Diagnostic and Statistical Manual of Mental Disorders – 4th

Mental and Behavioural Disorders (ICD-10) as a ‘repetitive and persistent pattern of opposition, defiant, disobedient and disruptive behaviours towards authority figures persisting for at least 6 months’.1,2 Oppositional defiant disorder does not include the more aggressive aspects of conduct disorder (CD) which is directed toward people, animals and property.1 Oppositional defiant disorder has a high co-occurrence with attention deficit hyperactivity disorder (ADHD) and many children with ODD go on to be diagnosed with CD. This means that families are under high levels of stress, dealing with several difficult behaviours. Does this child have ODD? Characteristics of ODD as described in the DSM-IV include: • persistent stubbornness and refusal to comply with instructions or unwillingness to compromise with adults or peers • deliberate and persistent testing of the limits • failing to accept responsibility for one’s own actions and blaming others for one’s own mistakes • deliberately annoying others • frequently losing one’s temper. It can be difficult to determine if a child qualifies for a diagnosis of ODD as many of the behaviours required to meet this diagnosis are not uncommon in the preschool child or adolescent. However, if the child’s behaviours are consistently presented by the parent as causing distress to the family system and are impacting on the child’s social and educational functioning then further evaluation is warranted. A preschool aged child will usually behave in this way at home and with people they know well. Oppositional behaviours may not be evident in other settings or during the medical examination, thus Background Oppositional defiant disorder (ODD) is defined as a repetitive and persistent pattern of opposition, defiant, disobedient and disruptive behaviours toward authority figures persisting for at least 6 months