Common Questions About Oppositional Defiant Disorder

 


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Oppositional defiant disorder (ODD) is a disruptive behavior disorder characterized by a pattern of angry or irritable mood, argumentative or defiant behavior, or vindictiveness lasting for at least six months. Children and adolescents with ODD may have trouble controlling their temper and are often disobedient and defiant toward others. There are no tools specifically designed for diagnosing ODD, but multiple questionnaires can aid in diagnosis while assessing for other psychiatric conditions. ODD is often comorbid with attention-deficit/hyperactivity disorder, conduct disorder, and mood disorders, including anxiety and depression. Behavioral therapy for the child and family members improves symptoms of ODD. Medications are not recommended as first-line treatment for ODD; however, treatment of comorbid mental health conditions with medications often improves ODD symptoms. Adults and adolescents with a history of ODD have a greater than 90% chance of being diagnosed with another mental illness in their lifetime. They are at high risk of developing social and emotional problems as adults, including suicide and substance use disorders. Early intervention seeks to prevent the development of conduct disorder, substance abuse, and delinquency that can cause lifelong social, occupational, and academic impairments.

Oppositional defiant disorder (ODD) is a disruptive behavior disorder characterized by a pattern of angry or irritable mood, argumentative or defiant behavior, or vindictiveness lasting for at least six months (Table 1).1 Children and adolescents with ODD may have trouble controlling their temper and are often disobedient and defiant toward others. ODD usually manifests in children by late preschool or early elementary school, although it can also begin in adolescence.2,3

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BEST PRACTICES IN PSYCHIATRY: RECOMMENDATIONS FROM THE CHOOSING WISELY CAMPAIGN

RecommendationSponsoring organization

Do not routinely prescribe antipsychotic medications as a first-line intervention for children and adolescents for any diagnosis other than psychotic disorders.

American Psychiatric Association


Source: For more information on the Choosing Wisely Campaign, see http://www.choosingwisely.org. For supporting citations and to search Choosing Wisely recommendations relevant to primary care, see http://www.aafp.org/afp/recommendations/search.htm.

BEST PRACTICES IN PSYCHIATRY: RECOMMENDATIONS FROM THE CHOOSING WISELY CAMPAIGN

RecommendationSponsoring organization

Do not routinely prescribe antipsychotic medications as a first-line intervention for children and adolescents for any diagnosis other than psychotic disorders.

American Psychiatric Association


Source: For more information on the Choosing Wisely Campaign, see http://www.choosingwisely.org. For supporting citations and to search Choosing Wisely recommendations relevant to primary care, see http://www.aafp.org/afp/recommendations/search.htm.

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Children and adolescents with ODD should be evaluated for comorbid mental health disorders, including attention-deficit/hyperactivity disorder, conduct disorder, and mood disorders.

C

5, 6, 14, 17

Parent management therapy and collaborative problem solving improve outcomes for children with ODD.

B

20, 21

Although medications should not be used as first-line treatment of ODD, pharmacotherapy for comorbid mental health conditions often improves symptoms of ODD.

C

6


ODD = oppositional defiant disorder.

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Children and adolescents with ODD should be evaluated for comorbid mental health disorders, including attention-deficit/hyperactivity disorder, conduct disorder, and mood disorders.

C

5, 6, 14, 17

Parent management therapy and collaborative problem solving improve outcomes for children with ODD.

B

20, 21

Although medications should not be used as first-line treatment of ODD, pharmacotherapy for comorbid mental health conditions often improves symptoms of ODD.

C

6


ODD = oppositional defiant disorder.

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

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Table 1.

Diagnostic Criteria for Oppositional Defiant Disorder

A. A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months as evidenced by at least four symptoms from any of the following categories, and exhibited during interaction

The Authors

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MARGARET RILEY, MD, FAAFP, is an assistant professor of family medicine at the University of Michigan Medical School, Ann Arbor, and the medical director of the Adolescent Health Initiative and the Regional Alliance for Healthy Schools in Ann Arbor....

SANA AHMED, MD, is a clinical instructor of pediatrics at the University of Michigan Medical School.

AMY LOCKE, MD, is an associate professor in the Department of Family and Preventive Medicine at the University of Utah School of Medicine, Salt Lake City, and an adjunct clinical professor at the University of Michigan Medical School. At the time the article was written, she was an assistant professor and director of integrative medicine in the Department of Family Medicine at the University of Michigan Medical School.

Address correspondence to Margaret Riley, MD, FAAFP, University of Michigan, 2025 Traverwood Dr., Ste. A6, Ann Arbor, MI 48105 (e-mail: marriley@med.umich.edu). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

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