Many preschool and early adolescent children occasionally display oppositional behaviors, but oppositional defiant disorder is diagnosed only if behaviors persist for 6 months or more and are serious enough to interfere with social or academic functioning.

What causes oppositional defiant disorder is unknown. It is probably more common among children from families in which adults have loud arguments. This disorder indicates underlying problems that may require further investigation and treatment.

Symptoms

Symptoms often begin in the time period from preschool through middle school.

Typical behaviors of these children include the following:

  • Arguing with adults

  • Losing their temper easily and often

  • Actively defying rules and instructions

  • Deliberately annoying people

  • Blaming others for their own mistakes

  • Being angry, resentful, and easily annoyed

  • Being spiteful and vindictive

These children do know the difference between right and wrong and feel guilty if they do anything that is seriously wrong. Many of them lack social skills.

Diagnosis

  • Symptoms and behavior

Doctors diagnose the disorder based on the child's symptoms and behavior, which must have been present for at least 6 months and be serious enough to interfere with the child's ability to function.

From time to time, children who have depression or anxiety are mistakenly diagnosed with oppositional defiant disorder. This misdiagnosis most commonly happens when the main symptom of depression is irritability. When oppositional defiant disorder is suspected, doctors carefully evaluate all children for signs of depression, such as sleep or appetite disturbances, as well as anxiety.

Treatment

  • Behavior management techniques

  • Possibly group therapy

Oppositional defiant disorder is best treated through behavior management techniques, which include a consistent approach to discipline and appropriate reinforcement of desired behavior (with rewards). Parents and teachers can be instructed in these techniques by the child’s counselor or therapist.

Children may benefit from group therapy that helps them improve their social skills.

Even without treatment, most children gradually improve over time.