Oppositional defiant disorder

Epidemiology[edit]

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.^[12] Children with ODD usually begin showing symptoms around age 6 to 8, although the disorder can emerge in younger children too. Symptoms can last throughout teenage years.^[12] The pooled prevalence is 3.6% up to age 18.^[13]


Oppositional defiant disorder has a prevalence of 1–11%.^[2] The average prevalence is approximately 3%.^[2] Gender and age play an important role in the rate of the disorder.^[2] ODD gradually develops and becomes apparent in preschool years, often before the age of eight years old.^[2][14][15] However, it is very unlikely to emerge following early adolescence.^[16]


There is a difference in prevalence between boys and girls, with a ratio of 1.4 to 1 before adolescence.^[2] Other research suggests a 2:1 ratio.^[17] Prevalence in girls tends to increase after puberty.^[14] Researchers have found that the general prevalence of ODD throughout cultures remains constant. However, the gendered disparities in diagnoses is only seen in Western cultures. It is unknown whether this reflects underlying differences in incidence or under-diagnosis of girls.^[18] Physical abuse at home is a significant predictor of diagnosis for girls only, and emotional responsiveness of parents is a significant predictor of diagnosis for boys only, which may have implications for how gendered socialization and received gender roles affect ODD symptoms and outcomes.^[19]


Children from lower-income backgrounds are more likely to be diagnosed with ODD.^[20][21] The correlative link between low income and ODD diagnosis is direct in boys, but in girls, the link is more complex; the diagnosis is associated with specific parental techniques such as corporal punishment which are in turn linked to lower income households. This disparity may be linked to a more general tendency of boys and men to display more externalized psychiatric symptoms, and girls to display more internalized ones (such as self-harm or anorexia nervosa).^[21]


African Americans and Latinos are more likely to receive diagnoses of ODD or other conduct disorders compared to non-Hispanic White youth with the same symptoms, who are more likely to be diagnosed with ADHD.^[22] This has wide-ranging implications about the role of racial bias in how certain behaviors are perceived and categorized as either defiant or inattentive/hyperactive.


Prevalence of ODD and conduct disorder are significantly higher among children in foster care. One survey in Norway found that 14 percent met the criteria, and other studies have found a prevalence of up to 17 or even 29 percent.^[23][24] Low parental attachment and parenting style are strong predictors of ODD symptoms.


Earlier conceptions of ODD had higher rates of diagnosis. 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.^[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.^[25] Consequently, future studies may find that there was also a decline in prevalence between the DSM-IV and the DSM-V.