History and Background

  Definitions, Research, and Questions
    Oppositional Defiant Disorder (ODD) was first listed as a disorder in 1980 in the American Psychiatric Association's DSM-III (The Diagnostic and Statistical Manual of Mental Disorders).  Almost immediately, questions arose about the definition of the disorder.  Many questioned if ODD wasn't just bad behavior.  Others suggested that ODD was really just a mild form of a Conduct Disorder (CD).  Revisions were made in 1987 and 1994 to try and answer these questions.  The first revisions to the definition clarified that ODD is a separate disorder than CD.  The symptoms of ODD are considered to be less aggressive than CD and research is starting to show that OD can be a pre-cursor to CD in some cases (Maughan, Costello, and Angold, 2005). A lot of research has been done about these disorders and other anti-social behavioral disorders by Benjamin Lahey, Rolf Lober, and  Paul Frick.  Their findings, and the research of others, have contributed to the clarifications of the definition throughout the years.  Although ODD has now become widely accepted as a disorder, questions about symptoms as well as frequency and severity have plagued the definition. 
    The new DSM-V has been released this year (2013) and it contains several updates regarding the diagnosis of ODD.  First, symptoms are grouped into three categories:  vindictiveness, angry/irritable mood, and argumentative/defiant behavior.  This was added to address the fact that this behavior is both behavioral and emotional.  Another update gives information about frequency of the symptomatic behaviors.  This information should help physicians to differentiate between poor, but normal, childhood behavior and behavior that is symptomatic of ODD. A third update is that a severity rating has been added.  This is to help physicians to analyze the severity of the disorder across different settings. 

     Because of the questions about the definition of this disorder as well as the somewhat subjective nature of the diagnosis criteria, there is a large range when it comes to estimating the prevalence of this disorder in children.  Several large studies seem to indicate 3% of children are affected by this disorder, with other studies ranging from as low as 1% to as high as 15% of children.  Most studies seem to indicate that the disorder is slowing becoming more prevalent.  And although it was initially believed to be more common in boys than in girls, an increasing amount of research is indicating that ODD is about equally prevalent between males and females.  However, in females, the symptomatic behavior may look different, with more covert behavior than overt, aggressive behavior (Oppositional Defiant Disorder, 2008).  
     One thing all of the research seems to suggest is that ODD  has a high comorbidity rate with ADHD, learning disabilities, and mood or anxiety disorders.  About 40% of children with ODD also have been diagnosed with ADHD, and in about 30% of ODD diagnoses, the child's diagnosis is later raised to the more severe Conduct Disorder diagnosis (Hamilton and Armando, 2008).