Diagnosis and Assessment of Oppositional Defiant Disorder

Diagnostic Criteria

The American Academy of Child and Adolescent Psychiatry recommends that Oppositional Defiant Disorder (ODD) is diagnosed when a child exhibits a recurrent pattern of negativistic, hostile, or defiant behavior lasting at least 6 months, causing functional impairment in home, school, or social settings 1
The American Academy of Child and Adolescent Psychiatry states that argumentative/defiant behavior toward authority figures is a core symptom cluster of ODD 1
The American Academy of Child and Adolescent Psychiatry indicates that symptoms of ODD must persist for a minimum of 6 months, though earlier intervention is reasonable when parents are exasperated 2
The American Academy of Child and Adolescent Psychiatry notes that ODD typically emerges in late preschool or early school-age children 1
The American Academy of Child and Adolescent Psychiatry recommends that functional impairment must be present in at least one of three domains: home, school, or peer relationships 1
The American Academy of Child and Adolescent Psychiatry states that behaviors must be more severe than expected for the developmental stage 1
The American Academy of Child and Adolescent Psychiatry indicates that ODD cannot be diagnosed if symptoms occur only during mood or psychotic disorders 1
The American Academy of Child and Adolescent Psychiatry notes that ODD must not meet the criteria for conduct disorder (no major antisocial violations of others' rights or age-appropriate societal norms) 1

The American Academy of Child and Adolescent Psychiatry recommends obtaining information directly from both the child and parents regarding core ODD symptoms, age at onset, duration, and degree of functional impairment across settings 3
The American Academy of Child and Adolescent Psychiatry states that a functional analysis should identify antecedents and consequences of oppositional behavior, parental responses that may unwittingly reinforce coercive behavior, and whether oppositionality is triggered by physical abuse, sexual abuse, or neglect 3
The American Academy of Child and Adolescent Psychiatry indicates that gathering information from teachers, daycare providers, and other school professionals can confirm that oppositional behavior persists across multiple settings and determine how many domains of functioning are affected 2
The American Academy of Child and Adolescent Psychiatry notes that there is generally low agreement between multiple informants, with teachers and parents agreeing more on externalizing behaviors than with the child 2
The American Academy of Child and Adolescent Psychiatry recommends systematically evaluating for highly prevalent comorbid conditions, including ADHD, anxiety disorders, depression, learning disabilities, and language disorders 3, 4
The American Academy of Child and Adolescent Psychiatry states that comorbid conditions, such as ADHD, anxiety disorders, and depression, have significant comorbidity rates with ODD, ranging from 9% to 14% 4

The American Academy of Child and Adolescent Psychiatry notes that ADHD has a 14% comorbidity rate with ODD, and is the most common comorbid condition 4
The American Academy of Child and Adolescent Psychiatry indicates that anxiety disorders have a 14% comorbidity rate with ODD 4
The American Academy of Child and Adolescent Psychiatry states that depression has a 9% comorbidity rate with ODD 4
The American Academy of Child and Adolescent Psychiatry recommends distinguishing ODD from normative oppositional behavior, adjustment reactions, conduct disorder, ADHD, anxiety/depression, and pervasive developmental disorders 1, 3, 5

The American Academy of Child and Adolescent Psychiatry notes that most children (67%) will exit the ODD diagnosis after a 3-year follow-up 5, 4
The American Academy of Child and Adolescent Psychiatry indicates that earlier age at onset and comorbid ADHD are poor prognostic indicators for ODD 5, 4
The American Academy of Child and Adolescent Psychiatry states that 30% of early-onset ODD progresses to conduct disorder, and approximately 10% of the baseline ODD cohort ultimately develops antisocial personality disorder 5, 4