Oppositional

Defiant Disorder
Jasmine Khan
Neha Konda
Zainab Saify
Zinia Jokhi
 Diagnostic Criteria
A- A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months as evidenced
by at least four symptoms from any of the following categories, and exhibited during interaction with at least one individual
who is not a sibling.
Angry/Irritable Mood
1. Often loses temper.
2. Is often touchy or easily annoyed.
3. Is often angry and resentful.
Argumentative/Defiant Behavior
4. Often argues with authority figures or, for children and adolescents, with adults.
5. Often actively defies or refuses to comply with requests from authority figures or with rules.
6. Often deliberately annoys others.
7. Often blames others for his or her mistakes or misbehavior
Vindictiveness
8. Has been spiteful or vindictive at least twice within the past 6 months.
B. The disturbance in behavior is associated with distress in the individual or others in his or her immediate social context
(e.g., family, peer group, work colleagues), or it impacts negatively on social, educational, occupational, or other important
areas of functioning.
C. The behaviors do not occur exclusively during the course of a psychotic, substance use, depressive, or bipolar disorder.
Also, the criteria are not met for disruptive mood dysregulation disorder.
Specify current severity:
• Mild: Symptoms are confined to only one setting (e.g., at home, at school, at work, with peers).
• Moderate: Some symptoms are present in at least two settings.
Associated Features
• ·Associated features may include temper outbursts, easily becoming annoyed or frustrated, and a general
disposition of irritability even in non-confrontational situations.
• ·frequent arguing with adults, refusal to comply with rules or requests, and deliberately annoying others.
• ·tendency to hold grudges, plotting or planning retaliation, and deliberately causing harm or distress to
others as a means of revenge.
• ·aggression towards peers, bullying behavior, and a lack of empathy or concern for the feelings of others.
• ·frequent arguments or power struggles within the family, strained parent-child relationships, and
disruption of family routines and activities due to the child's behavior.
• ·defiance towards teachers or school staff, refusal to complete schoolwork, and disruptive behavior that
interferes with learning.
• ·may include symptoms characteristic of these comorbid disorders, such as inattention and hyperactivity
in ADHD, or aggression and rule-breaking behavior in CD.
• ·Oppositional defiant disorder has been associated with increased risk for suicide attempts, even after
comorbid disorders are controlled for
 Development and
Prevalence Onset course
• The cross-national • Oppositional Defiant • The first symptoms of
prevalence of oppositional Disorder (ODD) typically oppositional defiant disorder
manifests in children, with usually appear during the
defiant disorder ranges from
symptoms often emerging preschool years.
1% to 11%, with an average
by early school age, around • Oppositional defiant disorder
prevalence estimate of
6-8 years old. also conveys risk for the
around 3.3%. • ODD is commonly development of anxiety
• The disorder appears to be diagnosed during childhood disorders and major
somewhat more prevalent or adolescence, usually depressive disorder.
in boys than in girls. between the ages of 6 and • Manifestations of the disorder
12, although it can also be across development appear
diagnosed later in life if consistent.
symptoms persist.
 Risk and prognostic factors
• Temperamental - Temperamental factors related to problems in emotional
regulation (e.g., high levels of emotional reactivity, poor frustration tolerance)
have been predictive of the disorder.
• Environmental - Children with oppositional defiant disorder influence their
environments, which in turn can influence them.
• Genetic and physiological - A number of neurobiological markers have been
associated with oppositional defiant disorder. E.G., lower heart rate and skin
conductance reactivity; reduced basal cortisol reactivity; abnormalities in the
prefrontal cortex and amygdala. Studies have demonstrated overlapping
genetic influences for the irritability and anger symptoms of oppositional
defiant disorder with depression and generalized anxiety disorder.
 Differential diagnosis
[Link] Disorder : Conduct Disorder shares similarities with ODD but involves more severe and
aggressive behaviours.
[Link] : ADHD primarily involves inattention, hyperactivity, and impulsivity,
[Link] Mood Dysregulation Disorder : DMDD presents with severe temper outbursts and
chronic irritability. DMDD is characterized by more severe and frequent temper outbursts that are
disproportionate to the situation.
4. PTSD : In children younger than 6 years, posttraumatic stress disorder may manifest initially as
dysregulated behaviours, opposition, and tantrums. In adolescents, traumatic re-enactment and
risk-taking may be misinterpreted as defiance and opposition or as conduct problems.
[Link] Disorders : Children with anxiety disorders may display oppositional behaviours as a
means of coping with distress or avoiding anxiety-provoking situations.
[Link] Spectrum Disorder : Some behaviours associated with ASD, such as resistance to changes
in routine and social communication difficulties, may resemble oppositional behaviours seen in
ODD.
[Link] disorder : Oppositional defiant disorder must also be distinguished from a failure to
follow directions that is the result of impaired language comprehension.
Comorbidity
[Link] Disorder : ODD often precedes or coexists with CD, particularly in adolescence.
[Link]: ODD frequently coexists with ADHD, with estimates suggesting that up to 50-60%
of children with ADHD also meet criteria for ODD.
[Link] Disorders : Children with ODD may experience significant anxiety, particularly in
response to social situations or academic demands.
[Link] Disorders : ODD may co-occur with mood disorders, such as depression or bipolar
disorder, particularly in adolescents.
[Link] Disabilities : Children with learning disabilities, such as dyslexia or specific
learning disorders, may experience frustration and academic difficulties, which can
contribute to oppositional behaviours.
[Link] Use Disorders : Adolescents with ODD are at an increased risk of engaging in
substance abuse or experimentation. Substance use can exacerbate oppositional
behaviours and impede treatment progress.
 Assessment Tools Treatment Plans
1)Clinical Interview: Structured or semi-structured clinical interviews
with child, parents and sometimes teachers allow for gathering
comprehensive information about the child’s behavior,
developmental history, family dynamics and contextual factors. • Parent
2) Behavior Rating Scale: Scale typically include items related to
defiance, disobedience, agrresssion, irritability & other ODD
Management
symptoms and completed by parents, teachers or the child Training
themselves.
3) Functional Behavior Assessment(Fba): The goal of FBA is
• Individual
determine the causes, actions, and outcomes of oppositional Therapy
behaviors in order understand their function or purpose. This include
direct observation, interviews, and data collection to analyze
• School Based
patterns of behavior and identify triggers and maintaining factors. Intervention
4)Observational Methods: observational data offer unbiased
information regarding the incidence, duration, and intensity of
• Family Therapy
oppositional behaviors. Aiding in diagnosis and treatment planning. • Medication
Case Study
James is a 14 year-old year 9 grade student, who has a keen interest in cars, motorbikes, aeroplanes,and anything
else with an engine. He enjoys reading books and magazines when the subject matter interests him; such as books
about cars. He plays soccer and cricket on the weekends, and his mother believes that playing team sports helps him
learn to interact with others in a positive way. According to his mother, James father was killed in a car accident when
James was six, and he began to develop the symptoms of ODD a year and a half later, at the age of eight .
Because of his behavioral issues James has missed a lot of lessons and is beginning to fall behind in most subjects. He
hates geography, and his teacher Mr. Perkins spends most of his lessons time in distracting other students by
annoying them so that he will get sent out of class and not have to do any work. James has a few good friends that he
has known since Primary School, however he has started hanging around with a group of kids older than him who
regularly truant and smoke cigarettes and this worries his mother. consequently he goes to special reading classes as
he gets taken out of some regular lessons to attend them, and some kids make fun of him which is affecting his self-
confidence, because of that James sometimes refuses to go to school. Sometimes James became very argumentative
with teachers, especially when they ask him to do a task which he thinks is too hard, or does not want to do. .He
started regularly annoy other students during class, lose his temper when he does not get his own way, disobey
teachers and his mother and worse, will become physically violent toward other students when taunted.
On one occasion a teacher became so frustrated with James’ behavior that she snapped and lost her temper with
him. As a result James became extremely aggressive and threatened to kill her. the result of the incident being a one-
week out of school suspension for James.
Thank you