Oppositional Defiant Disorder

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The ICD-10 Classification of Mental and Behavioural Disorders World Health Organization, Geneva, 1992

F91.3 Oppositional Defiant Disorder
This type of conduct disorder is characteristically seen in children below the age of 9 or 10 years. It is defined by the presence of markedly defiant, disobedient, provocative behaviour and by the absence of more severe dissocial or aggressive acts that violate the law or the rights of others. The disorder requires that the overall criteria for F91 be met: even severely mischievous or naughty behaviour is not in itself sufficient for diagnosis. Many authorities consider that oppositional defiant patterns of behaviour represent a less severe type of conduct disorder, rather than a qualitatively distinct type. Research evidence is lacking on whether the distinction is qualitative or quantitative. However, findings suggest that, in so far as it is distinctive, this is true mainly or only in younger children. Caution should be employed in using this category, especially in the case of older children. Clinically significant conduct disorders in older children are usually accompanied by dissocial or aggressive behaviour that go beyond defiance, disobedience, or disruptiveness, although, not infrequently, they are preceded by oppositional defiant disorders at an earlier age. The category is included to reflect common diagnostic practice and to facilitate the classification of disorders occurring in young children.

Diagnostic Guidelines
The essential feature of this disorder is a pattern of persistently negativistic, hostile, defiant, provocative, and disruptive behaviour, which is clearly outside the normal range of behaviour for a child of the same age in the same sociocultural context, and which does not include the more serious violations of the rights of others as reflected in the aggressive and dissocial behaviour specified for categories F91.0 and F91.2. Children with this disorder tend frequently and actively to defy adult requests or rules and deliberately to annoy other people. Usually they tend to be angry, resentful, and easily annoyed by other people whom they blame for their own mistakes or difficulties. They generally have a low frustration tolerance and readily lose their temper. Typically, their defiance has a provocative quality, so that they initiate confrontations and generally exhibit excessive levels of rudeness, uncooperativeness, and resistance to authority.

Frequently, this behaviour is most evident in interactions with adults or peers whom the child knows well, and signs of the disorder may not be evident during a clinical interview.

The key distinction from other types of conduct disorder is the absence of behaviour that violates the law and the basic rights of others, such as theft, cruelty, bullying, assault, and destructiveness. The definite presence of any of the above would exclude the diagnosis. However, oppositional defiant behaviour, as outlined in the paragraph above, is often found in other types of conduct disorder. If another type (F91.0-F91.2) is present, it should be coded in preference to oppositional defiant disorder.

Excludes: * conduct disorders including overtly dissocial or aggressive behaviour (F91.0-F91.2)

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