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Oppositional defiant disorder

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Abstract

Oppositional defiant disorder (ODD) is a disruptive behaviour disorder involving an ongoing pattern of angry/irritable mood, argumentative/defiant behaviour and vindictiveness. Onset is typically before 8 years of age, although ODD can be diagnosed in both children and adults. This disorder is associated with substantial social and economic burden, and childhood ODD is one of the most common precursors of other mental health problems that can arise across the lifespan. The population prevalence of ODD is ~3 to 5%. A higher prevalence in males than females has been reported, particularly before adolescence. No single risk factor accounts for ODD. The development of this disorder seems to arise from the interaction of genetic and environmental factors, and mechanisms embedded in social relationships are understood to contribute to its maintenance. The treatment of ODD is often successful, and relatively brief parenting interventions produce large sized treatment effects in early childhood. Accordingly, ODD represents an important focus for research, practice and policy concerning early intervention and prevention in mental health.

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Fig. 1: Bifactor and trifactor models of oppositional defiant disorder.
Fig. 2: Moment-to-moment reinforcement of parent–child coercion.
Fig. 3: Longer-term effects of coercive cycles on the parent–child relationship.
Fig. 4: Differences in brain structure in youths with oppositional defiant disorder.
Fig. 5: Brain regions which are under-responsive in youths with oppositional defiant disorder.
Fig. 6: Overview of management.

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Authors and Affiliations

  1. School of Psychology, University of Sydney, Sydney, New South Wales, Australia

    David J. Hawes & Mark R. Dadds

  2. Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK

    Frances Gardner

  3. Department of Psychology, Louisiana State University, Baton Rouge, LA, USA

    Paul J. Frick

  4. Parent-Child Research Clinic, School of Psychology, University of New South Wales, Sydney, New South Wales, Australia

    Eva R. Kimonis

  5. Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA

    Jeffrey D. Burke

  6. Department of Psychology, University of Bath, Bath, UK

    Graeme Fairchild

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Contributions

Introduction (D.J.H.); Epidemiology (J.D.B.); Mechanisms/pathophysiology (M.R.D. and G.F.); Diagnosis, screening and prevention (P.J.F. and E.R.K.); Management (F.G.); Quality of life (M.R.D.); Outlook (D.J.H.); Overview of Primer (D.J.H.).

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Nature Reviews Disease Primers thanks C. Dose, S. Evans, C. Hautmann, J. Lochman, U. Pauli-Pott and the other, anonymous reviewer(s) for their contribution to the peer review of this work.

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Hawes, D.J., Gardner, F., Dadds, M.R. et al. Oppositional defiant disorder. Nat Rev Dis Primers 9, 31 (2023). https://doi.org/10.1038/s41572-023-00441-6

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