[3] Unlike conduct disorder (CD), those with ODD do not generally show patterns of aggression towards random people, violence against animals, destruction of property, theft, or deceit.
Since the introduction of ODD as an independent disorder, the field trials to inform its definition have included predominantly male subjects.
This suggests that the process of clinically relevant research driving nosology, and vice versa, has ensured that the future will bring greater understanding of ODD.
[10]ODD is a pattern of negative, defiant, disobedient, and hostile behavior, and it is one of the most prevalent disorders from preschool age to adulthood.
[11] This can include frequent temper tantrums, excessive arguing with adults, refusing to follow rules, purposefully upsetting others, getting easily irked, having an angry attitude, and vindictive acts.
[20] The DSM-V made more changes to the criteria, grouping certain characteristics together in order to demonstrate that people with ODD display both emotional and behavioral symptoms.
[25] In addition, criteria were added to help guide clinicians in diagnosis because of the difficulty found in identifying whether the behaviors or other symptoms are directly related to the disorder or simply a phase in a child's life.
[28] Research indicates that parents pass on a tendency for externalizing disorders to their children that may be displayed in multiple ways, such as inattention, hyperactivity, or oppositional and conduct problems.
A variant of the gene that encodes the neurotransmitter metabolizing enzyme monoamine oxidase-A (MAOA), which relates to neural systems involved in aggression, plays a key role in regulating behavior following threatening events.
[31][32][33][34] Although pregnancy and birth factors are correlated with ODD, strong evidence of direct biological causation is lacking.
The BIS produces anxiety and inhibits ongoing behavior in the presence of novel events, innate fear stimuli, and signals of non-reward or punishment.
Some of these deficits include immature forms of thinking (such as egocentrism), failure to use verbal mediators to regulate their behavior, and cognitive distortions, such as interpreting a neutral event as an intentional hostile act.
In fact, students with ODD have limited social knowledge that is based only on individual experiences, which shapes how they process information and solve problems cognitively.
This model explains that children will go through five stages before displaying behaviors: encoding, mental representations, response accessing, evaluation, and enactment.
[37] Parenting practices not providing adequate or appropriate adjustment to situations as well as a high ratio of conflicting events within a family are causal factors of risk for developing ODD.
[38] Studies indicate that child and adolescent externalizing disorders like ODD are strongly linked to peer network and teacher response.
[41] Negative relationships from the socializing influences and support network of teachers and peers increases the risk of deviant behavior.
[1] 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.
[45][46][47] 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.
This intricate interplay between biological predispositions and social factors can lead to diverse clinical presentations, affecting the approaches to treatment and support.
This suggests that longitudinal support and intervention, taking into account the individual's biological makeup and social context, are vital for improving long-term outcomes for those with ODD.
[51] Since ODD is a neurological disorder that has biological correlates, an occupational therapist can also provide problem solving training to encourage positive coping skills when difficult situations arise, as well as offer cognitive behavioral therapy.
Effects that can result from taking these medications include hypotension, extrapyramidal symptoms, tardive dyskinesia, obesity, and increase in weight.
The second phase is parent-directed interaction, where the parents are coached on aspects including clear instruction, praise for compliance, and time-out for noncompliance.
[57] Anti-psychiatry scholars have extensively criticized this diagnosis through a Foucauldian framework, characterizing it as a tool of the psy apparatus which pathologizes resistance to injustice.
[58] Oppositional defiant disorder has been compared to drapetomania, a now-obsolete disorder proposed by Samuel A. Cartwright which characterized slaves in the Antebellum South who repeatedly tried to escape as being mentally ill.[59][60] Research has shown that African Americans and Latino Americans are disproportionately likely to be diagnosed with ODD compared to White counterparts displaying the same symptoms, who are more likely to be diagnosed with ADHD.
[61][62][63][22] Assessment, diagnosis and treatment of ODD may not account for contextual problems experienced by the patient, and can be influenced by cultural and personal racial bias on the part of counselors and therapists.
[64] This bias in perception and diagnosis leads to defiant behaviors being medicalized and rehabilitated in White children, but criminalized for Latino and African American ones.
[61] In one study over a quarter of children placed in the foster care system in the United States were found to have been diagnosed with ODD.
[64] African American males are known to be more likely to be suspended or expelled from school, receive harsher sentences for the same offenses as defendants of different races, or be searched, assaulted or killed by police officers.