pediatrics
Oppositional Defiant Disorder (ODD)
Introduction
Oppositional defiant disorder is a recurrent or persistent pattern of negative, defiant, or even hostile behavior directed at authority figures. Diagnosis is by clinical criteria. Treatment is with individual psychotherapy combined with family or caregiver therapy. Occasionally, medications may be used to reduce irritability. Prevalence estimates of oppositional defiant disorder vary widely because the diagnostic criteria are highly subjective; prevalence in children and adolescents may be as high as 15%. Before puberty, affected boys greatly outnumber girls; after puberty, the difference narrows. Although oppositional defiant disorder is sometimes viewed as a mild version of Conduct Disorder , similarities between the 2 disorders are only superficial. The hallmark of this disorder is an interpersonal style characterized by irritability and defiance. However, children with a conduct disorder seemingly lack a conscience and repeatedly violate the rights of others (eg, bullying, threatening or causing harm, being cruel to animals), sometimes without any evidence of irritability. Etiology of oppositional defiant disorder is unknown, but it is probably most common among children from families in which the adults engage in loud, argumentative, interpersonal conflicts. This diagnosis should not be viewed as a circumscribed disorder but rather as an indication of underlying problems that may require further investigation and treatment. 