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Oppositional Defiant Disorders

NIH - Medical Encyclopedia Oppositional Defiant Disorder "Oppositional defiant disorder is a pattern of disobedient, hostile, and defiant behavior toward authority figures. To fit this diagnosis, the pattern must persist for at least 6 months and must go beyond the bounds of normal childhood misbehavior.

Symptoms: • Arguing with adults • Loss of temper • Angry and resentful of others • Actively defies adults' requests • Spiteful or vindictive behavior • Blames others for own mistakes • Is touchy or easily annoyed • Few or no friends or loss of previous friends • Constant trouble in school ...

Possible Complications: In a significant proportion of cases, the adult condition of conduct disorder can be traced back to the presence of oppositional defiant disorder in childhood ...

Prevention: Consistency in rules and fair consequences should be practiced in the child's home. Punishments should not be overly harsh or inconsistently applied. Appropriate behaviors should be modeled by the adults in the household. Abuse and neglect increase the chances that this condition will occur. "

Highlighted Articles

Oppositional defiant disorder. (Aust Fam Physician. 2008) “DISCUSSION: Many of the behaviours required to meet this diagnosis are not uncommon in the preschool child or adolescent. However, in children with ODD the behaviours are persistent, cause significant distress to the family system, and impact on the child's social and educational functioning. Oppositional defiant disorder usually presents in the preschool years, although it may become evident during adolescence. There is strong evidence that early intervention to increase positive factors in family relationships and to increase both the parents' and child's skill levels can assist in the prevention of more serious disorders and mental health issues.”

Lifetime prevalence, correlates, and persistence of oppositional defiant disorder: results from the National Comorbidity Survey Replication. (J Child Psychol Psychiatry. 2007) "Results: Lifetime prevalence of ODD is estimated to be 10.2% (males = 11.2%; females = 9.2%). Of those with lifetime ODD, 92.4% meet criteria for at least one other lifetime DSM-IV disorder, including: mood (45.8%), anxiety (62.3%), impulse-control (68.2%), and substance use (47.2%) disorders. ODD is temporally primary in the vast majority of cases for most comorbid disorders. Both active and remitted ODD significantly predict subsequent onset of secondary disorders even after controlling for comorbid conduct disorder (CD). Early onset (before age 8) and comorbidity predict slow speed of recovery of ODD. Conclusions: ODD is a common child- and adolescent-onset disorder associated with substantial risk of secondary mood, anxiety, impulse-control, and substance use disorders. These results support the study of ODD as a distinct disorder."

Conduct Disorders

NIH - Medical Encyclopedia Conduct Disorder "Conduct disorder, a disorder of childhood and adolescence, involves chronic behavior problems, such as defiant, impulsive, or antisocial behavior; drug use; or criminal activity.

Causes: Conduct disorder has been associated with family conflicts, child abuse, poverty, genetic defects, and parental drug addiction or alcoholism. The diagnosis is more common among boys and is estimated to be as high as 10%. However, because many of the qualities necessary to make the diagnosis (such as "defiance" and "rule breaking") can be subjective, it is hard to know how common the disorder really is. For accurate diagnosis, the behavior must be far more extreme than simple adolescent rebellion or boyish exuberance. Conduct disorder is often associated with attention-deficit disorder, and the two together carry a major risk for alcohol and/or other drug dependence. Children with conduct disorder tend to be impulsive, difficult to control, and unconcerned about the feelings of others ...

Symptoms: Cruel or aggressive behavior toward people and animals • Destruction of property, including fire setting • Lying, truancy, running away • Vandalism, theft • Heavy drinking and/or heavy illicit drug use • Breaking rules without apparent reason • Antisocial behaviors, such as bullying and fighting ...

Possible Complications: Children with conduct disorder may go on to develop personality disorders as adults, particularly antisocial personality disorder. As their behaviors worsen, these individuals may also develop significant drug and legal problems.

When to Contact a Medical Professional: See your health care provider if your child seems to be overly aggressive, is bullying others, is being victimized, or continually gets in trouble. Early treatment may help."

Highlighted Articles

A 30-Year Prospective Follow-up Study of Hyperactive Boys With Conduct Problems: Adult Criminality. (J Am Acad Child Adolesc Psychiatry. 2007) "CONCLUSIONS: Hyperactive/ADHD boys with conduct problems are at increased risk for adult criminality. Hyperactive boys without childhood conduct problems are not at increased risk for later criminality. An intensive 3-year MMT treatment of 6- to 12-year-old hyperactive boys is insufficient to prevent later adult criminality."

From conduct disorder to severe mental illness: associations with aggressive behaviour, crime and victimization. (Psychol Med. 2007) "CONCLUSIONS: Men and women with severe mental illness who have a history of CD by mid-adolescence are at increased risk for aggressive behaviour and violent crime. These patients are easily identifiable and may benefit from learning-based treatments aimed at reducing antisocial behaviour. Longitudinal, prospective investigations are needed to understand why CD is more common among people with than without schizophrenia."

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Behavioral and Learning Disorders

Conduct and Oppositional Defiant Disorders

NEWS:

Link Between Antisocial Conduct And Decision Making About Aggressive Behavior In Teens “A new study challenges the idea that antisocial behavior is relatively unchangeable during the teenage years. The study, published in the March/April 2008 issue of the journal Child Development, found that decision making and behavior among adolescents are related across time, and that efforts to help may be more effective if they address how adolescents make decisions about acting aggressively.”

ARTICLES:

JOURNAL ARTICLES:

Attention-deficit/hyperactivity disorder and callous-unemotional traits as moderators of conduct problems when examining impairment and aggression in elementary school children. (Aggress Behav. 2007)

Conduct disorder in girls: neighborhoods, family characteristics, and parenting behaviors. (Child Adolesc Psychiatry Ment Health. 2008) “ … CD in adolescent girls is not significantly associated with neighborhood, but is associated with some family characteristics and some types of parental behaviors.”

Conduct disorder in referred children and adolescents: clinical and therapeutic issues. (Compr Psychiatry. 2008) “RESULTS: Patients with prepubertal onset were younger at referral and had a poorer socioeconomic status. Their condition was more severe at the baseline, but their response to treatments did not differ from those with adolescent onset. Predatory and affective aggression and attention deficit hyperactivity disorder comorbidity were higher in children with prepubertal-onset CD. Regarding to sex, females were older and had a lower socioeconomic status. Their condition was more severe at the baseline and presented higher scores in self-aggression, but they responded better to treatments. Rates of attention deficit hyperactivity disorder were significantly lower in females, whereas other comorbidities (including substance abuse) were similar between sexes. Nonresponders to treatments received less frequently a psychosocial intervention, have more severe condition at the baseline, presented a more severe verbal and physical aggression, a lower affective/predatory index, and a higher rate of substance abuse. CONCLUSIONS: Age at onset and sex may be critical variables for prognosis of CD. Psychosocial intervention can significantly improve the treatment response.”

[Conduct disorders in seven-year-old children--results of ELSPAC study 1. Co-morbidity] (Cas Lek Cesk. 2008)

Co-transmission of conduct problems with attention-deficit/hyperactivity disorder: familial evidence for a distinct disorder. (J Neural Transm. 2008) “Our finding that ADHD + CP can represent a familial distinct subtype possibly with a distinct genetic etiology is consistent with a high risk for cosegregation. Further, ADHD + CP can be a more severe disorder than ADHDonly with symptoms stable from childhood through adolescence. The findings provide partial support for the ICD-10 distinction between hyperkinetic disorder (F90.0) and hyperkinetic conduct disorder (F90.1).”

Dissociated Functional Brain Abnormalities of Inhibition in Boys With Pure Conduct Disorder and in Boys With Pure Attention Deficit Hyperactivity Disorder. (Am J Psychiatry. 2008)

Emotional processing in male adolescents with childhood-onset conduct disorder. (J Child Psychol Psychiatry. 2008)

Methylphenidate in Children With Oppositional Defiant Disorder and Both Comorbid Chronic Multiple Tic Disorder and ADHD. (J Child Neurol. 2008)

Morphometric Brain Abnormalities in Boys With Conduct Disorder. (Journal of the American Academy of Child & Adolescent Psychiatry 2008) “Conclusions: The data suggest that boys with CD and comorbid attention-deficit/hyperactivity disorder show brain abnormalities in frontolimbic areas that resemble structural brain deficits, which are typically observed in adults with antisocial behavior.”

Neuropsychological Function in Adolescent Girls With Conduct Disorder. (Journal of the American Academy of Child & Adolescent Psychiatry 2008) “Results: Girls with CD had lower general intelligence and poorer performance on visuospatial, executive function, and academic achievement domains. After adjusting for demographic factors, scores in the CD group were worse for general intelligence and in the visuospatial and academic achievement domains.”

Nicotine and alcohol use in adolescent psychiatric inpatients: Associations with diagnoses, psychosocial factors, gender and age. (Nord J Psychiatry. 2008) “To conclude, early initiation and elevated rates of nicotine and alcohol use are a particular risk for adolescents with CD and ADHD.”

Oppositional defiant disorder. (Aust Fam Physician. 2008) “DISCUSSION: Many of the behaviours required to meet this diagnosis are not uncommon in the preschool child or adolescent. However, in children with ODD the behaviours are persistent, cause significant distress to the family system, and impact on the child's social and educational functioning. Oppositional defiant disorder usually presents in the preschool years, although it may become evident during adolescence. There is strong evidence that early intervention to increase positive factors in family relationships and to increase both the parents' and child's skill levels can assist in the prevention of more serious disorders and mental health issues.”

Oppositional defiant disorder. (Am Fam Physician. 2008)

The longitudinal course of comorbid oppositional defiant disorder in girls with attention-deficit/hyperactivity disorder: findings from a controlled 5-year prospective longitudinal follow-up study. (J Dev Behav Pediatr. 2008)

The long-term longitudinal course of oppositional defiant disorder and conduct disorder in ADHD boys: findings from a controlled 10-year prospective longitudinal follow-up study. (Psychol Med. 2008) “RESULTS: ODD persisted in a substantial minority of subjects at the 10-year follow-up. Independent of co-morbid CD, ODD was associated with major depression in the interval between the 4-year and the 10-year follow-up. Although ODD significantly increased the risk for CD and antisocial personality disorder, CD conferred a much larger risk for these outcomes. Furthermore, only CD was associated with significantly increased risk for psychoactive substance use disorders, smoking, and bipolar disorder. CONCLUSIONS: These longitudinal findings support and extend previously reported findings from this sample at the 4-year follow-up indicating that ODD and CD follow a divergent course. They also support previous findings that ODD heralds a compromised outcome for ADHD youth grown up independently of the co-morbidity with CD.”

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