How is Oppositional Defiant Disorder Diagnosed?

Oppositional defiant disorder (ODD) is a mental condition that presents as a recurring pattern of irritable/angry mood, defiant/argumentative behavior, or vindictiveness, that lasts for a period of at least 6 months. While the exact cause of ODD is not clear, biological, genetic and environmental factors are all believed to play their roles.

Children with chemical imbalances in the brain, as well as those with a positive parental history of mental health disorders, and those born to mothers who smoked during pregnancy, are at a particularly increased risk for developing ODD.

Patients are typically hostile and aggressive, together with defiant, spiteful and generally negative attitudes towards figures of authority. They have no interest in adhering to rules, throw temper tantrums, blame others for their misconduct and are easily annoyed.

As many as 16% of children and adolescents may have ODD, and the condition is seen in up to half of those affected with attention-deficit/ hyperactivity disorder (ADHD). However, mood disorders, such as bipolar disorder and depression, and other conditions, including learning and language disorders, are also associated with ODD.

Clinical Analysis

Healthcare practitioners must have clinical experience with ODD to diagnose this condition, because there is no one test that can diagnose the disorder. A child’s behavioral patterns are carefully assessed in addition to the taking of a complete medical history and physical examination.

Diagnosis can be made on the grounds of a child having met the definition of ODD as stipulated by the Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition or DSM-5.

Clinical evaluation takes into account factors such as:

  • the overall health of the child
  • the intensity and frequency of the behavior
  • changes in behavioral patterns in different settings
  • the presence of other associated conditions that affect the child’s psychosocial and academic development.

The latter is particularly important, because it is not uncommon to find co-existing mental disorders in children who have ODD. It is critical to identify these conditions as well, since these may significantly affect the child’s prognosis if left untreated.

Diagnostic Criteria

A child must present with at least 4 symptoms with regards to his/ her mood, behavior or vindictiveness. In terms of mood, a child is assessed to find out if he/ she is often resentful or angry, easily annoyed and/or is quick to fly off the handle. Behavioral parameters to be evaluated include argumentative stances with figures of authority, failure to comply with requests (in a spirit of defiance), deliberate attempts to annoy others, and blaming others for one’s own misconduct and/or mistakes.

A child who has been vindictive or spiteful at least two times in a six-month period meets the vindictiveness criterion for ODD.

It is important to make a distinction between what is developmentally normal for a child’s given age and ODD. In children younger than the age of 5 years, the behavioral criteria should be met for a period of at least six months and should occur on most days during that timeframe.

Children who are 5 or older should exhibit typical traits associated with ODD at least once per week for a period of at least six months. These criteria serve as a diagnostic guide to establishing the age-appropriate frequency of the disorder. They should be taken into account with other factors to determine if the behavioral pattern is outside of the normative from a cultural, gender or developmental perspective.

Reviewed by Liji Thomas, MD

Further Reading

Last Updated: Mar 1, 2017

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