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Introduction

Oppositional defiant disorder (ODD) is characterized by a pervasive pattern of argumentative and defiant behavior toward authority figures.  Some children with ODD may also experience chronic anger/irritability and vindictiveness.  The behaviors often manifest at home with family members but can also extend to interactions with other individuals (eg, teachers, peers).  Initial symptoms typically start around age 4-5 and must be excessive in frequency and duration when compared to normative, age-appropriate behaviors.

Epidemiology and risk factors

ODD is estimated to have a prevalence rate from 1%-10% and is more common in boys than in girls prior to adolescence.

The etiology of ODD is multifactorial and can include a combination environmental (eg, child abuse, harsh discipline styles) and genetic (eg, family history of conduct disorder, bipolar disorder, or substance use disorder).  In addition, patients may have abnormalities of the prefrontal cortex and amygdala, which may contribute to emotional dysregulation as well as impaired impulse control and judgment.

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