Oppositional defiant disorder is a pattern of disobedient, hostile, and defiant behavior toward authority figures.

This disorder is more common in boys than in girls. Some studies have shown that it affects 20% of school-age children. However, most experts believe this figure is high due to changing definitions of normal childhood behavior, and possible racial, cultural, and gender biases.

This behavior typically starts by age 8. The cause of this disorder is unknown, and may be due to a combination of biology and parenting or environmental factors.

• Actively does not follow adults' requests
• Angry and resentful of others
• Argues with adults
• Blames others for own mistakes
• Has few or no friends or has lost friends
• Is in constant trouble in school
• Loses temper
• Spiteful or seeks revenge
• Touchy or easily annoyed

To fit this diagnosis, the pattern must last for at least 6 months and must be more than normal childhood misbehavior.

The pattern of behaviors must be different from those of other children around the same age and developmental level. The behavior must lead to significant problems in school or social activities.

It may help to get the child evaluated by a psychiatrist or psychologist. In children and adolescents, depression and attention-deficit /hyperactivity disorder (ADHD) can cause similar behavior problems, and should be considered as possibilities.

The best treatment for the child is talking with a mental health professional (psychotherapy). The parents should also learn how to manage the child's behavior. Medication may be helpful if the behaviors occur as part of another condition (such as depression, childhood psychosis, or ADHD).

Some children respond well to treatment, while others do not.

In many cases, children with oppositional defiant disorder grow up to have conduct disorder as adults.

Call your health care provider if you have concerns about your child's development or behavior.

Be consistent about rules and fair consequences at home. Don't make punishments too harsh or inconsistent.

Model the right behaviors for your child. Abuse and neglect increase the chances that this condition will occur.

Steiner H, Remsing L, Work Group on Quality Issues. Practice parameter for the assessment and treatment of children and adolescents with oppositional defiant disorder. J Am Acad Child Adolesc Psychiatry. 2007;46:126-141.