Symptoms of Oppositional Defiant Disorder (ODD) to Assess For
The core symptoms of Oppositional Defiant Disorder include a persistent pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months, with symptoms typically emerging by age 8 years. 1
Key Symptom Categories to Assess
1. Angry/Irritable Mood
- Often loses temper
- Is often touchy or easily annoyed
- Is often angry and resentful
2. Argumentative/Defiant Behavior
- Often argues with authority figures or adults
- Often actively defies or refuses to comply with requests from authority figures or with rules
- Often deliberately annoys others
- Often blames others for his or her mistakes or misbehavior
3. Vindictiveness
- Has been spiteful or vindictive at least twice within the past 6 months
Assessment Considerations
Duration and Frequency
- Symptoms must persist for at least 6 months 2
- Behaviors occur more frequently than typically observed in individuals of comparable age and developmental level 1
- Document the unrelenting nature of the problem - behaviors are not transient 2
Setting Specificity
- Determine if behaviors are present in multiple settings or limited to specific contexts 2
- Commonly, a child may be difficult with parents but compliant in school and with other adult figures 2
- Severity classification (mild, moderate, or severe) is based on the number of settings in which symptoms are present 1
Functional Analysis
- Identify antecedents and consequences of the child's behavior 2
- Assess parent and others' behaviors that may reinforce problematic behaviors 2
- Evaluate if parents unwittingly reinforce oppositional behavior (e.g., completing tasks assigned to child, giving in to demands) 2
Distinguishing Features
Differentiate from Normal Development
- Isolated occurrences of oppositional behavior with preserved functioning in most domains suggest normative behavior rather than ODD 2
- Consider if behaviors are reactions to peer conflicts or significant stressors 2
Differentiate from Other Disorders
- Distinguish ODD from:
Assessment Methods
Multi-Informant Approach
- Obtain information directly from the child and parents 2
- Include reports from teachers, daycare providers, and other school professionals 2
- Be aware that agreement between informants is often low 2
- Teachers and parents tend to agree more with each other about externalizing behaviors than with the child 2
Standardized Assessment Tools
- Use specific questionnaires and rating scales to evaluate ODD and track progress 2
- These can help distinguish ODD from normative oppositionality 1
Comorbidity Assessment
Common Comorbidities to Screen For
- ADHD (present in approximately 14% of ODD cases) 1
- Anxiety disorders (14%) 1
- Depressive disorders (9%) 1
- Learning disabilities and language disorders 1
- Chronic pediatric illness (often associated with increased disruptive behavior) 2
Impact of Comorbidities
- When ODD and ADHD co-occur, children tend to show more aggression, greater range of problem behaviors, and higher peer rejection 1
- ODD with comorbid CD shows higher rates of mood disorders and social impairment 1
- Treating comorbid conditions often improves ODD symptoms 3
Additional Assessment Areas
Bullying Involvement
- Assess the child's involvement in bullying as either victim or perpetrator 2
- This can indicate impaired functioning and risk for aggression or violence 2
Access to Weapons
- Evaluate children's access to weapons and supervision of such 2
Environmental Factors
- Explore if oppositionality is triggered by physical abuse, sexual abuse, or neglect 2
- Consider if child becomes oppositional in response to excessive or unrealistic parental demands 2