While Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD) are both categorized under the general heading of “Disruptive Behavior Disorders,” there are specific features that allow us to compare and contrast them during diagnosis. Primary features of ODD include a pattern of negativistic, defiant, noncompliant, and uncooperative behaviors. Primary features of CD include a pattern of behavior in which the basic rights of others and/or major age-appropriate norms or rules are violated. The primary feature that distinguishes ODD from CD is the emphasis in CD on the recurrent violation of the rights of others and/or societal norms and rules. (Netherton, Holmes, & Walker, 1999, p. 118) The diagnosis (of ODD) is not made if the disturbance in behavior occurs exclusively during the course of a Psychotic or Mood Disorder; or if the criteria are met for Conduct Disorder of Antisocial Personality Disorder (in an individual over age 18 years). (American Psychiatric Association, Diagnostic and statistical manual of mental disorders, 2000, p. 100)
Despite our ability to differentiate the diagnoses, current etiological evidence suggests that they do follow a common developmental course. Genetic, temperamental, family interaction and environmental stress variables have all been implicated in the development of ODD/CD. (Netherton et al., 1999, p. 122) In a comprehensive study of gender and its relationship to genetic influence of ODD/ADHD, Derks and associates (2007) concluded that the size of the genetic influences does not depend on the child’s sex, but partly different genes are expressed in boys and girls. They also found that parent and teacher ratings may be inconsistent because qualitative description depending on the context in which they are observed. Compensating for that inconsistency, there is no quantitative evidence indicating that ODD/CD is more common in boys than girls. (Derks, Dolan, Hudziak, Neale, & Boomsma, 2007)
These children often exhibit deficits in social skills, including difficulties developing and maintaining peer relationships. They are more aggressive, less empathetic, and more deficient in the social-problem-solving skills, and they tend to misperceive the social environment, often incorrectly attributing hostile intentions to others. (Netherton et al., 1999, p. 119) Considering these deficiencies are displayed in childhood, I would posit the question; how do they fare as adults? A recent study utilized data from a 20-year community follow-up study to investigate the extent to which youth irritability (one of the DSM-IV criteria for ODD) is a risk for adult psychiatric disorders. The results measured irritability in children and found that they could reliably predict depressive disorders and generalized anxiety disorder in same subject adults. (Stringaris, Cohen, Pine, & Leibenluft, 2009)
A recent study performed by Glantz and associates (2009) focused on early onset mental disorders and their ability predict substance dependence into adulthood. The study chose to focus on dependence rather than abuse because mental disorders are known to predict the dependence more strongly than abuse. Glantz and associates inquired about the efficacy mounting mental health treatments in childhood to produce results in substance dependence among adults. Although the study concluded that “treatment of prior mental disorders would not be a cost-effective way to prevent substance dependence,” they did acknowledge that “prevention of substance dependence might be considered an important secondary outcome of interventions for early-onset mental disorders.” (Glantz, Anthony, Berglund, & Degenhardt, 2009) This study serves to emphasize the lifelong benefits we can provide children as our efforts continue to yield dividends into their adult lives.
Ramchand and associates raised the stakes and underscored the possible outcomes of we fail to address ODD/CD in childhood. They examined outcomes for adolescent offenders, and gave them the opportunity to express how they were faring in young adulthood. Seven years after court referral to long-term residential group-home care, 12 of our sample of 449 youths were dead before turning 25, almost one third were in prison or jail, close to one half did not have a high-school diploma, two thirds reported ongoing criminal activity, and almost two thirds reported illegal drug use in the previous year (and more than half of those acknowledged the use of hard drugs). Nine of the 11 known causes of death involved gunshot wounds or murder, highlighting the dangerous conditions to which many delinquents are exposed even after long-term rehabilitative care. Supplemental analyses provided further evidence of this danger: 60% of the 383 surveyed respondents reported having been shot at with a gun, and 19% reported having suffered a gunshot wound. (Ramchand, Morral, & Becker, 2009)
Despite our challenges in determining a specific etiology, and subsequently diagnosing ODD/CD, it is clear that there is an unprecedented demand for work within the context of these two pathologies. Aside from the fact that they are among the most commonly referred for professional help, the stakes couldn’t be higher to resolve these mental health issues in childhood so as to prevent future problems for our clients in the future. Although current research provides a baseline for analysis, further research is needed to determine the specific effects mental health treatment in children as it relates to the punitive effects it can have leading into adulthood.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.
Derks, E., Dolan, C., Hudziak, J., Neale, M., & Boomsma, D. (2007, Jul). Assessment and etiology of attention deficit hyperactivity disorder and oppositional defiant disorder in boys and girls. Behavior Genetics, 37(4), 559-566. doi: 10.1007/s10519-007-9153-4
Glantz, M. D., Anthony, J. C., Berglund, P. A., & Degenhardt, L. (2009, Aug). Mental disorders as risk factors for later substance dependence: estimates of optimal prevention and treatment benefits. Psychological Medicine, 39(8), 1365-1378. doi: 10.1017/S0033291708004510
Netherton, S. D., Holmes, D., & Walker, C. E. (1999). Child and adolescent psychological disorders: A comprehensive textbook. Oxford, NY: Oxford University Press.
Ramchand, R., Morral, A. R., & Becker, K. (2009, May). Seven-year life outcomes of adolescent offenders in los angeles. American Journal of Public Health, 99(5), 863-871. Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://proquest.umi.com.ezproxy.bellevue.edu/pqdweb?did=1683162651&sid=2&Fmt=3&clientId=4683&RQT=309&VName=PQD
Stringaris, A., Cohen, P., Pine, . S., & Leibenluft, E. (2009, Sep). Adult outcomes of youth irritability: A 20-year prospective community-based study. The American Journal of Psychiatry, 166(9), 1048-1055. doi: 10.1176/appi.ajp.2009.08121849