Oppositional Defiant Disorder

Abstract

Oppositional defiant disorder (ODD) was first introduced as a childhood disorder in DSM-III in 1966. It has since become one of the most common childhood disorders, often occurring comorbidly with other childhood disorders. ODD has a lifetime prevalence of up to 11% of the general population, with symptoms typically present by age 8 years. Approximately 70% of children and adolescents with oppositional defiant disorder no longer meet the criteria for the disorder by age 18, with only a small percentage progressing to antisocial personality disorder in adulthood. The etiology of the disorder is multifactorial—heritability, parenting styles, and other psychosocial factors have been well documented. Changes in anatomical structure and brain functioning have also been associated with the disorder.

Oppositional defiant disorder is responsive to therapeutic interventions, and recommendations for these evidence-based treatment models vary by age. Younger children respond best to parent management training, middle school children to cognitive behavioral therapies, and older adolescents to multimodal programs rooted in the social learning model. While no psychotropic medications have been approved by the Food and Drug Administration (FDA) for the treatment of oppositional defiant disorder, certain classes of medications reduce oppositional and aggressive behaviors while treating other comorbid illnesses. The most widely studied of these classes include stimulants, alpha-2 adrenergic agonists, mood stabilizers, and antipsychotics. Parents of these children present to pediatric offices seeking advice on management and treatment options. This chapter will provide the pediatric primary care physician with an overview of etiology, comorbidity, prognosis, treatment strategies, and management techniques for parents.