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Oppositional defiant disorder

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

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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. It may also possibly have racial, cultural, and gender biases.

This behavior typically starts by age 8. However, 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

Symptoms include:

• 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 often in 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:

• Anxiety disorders
• Attention-deficit/hyperactivity disorder (ADHD)
• Bipolar disorder
• Depression
• Learning disorders
• Substance use disorders

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.

Medicines 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

Contact 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

American Psychiatric Association website. Disruptive, impulse-control, and conduct disorders. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Text Revision (DSM-5-TR), Washington, DC: American Psychiatric Association Publishing; 2022.

Lee EH, Sinclair-McBride KR, DeMaso DR, Walter HJ. Disruptive, impulse-control, and conduct disorders. In: Kliegman RM, St. Geme JW, Blum NJ, et al, eds. Nelson Textbook of Pediatrics. 22nd ed. Philadelphia, PA: Elsevier; 2025:chap 42.

Moser SE, Netson KL. Behavioral problems in children and adolescents. In: Rakel RE, Rakel DP, eds. Textbook of Family Medicine. 9th ed. Philadelphia, PA: Elsevier; 2016:chap 23.

Review Date: 5/4/2024  

Reviewed By: Fred K. Berger, MD, addiction and forensic psychiatrist, Scripps Memorial Hospital, La Jolla, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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