Is there a link between childhood Oppositional defiant disorder (ODD) and childhood Conduct Disorder (CD)?

Jason Brien — 29/10/2020

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) characterises Oppositional defiant disorder (ODD) as a childhood behavioural problem consisting primarily of disobedience and hostility in pre-teen children. The development of ODD may be linked to the following factors;

• Parental neglect and parental drug and alcohol abuse,
• marital conflict and interpersonal violence,
• physical, sexual and emotional abuse,
• low socio-economic status,
• lack of social, familial, religious and spiritual connections

Children diagnosed with ODD may exhibit the following behaviours;

• Low sensitivity to anger, annoyance and irritation,
• become easily frustrated and are more prone to frequent temper tantrums than the average child,
• strong tendency to argue with familiar adults (parents, teachers, caregivers, etc),
• frequent disobedience and disregard of rules,
• low self-esteem and poor self-image,
• inability to take responsibility and prone to blame shifting,
• frequent deliberate attempts to annoy and aggravate others,
• poor respect for personal boundaries.

Early intervention and treatment of ODD is critical as leaving this condition untreated can lead to the formation of the more serious condition known as Conduct Disorder (CD) which, again, if left untreated, can ultimately lead to a diagnosis of Antisocial personality disorder (ASPD) come adulthood. Conduct disorder is the progression to more harmful behaviours such as;

• Lying
• sadistic and cruel treatment of animals and people,
• physically or sexually abusing others,
• increased manipulativeness,
• frequent truancy and running away,
• law-breaking behaviours such as deliberately lighting fires, vandalism, stealing cars, armed robberies or shop lifting,
• increased lack of empathy and insight,
• Lack of respect for authority and morals

Some researchers estimate that between 25% and 40% of children diagnosed with Conduct disorder in childhood will become diagnosed with Antisocial personality disorder (ASPD) in adulthood. In fact, according to the DSM-5, a diagnosis of Conduct Disorder in childhood (or a retrospective diagnosis of Conduct Disorder) is a pre-requisite for a diagnosis of ASPD in adulthood. Fortunately, not all children diagnosed with Conduct Disorder will experience the degree of dysfunctionality as those diagnosed with ASPD, however they will still exhibit a degree of social dysfunction and will struggle with day-to-day living and forming and maintaining healthy relationships.

Resources

Fraser, A., & Wray, J. (2008). Oppositional defiant disorder. health, 3, 7.

Jennifer W. Kaminski & Angelika H. Claussen (2017) Evidence Base Update for Psychosocial Treatments for Disruptive Behaviors in Children, Journal of Clinical Child & Adolescent Psychology, 46:4, 477–499, DOI: 10.1080/15374416.2017.1310044

Khadar, M. G., Babapour, J., & Sabourimoghaddam, H. (2013). The effect of art therapy based on painting therapy in reducing symptoms of oppositional defiant disorder (ODD) in elementary School Boys. Procedia-Social and Behavioral Sciences, 84, 1872–1878.

Scott S. (2007). Conduct disorders in children. BMJ (Clinical research ed.), 334(7595), 646. https://doi.org/10.1136/bmj.39161.370498.BE

Zocccolillo M.; Pickles A.; Quinton D.; Rutter M. (1992). “The outcome of conduct disorder: Implications for defining adult personality disorder and conduct disorder”. Psychological Medicine. 22 (4): 971–986. doi:10.1017/s003329170003854x. PMID 1488492.