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A.D.A.M. Medical Encyclopedia [Internet]. Atlanta (GA): A.D.A.M.; 2013.

A.D.A.M. Medical Encyclopedia.

Oppositional defiant disorder

Last reviewed: February 24, 2014.

Oppositional defiant disorder is a pattern of disobedient, hostile, and defiant behavior toward authority figures.

Causes

This disorder is more common in boys than in girls. Some studies have shown that it affects 20% of school-age children. However, most experts believe this figure is high due to changing definitions of normal childhood behavior, and possible racial, cultural, and gender biases.

This behavior typically starts by age 8, but it may start as early as the preschool years. This disorder is thought to be caused by a combination of biological, psychological, and social factors.

Symptoms

  • Actively does not follow adults' requests
  • Angry and resentful of others
  • Argues with adults
  • Blames others for own mistakes
  • Has few or no friends or has lost friends
  • Is in constant trouble in school
  • Loses temper
  • Is spiteful or seeks revenge
  • Is touchy or easily annoyed

To fit this diagnosis, the pattern must last for at least 6 months and must be more than normal childhood misbehavior.

The pattern of behaviors must be different from those of other children around the same age and developmental level. The behavior must lead to significant problems in school or social activities.

Exams and Tests

Children with symptoms of this disorder should be evaluated by a psychiatrist or psychologist. In children and adolescents, the following conditions can cause similar behavior problems and should be considered as possibilities:

Treatment

The best treatment for the child is to talk with a mental health professional in individual and possibly family therapy. The parents should also learn how to manage the child's behavior.

Medications may also be helpful, especially if the behaviors occur as part of another condition (such as depression, childhood psychosis, or ADHD).

Outlook (Prognosis)

Some children respond well to treatment, while others do not.

Possible Complications

In many cases, children with oppositional defiant disorder grow up to have conduct disorder as teenagers or adults. In some cases children may grow up to have antisocial personality disorder.

When to Contact a Medical Professional

Call your health care provider if you have concerns about your child's development or behavior.

Prevention

Be consistent about rules and consequences at home. Don't make punishments too harsh or inconsistent.

Model the right behaviors for your child. Abuse and neglect increase the chances that this condition will occur.

References

  1. Steiner H, Remsing L, Work Group on Quality Issues. Practice parameter for the assessment and treatment of children and adolescents with oppositional defiant disorder. J Am Acad Child Adolesc Psychiatry. 2007;46:126-141. [PubMed: 17195736]

Review Date: 2/24/2014.

Reviewed by: Fred K. Berger, MD, Addiction and Forensic Psychiatrist, Scripps Memorial Hospital, La Jolla, California. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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Copyright © 2013, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only — they do not constitute endorsementscof those other sites. © 1997–2011 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Copyright © 2013, A.D.A.M., Inc.

What works?

  • Atypical antipsychotic drugs for disruptive behaviour disorders in children and youthsAtypical antipsychotic drugs for disruptive behaviour disorders in children and youths
    Children and young people with disruptive behaviour disorders often present with aggression and severe behaviour problems. These can result in families seeking psychiatric services, where a number of medications, including atypical antipsychotics, may be used to reduce these symptoms. There is evidence that the use of atypical antipsychotics for disruptive behaviour disorders in youths is on the increase. We searched for clinical studies of atypical antipsychotics used for disruptive behaviour disorders in children and young people to evaluate whether these medications are effective and safe. We found eight studies. Seven of these studies investigated the efficacy of risperidone and one study used quetiapine. The analysis suggested that risperidone led to a reduction of aggression and conduct problems to some extent after six weeks of treatment and that the medication appeared safe during the study period. Use of medication, however, was associated with significant weight gain. The findings need to be considered with caution because of the limitations of the evidence. For example, the studies measured and reported different outcome measures, which limited our ability to combine the findings, and there were no studies with children under the age of five years. We recommend that more research is carried out in this field to find out the long‐term efficacy and safety of these medications in treating disruptive behaviour disorders in children and youths.
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