• Clinical Presentation: persistent chronic negative attitudes toward authority figures and oppositional behaviors
• cuts across several domains; adults often consider these children to be "provocative"
• Etiology: 2 theories:
• (1) syndrome is a carrying forward of typical toddler-appropriate defiance
• (2) this is a way that youngsters attempt "to get attention"
• although there isn’t a definitive etiology for oppositional defiant disorder per se, it appears that this syndrome appears to be a psychological response to a youth’s difficulties with interacting with their environment(s) and/or meeting others’ expectations.
• Epidemiology: Occurs in approximately 5% of children and adolescents
• increased male:female ratio in pre-adolescence; equal male:female ratio in adolescence
• Co-morbidity: may co-exist with other psychiatric syndromes and may be mimicked by other psychiatric disorders
• youths with attention-deficit hyperactivity disorder often have oppositional defiant disorder
• youths with conduct disorder often have or have had oppositional defiant disorder.
• Diagnostic Criteria:
• often loses temper
• often argues with adults
• defies requests/rules
• deliberately annoys
• blames others for mistakes
• touchy/easily annoyed
• angry/resentful
• spiteful or vindictive
• Differential Diagnosis: important to rule out other psychiatric disorders, as many disorders may mimic symptoms
• Treatment: identification of co-morbid disorders and appropriate intervention

• Clinical Presentation: aggression, destruction of property, deceitfulness/theft, and severe violation of adult prohibitions
• repetitive behavior pattern in which basic rights of others or major age-appropriate societal norms are violated
• associated with significant dysfunction; onset prior to age 10
• Areas Of Dysfunction:
• Aggression - bullies, threatens, intimidates, initiates physical fights, has used a weapon to harm, physically cruel to people and/or animals
• Destruction of Property - deliberately set fires with intention of causing serious damage
• Deceitfulness/Theft - has broken into someone’s house, building, or car. Often lies to obtain goods or favors or avoids obligations. Has stolen items of non-trivial value without confronting victim (i.e. shoplifting)
• Epidemiology: uncommon in preschool; in teens approximately 10%; males outnumber females
• most children will not "grow out of it"
• conduct disorder is regarded as being associated with a poor prognosis: often leads to adult dysfunction (criminality, substance abuse, etc.), and 75% will have significant antisocial behavior as adults
• Differential Diagnosis:
• other disruptive behavior disorders (ADHD, ODD, non-syndromal problems like environmental stressors)
• mood disorders (depression/bipolar disorder)
• subsyndromal bipolar disorder
• anxiety disorders
• psychotic disorders
• intoxication/substance abuse
• Etiology: no single definitive cause; probably due to biologic, psychological and environmental influences
• Co-morbidity: most often associated with co-morbid Oppositional Defiant Disorder and ADHD
• chronic anxiety, somatoform and mood disorders must also be considered; substance abuse is a common co-morbidity
• Treatment: multimodal, though few treatments have consistently demonstrated real long-term efficacy
• Psychotherapeutic interventions - generally directed towards the patient, his/her family, and group/peer interactions
• Some pharmacological interventions have been studied though there is no clear treatment
• Several medications may have a role in the treatment of conduct disorder (lithium, carbamazepine, divalproex, atypical antipsychotics). Treating co-morbid diseases (ADHD, etc) can help reduce aggression, though treatment for ADHD is NOT treatment for conduct disorder. There are high placebo-response rates.

Summary of ADHD, Oppositional Defiant Disorder, and Conduct Disorder