Oppositional Defiant Disorder (ODD)

Oppositional Defiant Disorder (ODD) is one of the most common conditions that can occur with AD/HD, the comorbidity rate being around 50%. The ODD spectrum ranges from a mildly oppositional attitude to a constant state of hostile defiance. These children tend to blame others for their problems; they are never to blame themselves for anything. This behaviour rarely starts before the preschool years, but once it does it continues into adulthood.

Children with this disorder exhibit more extreme behaviours than those with AD/HD alone. Whereas children with AD/HD can be unthinking and impulsive, they are usually genuinely remorseful afterwards. Children with ODD, however, may firmly believe that what they do is justified and therefore show no remorse. These children are always on the defensive and seem to thrive on confrontation.

ODD can occur alone, but when it occurs with AD/HD, the resulting behaviour can be very difficult to manage. It is important for parents to develop an appropriate parenting style with these children because it can make a difference; it is believed that parents who force, confront and are hostile in their relationships greatly increase the risk and the extent of the ODD in their children.

There is no drug to "cure" or "modify" ODD and there is often confusion about the effectiveness of the AD/HD medication in children who also have ODD. In fact, the AD/HD medication reduces the AD/HD symptoms, but the ODD symptoms remain unchanged.

Cognitive Behaviour Therapy (CBT) is one of the best forms of therapy for such children, but one should not expect changes in behaviour overnight as this form of therapy works best over time. 

DSM-IV TR Criteria for Identifying ODD:

  • A pattern of negativistic, hostile and defiant behaviour lasting at least 6 (six) months, during which four (or more) of the following are present:
    1. Often loses temper
    2. Often argues with adults
    3. Often actively defies or refuses to comply with adults' requests or rules
    4. Often deliberately annoys people
    5. Often blames others for his or her mistakes or misbehaviour
    6. Is often touchy or easily annoyed with others
    7. Is often angry and resentful
    8. Is often spiteful or vindictive

    Note: consider a criterion met only if the behaviour occurs more frequently than is typically observed in individuals of comparable age and developmental level.

  • The disturbance in behaviour causes clinically significant impairment in social, academic or occupational functioning.
  • The behaviours do not occur exclusively during the course of a Psychotic or Mood Disorder.
  • Criteria are not met for Conduct Disorder, and, if the individual is age 18 years or over, criteria are not met for Antisocial Personality Disorder.

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