Oppositional Defiant Disorder (ODD) is a recurrent pattern of negativistic, defiant, disobedient, and hostile behavior toward authority figures that lasts for more than 6 months.  To meet the DSM-IV diagnosis, it must have at least four of the following: 1) often loses temper, 2) often argues with adults, 3) often defies or refuses to comply with adult requests or rules, 4) often deliberately annoys people, 5) often blames others for his or her mistakes or misbehaviors, 6) is often touchy or easily annoyed by others, 7) is often angry and resentful, and 8) is often spiteful or vindictive.  The frequency has to be more than is normal for age and developmental level.  It must cause a significant impairment in functioning and may not occur only during psychotic or mood disorders.  The youth cannot meet the requirements for a Conduct Disorder or, if over 18, for Antisocial Personality Disorder.

Oppositional Defiant Disorder (ODD) is a less severe condition than Conduct Disorder.  It does not usually include serious aggression problems toward people or animals, destruction of property, or a pattern of lying and stealing.  The ADHD diagnosis can be used simultaneously with ODD if the requirements for each diagnosis are met.  

There is no controlled medication research for youth with only an Oppositional Defiant Disorder.  It appears that many of the treatments that help ADHD will also help ODD.  Counseling and environmental interventions are also important.  The research suggesting benefit from a good multivitamin and mineral supplement with omega-3 fatty acids probably applies as well. 

Obviously, anger and poor temper control are major aspects to this disorder.  My book on anger, Anger is a Mistake, can be found on this website and is full of good information and practical ideas.  I strongly advise you to read it.  It is sure to be both interesting and educational.

Frequency

Puerto Rico: Oppositional/Defiant Second Most Common Disorder for Kids: In a national sample of 1886 children with parents, ADHD was the most common disorder at 8.0% followed by ODD at 5.5%. While 16.9% of children had a diagnosable illness, only 6.9% were so severe as to need treatment. The DSM-IV rates of child and adolescent disorders in Puerto Rico: prevalence, correlates, service use, and the effects of impairment. Canino G, Shrout PE, Rubio-Stipec M, Bird HR, Bravo M, Ramirez R, Chavez L, Alegria M, Bauermeister JJ, Hohmann A, Ribera J, Garcia P, Martinez-Taboas A. Arch Gen Psychiatry. 2004 Jan;61(1):85-93.

Substance Abuse Increased with ODD & CD: A literature review of 15 studies concludes that 60% of teenagers with substance use, abuse or dependence had either Conduct Disorder or Oppositional Defiant Disorder co-morbid.  While ODD was connected, CD was particularly linked with early substance use and abuse. Community studies on adolescent substance use, abuse, or dependence and psychiatric comorbidity. Armstrong TD, Costello EJ. J Consult Clin Psychol. 2002 Dec;70(6):1224-39

Sweden: ADHD Often Have ODD: A study of 131 children with ADHD found 60% met DSM-IV criteria for ODD. Only 10 of the 131 children with ADHD had no symptoms of ODD at all. The rate of children meeting full diagnostic criteria for ODD was similar across all age cohorts. Males were overrepresented in ODD, as were children of divorced parents and of mothers with low socioeconomic status. Univ. Umea. Attention-deficit-hyperactivity disorder with and without oppositional defiant disorder in 3- to 7-year-old children. Kadesjo C, Hagglof B, Kadesjo B, Gillberg C. Dev Med Child Neurol. 2003 Oct;45(10):693-9

Causation

Shared Environment Leading Factor Although Genetics a Factor: Minnesota Family Twin Study 11-year-olds were studied with child and parent interviews. The findings from the 1506 twins studied revealed that although each disorder was influenced by genetic and environmental factors, a single shared environmental factor made the largest contribution to the covariation among ADHD, ODD, and CD. Univ Minnesota. Sources of covariation among attention-deficit/hyperactivity disorder, oppositional defiant disorder, and conduct disorder: the importance of shared environment. Burt SA, Krueger RF, McGue M, Iacono WG. J Abnorm Psychol. 2001 Nov;110(4):516-25.

Treatment

Nortriptyline Did Well in DB: This is an odd study design with an open 6 week trial of 35 children and teens at 2mg/kg/d with DB PC termination. Nortriptyline patients improved considerably more during the open phase for both hyperactivity and oppositionality (p<.001 for each). Blood level 81 ng/ml with an average dose of 80 mg/d. No serious side-effects were reported. MGH-Harvard.   A controlled study of nortriptyline in children and adolescents with attention deficit hyperactivity disorder. Prince JB, Wilens TE, Biederman J, Spencer TJ, Millstein R, Polisner DA, Bostic JQ. J Child Adolesc Psychopharmacol 2000 Fall;10(3):193-204

Omega-3, Vit E, and Omega-6 Supplement Mild Benefit in DB: 50 children with ADHD who also had thirst and skin problems suggesting a possible omega-3 deficiency were studied in a 4-month DB PC program with half taking a daily dose of 480 mg DHA, 80 mg EPA, 40 mg arachidonic acid (AA), 96 mg GLA, and 24 mg alpha-tocopheryl acetate and half on placebo. On only two of 16 measures was there a significant advantage to the supplemented group: conduct problems rated by parents (-42.7 vs. -9.9%, P = 0.05), and attention symptoms rated by teachers (14.8 vs. +3.4%, P = 0.03). A greater number of participants also showed improvement in oppositional defiant behavior (8 out of 12 vs. 3 out of 11, P = 0.02). Purdue. EFA supplementation in children with inattention, hyperactivity, and other disruptive behaviors. Stevens L, Zhang W, Peck L, Kuczek T, Grevstad N, Mahon A, Zentall SS, Arnold LE, Burgess JR. Lipids. 2003 Oct;38(10):1007-21

Risperidone Better than Placebo for ADHD with Conduct or Oppositional/Defiant Disorders: In 2 PC DB 6 week studies funded by pharmaceutical companies 5-12-year-olds with CD/ADHD, CD, OD/ADHD and OD were studied.  Risperidone treated youth improved considerably more than placebo patients with a 55% vs. 22% decrease in baseline aggression scores.  Improvement occurred unrelated to diagnosis, age, or IQ. John LeBlanc, Dalhousie Univ., Canada. Canadian Assoc. of Psychiatry Annual Meeting 11/1/03.

Risperidone Helped CD/ODD Children with Low IQs: In a 6-week DB PC study of 110 children ages 5-12 with IQs 36-84 and disruptive behavior, there was a 47% decrease in disruptive behavior with risperidone vs. 20% with placebo.  Risperidone was given at 0.02-.06 mg/kg/day with a mean of 1.4 mg/day.  All were diagnosed CD or ODD with 80% also having ADHD. Industry funded. Saskatoon, Canada. Effects of risperidone on conduct and disruptive behavior disorders in children with subaverage IQs. Snyder R, Turgay A, Aman M, Binder C, Fisman S, Carroll A; Risperidone Conduct Study Group. J Am Acad Child Adolesc Psychiatry. 2002 Sep;41(9):1026-36. Risperidone, administered as an oral solution at a mean dose of 1.38 mg/d (range: 0.02-0.06 mg/kg/d) for 1 year, was well tolerated, safe, and showed maintenance of effect in the treatment of disruptive behavior disorders in children aged 5 to 12 years with subaverage IQs. Pediatrics. 2002 Sep;110(3):e34

Social Skills Training Didn't Help ADHD-ODD Children: In a random assignment study, 120 children with either ADHD-ODD, ADHD without ODD, or neither were assigned to an 8 week social skills training group or a no treatment control.  While ADHD children showed some benefit, especially in appropriate assertiveness skills, there was no measurable benefit for ADHD-ODD children. Social Skills Training in Children With Attention Deficit Hyperactivity Disorder: A Randomized-Controlled Clinical Trial. Antshel KM, Remer R. J Clin Child Adolesc Psychol. 2003;32(1):152-165. Ed: ADHD-ODD children have a more serious condition that is more treatment resistant and more strongly linked with problems in adult life.