Disorders usually first diagnosed in
infancy, childhood, or adolescence.
Oppositional Defiant Disorder--

Oppositional defiant disorder is a controversial psychiatric category listed in the Diagnostic and
Statistical Manual of Mental Disorders where it is described as an ongoing pattern of disobedient,
hostile, and defiant behavior toward authority figures that goes beyond the bounds of normal
childhood behavior.

DSM criteria

To meet DSM-IV-TR criteria, certain factors must be taken into account. First, the defiance must
interfere with the child’s ability to function in school, home, or the community. Second, the defiance
cannot be the result of another disorder, such as depression, anxiety, or the more serious Conduct
disorder. Third, the child's problem behaviors have been happening for at least six months. The
diagnostic criteria for this disorder are as follows:

* Losing temper
* Arguing with adults
* Refusing to follow the rules
* Deliberately annoying people
* Blaming others for own mistakes
* Easily annoyed
* Angry and resentful
* Spiteful or even vengeful

If the child meets at least four of these criteria, and they are interfering with the child’s ability to
function, then he or she technically meets the definition of Oppositionally defiant.[1]

Prevalence

The DSM-IV cites a prevalence of between 2 & 16% for ODD.

Prognosis

Childhood Oppositional Defiant Disorder is strongly associated with later developing Conduct
disorder.[2] Untreated, about 52% of children with ODD will continue to meet the DSM-IV criteria up
to three years later and about half of those 52% will progress into Conduct Disorder.[3]

Treatment

There are a variety of approaches to the treatment of Oppositional Defiant Disorder (ODD). One
evidence-based approach with empirical support is an approach developed by Russell A. Barkley, Ph.
D.[4][5][6] This approach uses a parent training model and begins by focusing on positive
approaches to increase compliant behaviours. Only later in the program are methods introduced to
extinguish negative or noncompliant behaviours.

Controversy

The category of Oppositional Defiant Disorder as outlined in the DSM has attracted criticism and
controversy since DSM III-R where it was established that while Oppositional Defiant Disorder was
one of only seven categories (out of more than 300) in that revision for which field trials had taken
place, the results of those field trials are not reported in the DSM III-R and do not seem to be
available for examination elsewhere [7].

In the course of trying to determine the possible extent of the effects of gender bias on the
precision of categories in the DSM, Psychologist Paula J. Caplan, PhD and graduate student Kaye Lee
Pantony wrote about whether the research confirmed the existence of such mental disorders as
those represented by the labels of the categories they had chose to study, whether research had
made it possible to discover the actual elements, or criteria, of each disorder; and whether research
had made it possible to discover exactly how many criteria a person had to meet in order to belong
clearly to a particular category.

Aiming for a wide variety of diagnoses, they chose to examine three categories that could be applied
to people of either sex. One of the categories they selected was Oppositional Defiant Disorder[8].
Their opinion was that, "In view of all of that research, we were frankly amazed to find that not a
single empirically based article included any evidence of what the cutoff point for any of these three
categories ought to be. In other words, there was no research on which to base the DSM's
prescriptions about many criteria a person had to meet in order to be given any of those three
labels: AD, ODD, or OCD. Those prescriptions cannot be said to have been derived from any
scientific work whatsoever.[9]" They could only find seven articles that mentioned Oppositional
Defiant Disorder at all, and none of them mentioned the selection of criteria, or the cutoff point, for
ODD. Their opinion was that, "All told, then, there was little or no scientific evidence to justify the
ways the criteria and cutoff points were chosen for a wide variety of DSM categories. It seems
possible but highly unlikely that more rigorous standards were used for the categories that we
happened not to study." [10].


References

1. ^ The Diagnostic and Statistical Manual published by the American Psychiatric Association
2. ^ Lahey, B., & Loeber, R. (1994), Framework for a developmental model of oppositional defiant
disorder and conduct disorder. In D.K. Routh (Ed.) Disruptive Behavior Disorders in Childhood (pp.
139-180). NY: Plenum Press.
3. ^ Lahey, B., Loeber, R., Quay, H., Frick, P., & Grimm, J., (1992) Oppositional defiant and conduct
disorders: Issues to be resolved for the DSM-IV. Journal of the American Academy of Child and
Adolescent Psychiatry, 31, 539-546.
4. ^ Barkley, R., (1997) Defiant Children: A Clinician's Manual for Assessment and Parent Training,
NY: Guilford Press
5. ^ Barkley, R., & Benton, C., (1998), Your Defiant Child, NY: Guilford Press
6. ^ Barkley, R., Edwards, G., & Robin, A., (1999), Defiant Teens: A Clinician's Manual for
Assessment and Family Intervention, NY: Guilford Press
7. ^ Caplan, Paula J. (1995). They Say You're Crazy: How the World's Most Powerful Psychiatrists
Decide Who's Normal. Reading, MA: Addison Wesley pages 202-203
8. ^ Caplan, Paula J. (1995). They Say You're Crazy: How the World's Most Powerful Psychiatrists
Decide Who's Normal. Reading, MA: Addison Wesley pages 212-213