Oppositional defiant disorder is a pattern of disobedient, hostile, and defiant behavior towards authority figures. The pattern must persist for at least six months and must go beyond the bounds of normal childhood misbehavior.

Causes, incidence, and risk factors

This disorder is more prevalent in boys than girls. Some studies have found that as much as 20% of the school age population are affected, but most experts believe this figure is over-inflated due to changing cultural definitions of normal childhood behavior and other possible racial, cultural, and gender biases. The onset typically begins by age 8. The cause of this disorder is unknown, and may be due to a combination of biology and parenting or environmental factors.

Signs and tests

The pattern of behaviors must be distinguished from what is commonly observed in other children of similar age and developmental level, and must result in significant social or academic problems. Evaluation by a psychiatrist or psychologist may be recommended. In children and adolescents, depression and attention-deficit /hyperactivity disorder (ADHD) may cause similar disturbances in behavior, and should be considered as alternate or additional diagnoses.

Treatment

The best treatment for the child is individual psychotherapy. The parents should also learn behavioral management skills. Medication may be helpful if the behaviors occur in the course of another condition (such as depression, childhood psychosis, or ADHD). Punitive treatments like boot camps and "behavioral modification" schools which restrict contact with parents and place the child amongst other disturbed children can do more harm than good.

Expectations (prognosis)

The outcome varies. Some children respond well to treatment.

Complications

In a significant proportion of cases, the adult condition of conduct disorder can be traced back to the presence of oppositional defiant disorder in childhood.

Calling your health care provider

Call your health care provider if you have concerns about your child's development or behavior.

Prevention

Consistency in rules and fair consequences should be practiced in the child's home. Punishments should not be overly harsh or inconsistently applied. Appropriate behaviors should be modeled by the adults in the household. Abuse and neglect increase the chances that this condition will occur.