A pattern of negativistic, hostile, and defiant behavior lasting at least 6 months, in which the child loses temper, argues with adults, often actively defies or refuses adult requests or rules, blames others, deliberately does annoying things, and swears or uses obscene language. This behavior creates significant impairment in academic/social functioning but does not meet the criteria for conduct disorder. (Disruptive behavior disorder NOS reflects clinical features that constitute the subthreshold for both oppositional defiant and conduct disorders.)
The oppositional youth is fixed in the separation-individuation stage of development. The youth insists on autonomy by negative adaptive maneuvers in which he or she continually provokes adults or peers. As the youth develops internal controls, he or she will eventually grow out of these behaviors.
Similar to the predisposition for conduct disorder, heredity contributes to individual temperament, frustration, tolerance, and the tendency to seek risks or disobey authority. The disorder may be gender-linked, as the incidence is higher in boys than in girls.
Familial and cultural norms may prohibit the degree of individual differentiation among the family members. Attempts to maintain conformity are met by negativism, disobedience, and quarrelsome defiance. Parenting skills are ineffective and/or inconsistent with reactive and emotionally charged interchanges between parent and child. Some parents interpret average or increased levels of developmental oppositionalism as hostility and as the child\u2019s deliberate effort to be in control. If power and control are issues for parents, or if they exercise authority for their own needs, a power struggle can be established between the parents and the child that sets the stage for the development of oppositional defiant disorder.
A relationship between life events and the development of anxiety disorders has been identified. This theory suggests that disruptive behavior is learned as a means for a child to gain adult attention. Anxiety generated by a dysfunctional family system, marital problems, etc., could also contribute to symptoms of this disorder. Parents become frustrated with the child\u2019s poor response to limit-setting. Parenting intervention become oversensitive or the reverse, with no external structure provided.
Feelings of rejection, powerlessness, fear of abandonment
Blames others for what happens to self; easily annoyed by others
Passive-dependent or demanding attitude of entitlement
Family may report emotional lability
Displays impaired social and academic functioning
Shows provocative display of defiance of adult authority figures
Deliberately engages in annoying behaviors; ignores verbal instructions/requests
Often bullies or bosses others (peers, siblings)
Aggressively interrupts play activity of others; breaking toys, making up own rules
for games, etc.
May/may not participate in social activities
Interpersonal relationships impaired (e.g., loses temper, argues, refuses to comply
Note presence of physical symptoms that might indicate the existence of physical illness (e.g., rashes, upper respiratory illness, or other allergic symptoms, CNS infection [cerebritis] requiring appropriate diagnostic studies).
Situational or maturational crisis
Mild neurological deficits/retardation
Retarded ego development; low self-esteem
Family system with dysfunctional coping
Identify adaptive coping skills that will achieve a
healthy balance between independence and
Recognizing the onset of anxiety and providing another, particularly transitioning at bedtime for flexibility will decrease likelihood of child taking younger children.
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