According to the Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition (DSM-5), oppositional defiant disorder (ODD) is a recurring pattern of irritable/ angry mood, defiant/ argumentative behavior or vindictiveness that lasts for a period of at least 6 months. It is estimated to occur in between 1 to 16% of children and adolescents.
In younger children it is more common in boys than in girls. However, the prevalence is fairly equally distributed between both sexes later on in childhood and early adolescence.
While even normally well-behaved children may be oppositional at given points in their lives, which is normal, it becomes abnormal when there is persistent disobedient, hostile and defiant behavior towards figures of authority.
Children with ODD often question and break rules, throw temper tantrums, deliberately attempt to upset others, are easily annoyed and tend to blame others for their own misconduct. If left untreated, ODD may develop into more serious mental health issues that may affect the child both socially and academically. These children are also at an increased risk for substance abuse and juvenile delinquency.
Biological and Genetic Etiology
The exact cause of ODD remains elusive. However, several factors, including biological, genetic and environmental, which may play a role in the pathogenesis.
Susceptibility to ODD is increased in those who have a positive family history (i.e. an affected parent) with attention-deficit/ hyperactivity disorder (ADHD), conduct disorder, ODD, mood disorders (such as. bipolar disorder and depression), drinking or substance abuse. Children born to mothers who smoked during gestation are also at an increased risk of developing ODD.
Some research suggests that the behavioral patterns seen with ODD are developed in children with mood/ anxiety disorders as a means of coping. These are children who have temperament issues and are incapable of dealing with and/ or regulating their emotions.
They tolerate frustration very poorly and they are very sensitive or, in other words, highly emotional in their responses to, situations that should not warrant such strong reactions.
Any impairment in areas of the brain that are responsible for higher functions, such as judgment, reasoning and the control of impulses, may also be a factor associated with increased ODD susceptibility. Furthermore, chemical imbalances within the central nervous system, as well as exposure to noxious toxins, and malnutrition, are all implicated in ODD as contributors to its pathogenesis.
The temperament or natural disposition of a child, in addition to the differences seen in the functioning of the brain and nerves from a neurobiological perspective, may also play a genetic role in the development of ODD.
Several studies suggest that nurture and nature act together to increase one’s susceptibility to developing the condition. Poor relationships with guardians, feelings of neglect, and/ or the absence of a parent, as well as an inability to form healthy social relationships, are just some of the psychological factors that contribute to ODD.
The disorder is more often seen in children who come from lower socioeconomic backgrounds. Essentially, an environment that is chaotic, abusive or unstable, in terms of inconsistencies in discipline or housing conditions, may be implicated in the pathogenesis of ODD.
Reviewed by Liji Thomas, MD