Oppositional Defiant Disorders Definition/description Anger, irritable mood and defiant behaviour towards authority figures that significantly impairs social and/or academic functioning. Epidemiology • • Before puberty more common in boys After puberty equal among both girls and boys. Aetiology • • • • • • • • • • Reaction to excessive parental control Lack of attention from parents - Child sees getting attention as a reward Genetic Environmental Psychological Social factors: - Abuse - Exposure to toxins Positive family history Neglectful parents Family instability Child with a difficult temperament or ADHD grows up in a family with parents who respond to the child with harsh, punitive or inconsistent parenting Clinical features • • • • • Initially appear at home Affect relationships with peers and teachers Usually appear during preschool and rarely later than early adolescence Associated with poor school performance, few friends, strained parent/child relationships Risk of developing mood disorders later on Diagnosis DSM V A. A pattern of angry/irritable mood, argumental/defiant behaviour or vindictiveness lasting at least 6 months with at least four of any of and exhibited with at least one person who is NOT a sibling: - Angry/irritable mood: 1. Often loses temper 2. Is often touchy or annoyed 3. Is often angry and resentful - Argumentative/defiant behaviour 4. Often argues with authority figures or child and adolescents with adults 5. Often actively defies or refuses to comply with requests from authority figures or with rules 6. Often deliberately annoys others. 7. Often blames others for his or her mistakes or misbehaviour 8. Has been spiteful or vindictive at least twice within the past 6 months. B. The disturbance in behaviour is associated with distress in the individual or others in his or her immediate social context e.g. family, friend group, colleagues at work or it impacts negatively on social, educational, occupational or other important areas of functioning. C. The behaviours do not occur exclusively during the course of psychotic, substance use, depressive or bipolar disorder. - Criteria of disruptive mood dysregulation disorder is not met. • Specify current disorder: - Mild: symptoms are confined to only one setting - Moderate: some symptoms are present in at least two setting - Severe: some symptoms are present in three or more setting. Treatment and Management • • • Psychotherapy - Individual and family Parent management training Social skills programs After 18 turns into anti-social disorder