• negativistic
• defiant
• disobedient
• hostile

behavior toward authority figures that persists for at least 6 months.

Behaviors included in the definition include the following:

• losing one's temper
• arguing with adults
• actively defying requests
• refusing to follow rules
• deliberately annoying other people
• blaming others for one's own mistakes or misbehavior
• being touchy
• easily annoyed or angered
• resentful
• spiteful
• vindictive

ODD is usually diagnosed when a child has a persistent or consistent pattern of disobedience & hostility toward parents, teachers, or other adults.

The primary behavioral difficulty is the consistent pattern of refusing to follow commands or requests by adults.

Children with ODD are often:

• easily annoyed
• they repeatedly lose their temper
• argue with adults
• refuse to comply with rules & directions
• blame others for their mistakes
• stubbornness 
• testing limits is common, even in early childhood

The criteria for ODD are met only when the problem behaviors occur more frequently in the child than in other children of the same age & developmental level.

These behaviors cause significant difficulties with family & friends & the oppositional behaviors are the same both at home & in school. Sometimes, ODD may be a precursor of a conduct disorder. ODD isn't diagnosed if the problematic behaviors occur exclusively with a mood or psychotic disorder.

Diagnosis is complicated by relatively high rates of comorbid, disruptive, behavior disorders.

Some symptoms of attention-deficit/hyperactivity disorder (ADHD) & conduct disorder overlap. Researchers have postulated that, in some children, ODD may be the developmental precursor of conduct disorder.

Comorbidity of ODD with ADHD has been reported to occur in 50-65% of affected children.

In some children, ODD commonly occurs in conjunction with anxiety disorders & depressive disorders. Cross-sectional surveys have revealed the comorbidity of ODD with an affective disorder (mood disorder, such as depression) in about 35% of cases, with rates of comorbidity increasing with patient age.

High rates of comorbidity are also found among ODDs:

• learning disorders
• academic difficulties

Given these findings, children with significant oppositional & defiant behaviors often require multidisciplinary assessment & they may need components of mental health care, case management & educational intervention to improve.

• irritability
• impulsivity
• intensity of reactions to negative stimuli

may contribute to the development of a pattern of oppositional & defiant behaviors in later childhood.

Family instability, including:

• economic stress
• parental mental illness - some info concerning this at teenscene - the facts page!
• harshly punitive behaviors
• inconsistent parenting practices
• multiple moves
• divorce

may also contribute to the development of oppositional & defiant behaviors.

The interactions of a child who has a difficult temperament & irritable behavior with parents who are harsh, punitive & inconsistent usually lead to a coercive, negative cycle of behavior in the family.

In this pattern, the child's defiant behavior tends to intensify the parents' harsh reactions. The parents respond to misbehavior with threats of punishment that are inconsistently applied.

When the parent punishes the child, the child learns to respond to threats. When the parent fails to punish the child, the child learns that he or she doesn't have to comply.

Research indicates that these patterns are established early, in the child's preschool years; left untreated, pattern development accelerates & patterns worsen.

Developmentally, the presenting problems change with the child's age; i.e., younger children are more likely to engage in oppositional & defiant behavior, whereas older children are more likely to engage in more covert behavior such as stealing.

By the time they're school aged, children with patterns of oppositional behavior tend to express their defiance with teachers & other adults & they exhibit aggression toward their peers.

As children with ODD progress in school, they experience increasing peer rejection due to their poor social skills & aggression. These children may be more likely to misinterpret their peers' behavior as hostile & they lack the skills to solve social conflicts.

In problem situations, children with ODD are more likely to resort to aggressive physical actions rather than verbal responses. Children with ODD & poor social skills often don't recognize their role in peer conflicts; they blame their peers (e.g., "He made me hit him.") & usually fail to take responsibility for their own actions.

The following 3 classes of behavior are hallmarks of both oppositional & conduct problems:

(1) noncompliance with commands

(2) emotional overreaction to life events, no matter how small

(3) failure to take responsibility for one's own actions.

When behavioral difficulties are present beginning in the preschool period, teachers & families may overlook significant deficiencies in the child's learning & academic performance.

When many children with behavioral problems & academic problems are placed in the same classroom, the risk for continued behavioral & academic problems increases. ODD behavior may escalate & result in serious antisocial actions that, when sufficiently frequent & severe, become criteria to change the diagnosis to conduct disorder.

Milder forms of ODD in some children spontaneously remit over time. More severe forms of ODD, in which many symptoms are present in the toddler years & continually worsen after the child is aged 5 years, may evolve into conduct disorder in older children & adolescents.

• attention disorders
• learning disorders 
• conduct disturbances

an evaluation for these disorders is indicated for comprehensive treatment.

Pharmacologic treatment (e.g., stimulant medication) for ADHD may be beneficial once this is diagnosed.

Children with oppositional behavior in the school setting should undergo necessary screening testing in school to evaluate for possible learning disabilities.

With the multifaceted nature of associated problems in ODD, comprehensive treatment may include:

• medication
• parenting & family therapy
• consultation with the school staff

If children with ODD are found to have ADHD as well, appropriate treatment of ADHD may help them to restore their focus & attention & decrease their impulsivity; such treatment may enable their social & behavioral interventions to be more effective.

Parent management training (PMT) is recommended for families of children with ODD because it'as been demonstrated to affect negative interactions that repeatedly occur between the children & their parents.

PMT consists of procedures with which parents are trained to change their own behaviors & thereby alter their child's problem behavior in the home.

PMT is based on 35 years of well-developed research showing that oppositional & defiant patterns arise from maladaptive parent-child interactions that start in early childhood.These patterns develop when parents inadvertently reinforce disruptive & deviant behaviors in a child by giving those behaviors a significant amount of negative attention.

At the same time, the parents, who are often exhausted by the struggle to obtain compliance with simple requests, usually fail to provide positive attention; often, the parents have infrequent positive interactions with their children.

The pattern of negative interactions evolves quickly as the result of repeated, ineffective, emotionally expressed commands & comments; ineffective harsh punishments; & insufficient attention & modeling of appropriate behaviors.

PMT alters the pattern by encouraging the parent to pay attention to prosocial behavior & to use effective, brief, nonaversive punishments.

Treatment is conducted primarily with the parents; the therapist demonstrates specific procedures to modify parental interactions with their child. Parents are first trained to simply have periods of positive play interaction with their child.

They then receive further training to identify the child's positive behaviors & to reinforce these behaviors. At that point, parents are trained in the use of brief negative consequences for misbehavior. Treatment sessions provide the parents with opportunities to practice & refine the techniques.

Follow-up studies of operational PMT techniques in which parents successfully modified their behavior showed continued improvements for years after the treatment was finished. Treatment effects have been stronger with younger children, especially in those with less severe problems.

Recent research suggests that less severe problems, rather than a younger patient age, is predictive of treatment success.

Approximately 65% of families show significant clinical benefit from well-designed parent management programs.

Regardless of the child's age, intervention early in the developing pattern of oppositional behavior is likely to be more effective than waiting for the child to grow out of it. These children can benefit from group treatment.

The process of modeling behaviors & reactions within group settings creates a real-life adaptation process. In younger children, combined treatment in which parents attend a PMT group while the children go to a social skills group has consistently resulted in the best outcome.

Concerns exist regarding the efficacy of group treatment of adolescents with oppositional behaviors. Group therapy for adolescents with ODD is most beneficial when it is structured & focused on developing the skills of:

• listening
• empathy
• effective problem solving

In situations in which the parents lack the resources to effectively manage their child, services can be obtained thru the schools &/or county mental health agencies.

Many states have effective "wrap around" services, which include a full-day school program & home-based therapy services to maintain progress in the home setting. Thus, effective treatment can include resources from several agencies & coordination is critical.

If county mental health or school special education services are involved, one person is usually designated to coordinate services in those systems.