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INTRODUCTION

Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD)—together referred to as the Disruptive Behavior Disorders (DBD) of Childhood and Adolescence—are frequently occurring and highly impairing disorders that share many core symptoms, associated features, and impairments. In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), ODD and CD have been placed with like-kind conditions that occur across the life span in the subgrouping "Disruptive, Impulse-Control, and Conduct Disorders." Each condition can present with disruptive behavior, academic underachievement, and poor social skills; impulsivity is often present. ODD represents a risk factor for subsequent development of CD, and almost all youth with CD also have ODD. However, the two conditions also differ in important ways and are therefore best considered to be related, but distinct.

OPPOSITIONAL DEFIANT DISORDER

ESSENTIALS OF DIAGNOSIS ICD-10 Diagnostic Criteria for Oppositional Defiant Disorder

Oppositional Defiant Disorder (F91.3)

A conduct disorder, usually occurring in younger children, primarily characterized by markedly defiant, disobedient, disruptive behavior that does not include delinquent acts or the more extreme forms of aggressive or dissocial behavior. Caution should be employed before using this category, especially with older children, because clinically significant conduct disorder will usually be accompanied by dissocial or aggressive behavior that goes beyond mere defiance, disobedience, or disruptiveness. The key to distinguishing ODD from other types of conduct disorders is the absence of behaviors that violate the law and the basic rights of others.

Adapted with permission from International Statistical Classification of Diseases and Related Health Problems 10th Revision <http://apps.who.int/classifications/icd10/browse/2010/en#/F90-F98>

General Considerations

As defined in DSM-5, ODD is categorized by a persistent pattern of age-inappropriate oppositional and defiant behavior towards adults (e.g., parents, teachers) and/or peers, and violation of minor rules and social conventions. Youth with ODD are often argumentative, defiant, annoying, irritable, resentful, and vindictive, and they tend to blame others for their own transgressions or omissions. Aggression, which is often but not always present, is predominantly verbal rather than physical. However, physical aggression can occur and does not necessarily signal the presence of CD. Aggression tends to be reactive (e.g., in response to imposition of unwanted rules by adults) rather than proactive or instrumental (e.g., bullying of peers for some perceived gain). It is more often overt (e.g., shouting) than covert (e.g., spreading malicious rumors), though there are important gender differences. Symptoms often begin early in life, though there are also later-onset cases. Often the behaviors persist into adolescence and adulthood in one form or another, though they may also desist. Consequently, the diagnosis is relatively unstable. Clinical treatment and research are complicated by the high prevalence of comorbidity, which has an important role in moderating clinical presentation, response to treatment, and longitudinal course.

The definition of ODD as a categorical disorder is fraught with important and challenging questions. Specifically, it is unclear to what extent oppositional behavior is best considered to ...

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