Oppositional Defiant Disorder Conduct Disorder

Patterns of negativistic, disobedient, and hostile behavior toward Epidemiology:

authority figures M: 6-16%, F: 2-9%, Ratio M:F 4:1 to 12:1
Inability to take responsibility for mistakes Occurs in greater frequency in children with parents with
Epidemiology: antisocial personality disorder and alcohol dependence
2-16% of school age children Association with socioeconomic factors and parental
Dx as early as 3 yo psychopathology
Typically Dx between ages 8 - early adolescence Etiology:
M > F pre-puberty M = F after puberty Parental Factors
Etiology: Genetic Factors
Persistence of developmental phase of terrible twos, authority Sociocultural Factors
overreacts, frequent recurrence Psychological Factors
Later in childhood environmental trauma, illness, chronic Neurobiological Factors
incapacity (MR) can trigger oppositionality as defense against Neurologic Factors
helplessness, anxiety, and loss of self-esteem Child Abuse & Maltreatment
Presentation: Presentation
Children with ODD argue with adults and are easily annoyed with Enduring aggressive patterns of behaviors in child or adolescent
others state of anger & resentment & easily annoyed with that violate the basic rights of peers and family members
others at level and frequency that is outside of the expected range Subtypes
for their age and developmental level Childhood-onset
NO physical aggression or destructive behavior, serious violations Adolescent-onset
of the rights of others Unspecified-onset
Actively defy requests and rules or deliberately annoy others Dx:
Blame others for mistakes & misbehavior 3 of 15 criteria related to:
Symptoms present at home & sometimes at school most - often A. Must be present in last 12 months from any category and at
with well known adults least 1 in the past 6 months
Dx: o Aggression to People and Animals
No specific lab findings or pathology will make diagnosis o Destruction of Property
+/- low levels of CNS serotonin in older pts o Deceitfulness or Theft
Tx: o Serious Violation of Rules
Family Intervention B. The disturbances in behavior causes clinically significant
Individual Psychotherapy impairment at school, academic, or occupational functioning.
Role play C. If the individual is age 18 years or older, criteria are not met for
Self-esteem restoration antisocial personality disorder.
Increase positive parent-child interactions Specifiers:
Course & Prognosis: With limited prosocial emotions
25% will no longer meet criteria Lack of remorse or guilt
Persistence of Sx increases risk for Callous lack of empathy
Mood disorders, conduct disorder, substance use Unconcerned about performance
disorders Shallow of deficient affect
Best prognosis with Mild, Moderate or Severe
Intact families DDX:
Family willing to modify their demands & give attention ADHD
to argumentative behaviors Oppositional Defiant Disorder
Prognosis dependent on family functioning & comorbid Disruptive Mood Dysregulation Disorder
psychopathology Major Depression
Bipolar Disorder
Learning Disorder
Psychotic Disorders
Tx:
Psychosocial Interventions: CBT, School based behavioral
techniques
Pharm:
Atypical Antipsychotics aggressive and
assaultive behaviors
SSRIs used to address impulsivity, irritability, and
mood lability
Course & Prognosis:
Worse prognosis for children
Symptoms at young age
Exhibit lots of symptoms
Severe symptoms
Symptoms occur frequently
Better prognosis for children
Mild conduct disorder
Absence of coexisting psychopathology
Nl intellectual functioning
Assaultive behavior + Parental criminality = risk for
incarceration later in life