What is the difference between Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD)?

From the Guidelines

Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD) are distinct conditions, with ODD being a milder form of psychopathology compared to CD. The key differences between the two disorders lie in their severity, duration, and impact on functioning.

Key Differences

• Severity: ODD is characterized by recurrent patterns of negativistic, hostile, or defiant behavior, whereas CD involves more severe antisocial behaviors, such as aggression, destruction of property, and violation of rights of others 1.
• Duration: ODD symptoms must be present for at least 6 months, whereas CD symptoms can be more variable in duration 1.
• Impact on functioning: Both disorders can interfere with social, academic, or occupational functioning, but CD tends to have a more significant impact due to its severity and frequency of antisocial behaviors 1.

Diagnostic Considerations

• Comorbidity: ODD and CD can co-occur, and ODD often precedes the development of CD 1.
• Differential diagnosis: ODD must be distinguished from normative oppositional behavior, transient antisocial acts, and CD, as well as other psychiatric conditions, such as attention-deficit/hyperactivity disorder (ADHD) and mood disorders 1.
• Assessment: A comprehensive assessment of ODD should include information from the child, parents, and other caregivers, as well as a functional analysis of the child's behavior 1.

Treatment Implications

• Intensity and duration of treatment: Treatment of ODD may require intensive and prolonged interventions, especially in severe and persistent cases 1.
• Level of care: The level of care should be determined by the severity of symptoms, the need for safety, and the ability of the family to collaborate with treatment 1.

From the Research

Difference between Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD)

• ODD and CD are two distinct disorders, although they are developmentally related and often co-occur 2, 3, 4, 5, 6
• ODD is characterized by a pattern of emotional regulation difficulties, including irritability and emotional lability, whereas CD is marked by more severe antisocial behaviors 2, 6
• Factor analyses have identified distinct covarying groups of ODD and CD symptoms, although some symptoms, such as mild aggression and lying, relate to both disorders 3, 4
• The age of onset for ODD is typically earlier than for most CD symptoms, and nearly all youths with CD have a history of ODD, but not all ODD cases progress to CD 3, 4
• The disorders demonstrate similar forms of parental psychopathology and family adversity, but to a greater degree for CD than for ODD 3, 4

Developmental Relationship between ODD and CD

• The Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) specifies a developmental relationship between ODD and CD, but evidence for this link is mixed 6
• Transitions between ODD and CD are less common than anticipated, particularly during adolescence 6
• ODD is a significant predictor of later CD in boys, but not in girls, after controlling for comorbid CD and subthreshold CD symptomatology 6

Distinction between ODD and CD

• Many youths with ODD never develop CD, and CD that emerges for the first time in adolescence appears to be independent of ODD 4, 6
• CD largely predicts behavioral outcomes, whereas ODD shows stronger prediction to emotional disorders in early adult life 6
• Factor analysis has identified irritable and headstrong dimensions in ODD symptoms that show differential prediction to later behavioral and emotional disorders 6