Oppositional defiant disorder

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Overview
Oppositional defiant disorder is a controversial psychiatric category listed in the Diagnostic and Statistical Manual of Mental Disorders where it is described as an ongoing pattern of disobedient, hostile, and defiant behavior toward authority figures which supposedly goes beyond the bounds of normal childhood behavior.

DSM criteria
To meet DSM-IV-TR criteria, certain factors must be taken into account. First, the defiance must interfere with the child’s ability to function in school, home, or the community. Second, the defiance cannot be the result of another disorder, such as depression, anxiety, or the more serious Conduct disorder. Third, the child's problem behaviors have been happening for at least six months. The diagnostic criteria for this disorder are as follows:


 * Losing temper
 * Arguing with adults
 * Refusing to follow the rules
 * Deliberately annoying people
 * Blaming others for own mistakes
 * Easily annoyed
 * Angry and resentful
 * Spiteful or even vengeful

If the child meets at least four of these criteria, and they are interfering with the child’s ability to function, then he or she technically meets the definition of Oppositionally defiant.

Prevalence
The DSM-IV cites a prevalence of between 2 & 16% for ODD.

Prognosis
Childhood Oppositional Defiant Disorder is strongly associated with later developing Conduct disorder. Untreated, about 52% of children with ODD will continue to meet the DSM-IV criteria up to three years later and about half of those 52% will progress into Conduct Disorder.

Treatment
There are a variety of approaches to the treatment of Oppositional Defiant Disorder (ODD). One evidence-based approach with empirical support is an approach developed by Russell A. Barkley, Ph.D.  This approach uses a parent training model and begins by focusing on positive approaches to increase compliant behaviours. Only later in the program are methods introduced to extinguish negative or noncompliant behaviours.

Controversy
The category of Oppositional Defiant Disorder as outlined in the DSM has attracted criticism and controversy since DSM III-R where it was established that while Oppositional Defiant Disorder was one of only seven categories (out of more than 300) in that revision for which field trials had taken place, the results of those field trials are not reported in the DSM III-R and do not seem to be available for examination elsewhere.

In the course of trying to determine the possible extent of the effects of gender bias on the precision of categories in the DSM, Psychologist Paula J. Caplan, PhD and graduate student Kaye Lee Pantony wrote about whether the research confirmed the existence of such mental disorders as those represented by the labels of the categories they had chose to study, whether research had made it possible to discover the actual elements, or criteria, of each disorder; and whether research had made it possible to discover exactly how many criteria a person had to meet in order to belong clearly to a particular category.

Aiming for a wide variety of diagnoses, they chose to examine three categories that could be applied to people of either sex. One of the categories they selected was Oppositional Defiant Disorder. Their opinion was that, "In view of all of that research, we were frankly amazed to find that not a single empirically based article included any evidence of what the cutoff point for any of these three categories ought to be. In other words, there was no research on which to base the DSM's prescriptions about many criteria a person had to meet in order to be given any of those three labels: AD, ODD, or OCD. Those prescriptions cannot be said to have been derived from any scientific work whatsoever. "

They could only find seven articles that mentioned Oppositional Defiant Disorder at all, and none of them mentioned the selection of criteria, or the cutoff point, for ODD. Their opinion was that, "All told, then, there was little or no scientific evidence to justify the ways the criteria and cutoff points were chosen for a wide variety of DSM categories. It seems possible but highly unlikely that more rigorous standards were used for the categories that we happened not to study." .