It is possible that there is a decreased prevalence of ODD in boys or an increased prevalence of ODD in girls in non-Western cultures, but it is also possible that the disorder is either over- or under-diagnosed in boys or girls, respectively, in Western cultures. Other factors can influence the prevalence of the disorder. Youths living in families of low socioeconomic status have a higher prevalence. Another factor is based on the criteria used to diagnose an individual. When the disorder was first included in the DSM-III, the prevalence was 25% higher than when the DSM-IV revised the criteria of diagnosis. The DSM-V made more changes to the criteria, grouping certain characteristics together in order to demonstrate that ODD display both emotional and behavioral symptomatology. In addition, criteria were added to help guide clinicians in diagnosis because of the difficulty found in identifying whether the behaviors or symptoms are directly related to the disorder or simply a phase in a childs life. Consequently, future studies may obtain results indicating a decline in prevalence between the DSM-IV and the DSM-V.

Signs and symptoms
The fourth revision of the Diagnostic and Statistical Manual (DSM-IV-TR) (now replaced by DSM-5) states that a person must exhibit four out of the eight signs and symptoms to meet the diagnostic threshold for ODD.
Negative relationships from the socializing influences and support network of teachers and peers increases the risk of deviant behavior. This is because the child consequently gets affiliated with deviant peers that reinforce antisocial behavior and delinquency. Due to the significant influence of teachers in managing disruptive behaviors, teacher training is a recommended intervention to change the disruptive behavior of ODD children. In a number of studies, low socioeconomic status has also been associated with disruptive behaviors such as ODD.Other social factors such as neglect, abuse, parents that are not involved, and lack of supervision can also contribute to ODD.Externalizing problems are reported to be more frequent among minority-status youth, a finding that is likely related to economic hardship, limited employment opportunities, and living in high-risk urban neighborhoods. Studies have also found that the state of being exposed to violence was a contribution factor for externalizing behaviors to occur. Diagnosis
For a child or adolescent to qualify for a diagnosis of ODD, behaviors must cause considerable distress for the family or interfere significantly with academic or social functioning. Interference might take the form of preventing the child or adolescent from learning at school or making friends or placing him or her in harmful situations. These behaviors must also persist for at least six months. Effects of ODD can be greatly amplified by other disorders in comorbidity such as ADHD. Other common comorbid disorders include depression and substance use disorders.