Oppositional defiant disorder is a pattern of disobedient, hostile, and defiant behavior toward authority figures.
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.
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.
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:
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).
Some children respond well to treatment, while others do not.
Contact your health care provider if you have concerns about your child's development or behavior.
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.
American Psychiatric Association website. Disruptive, impulse-control, and conduct disorders. In: American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing. 2013:461-480.
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.
Walter HJ, DeMaso DR. Disruptive, impulse-control, and conduct disorders. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 42.BACK TO TOP
Review Date: 4/30/2022
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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