The first symptoms of oppositional defiant disorder usually appear during the preschool years and rarely later than early adolescence. Oppositional defiant disorder often precedes the development of conduct disorder, especially for those with the childhood-onset type of conduct disorder. However, many children and adolescents with oppositional defiant disorder do not subsequently develop conduct disorder. Oppositional defiant disorder also conveys risk for the development of anxiety disorders and major depressive disorder, even in the absence of conduct disorder. The defiant, argumentative, and vindictive symp- toms carry most of the risk for conduct disorder, whereas the angry-irritable mood symp- toms carry most of the risk for emotional disorders.
Manifestations of the disorder across development appear consistent. Children and adolescents with oppositional defiant disorder are at increased risk for a number of prob— lems in adjustment as adults, including antisocial behavior, impulse-control problems, substance abuse, anxiety, and depression.
Many of the behaviors associated with oppositional defiant disorder increase in fre- quency during the preschool period and in adolescence. Thus, it is especially critical dur- ing these development periods that the frequency and intensity of these behaviors be evaluated against normative levels before it is decided that they are symptoms of opposi- tional defiant disorder.
Temperamental. Temperamental factors related to problems in emotional regulation (e.g., high levels of emotional reactivity, poor frustration tolerance) have been predictive of the disorder.
Environmental. Harsh, inconsistent, or neglectful child-rearing practices are common in families of children and adolescents with oppositional defiant disorder, and these parent- ing practices play an important role in many causal theories of the disorder.
Genetic and physiological. A number of neurobiological markers (e.g., lower heart rate and skin conductance reactivity; reduced basal cortisol reactivity; abnormalities in the pre- frontal cortex and amygdala) have been associated with oppositional defiant disorder.
However, the vast majority of studies have not separated children with oppositional de- fiant disorder from those with conduct disorder. Thus, it is unclear whether there are markers specific to oppositional defiant disorder.
The prevalence of the disorder in children and adolescents is relatively consistent across countries that differ in race and ethnicity.
When oppositional defiant disorder is persistent throughout development, individuals with the disorder experience frequent conﬂicts with parents, teachers, supervisors, peers, and romantic partners. Such problems often result in significant impairments in the iridi- vidual’s emotional, social, academic, and occupational adjustment.
Conduct disorder. Conduct disorder and oppositional defiant disorder are both related to conduct problems that bring the individual in conﬂict with adults and other authority figures (e.g., teachers, work supervisors). The behaviors of oppositional defiant disorder are typically of a less severe nature than those of conduct disorder and do not include ag- gression toward people or animals, destruction of property, or a pattern of theft or deceit.
Furthermore, oppositional defiant disorder includes problems of emotional dysregulation (i.e., angry and irritable mood) that are not included in the definition of conduct disorder.
Attention-deficit/hyperactivity disorder. ADHD is often comorbid with oppositional de- fiant disorder. To make the additional diagnosis of oppositional defiant disorder, it is impor- tant to determine that the individual’s failure to conform to requests of others is not solely in sihiations that demand sustained effort and attention or demand that the individual sit still.
Depressive and bipolar disorders. Depressive and bipolar disorders often involve neg- ative affect and irritability. As a result, a diagnosis of oppositional defiant disorder should not be made if the symptoms occur exclusively during the course of a mood disorder.