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Tests and diagnosis
By Mayo Clinic staffTo be diagnosed with oppositional defiant disorder, a child must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.
Criteria for oppositional defiant disorder to be diagnosed include a pattern of behavior that lasts at least six months and includes at least four of the following:
- Often loses temper
- Often argues with adults
- Often actively defies or refuses to comply with adults' requests or rules
- Often deliberately annoys people
- Often blames others for his or her mistakes or misbehavior
- Is often touchy or easily annoyed by others
- Is often angry and resentful
- Is often spiteful or vindictive
These behaviors must be displayed more often than is typical for your child's peers.
In addition, to be diagnosed with oppositional defiant disorder, a child's disruptive behavior:
- Must cause significant problems at work, school or home
- Must occur on its own, rather than as part of the course of another mental health problem, such as depression or bipolar disorder
- Must not meet the diagnostic criteria for conduct disorder or, if the affected person is older than age 18, antisocial personality disorder
It can be difficult for doctors to sort and exclude other associated disorders — for example, attention-deficit/hyperactivity disorder versus oppositional defiant disorder. These two disorders are commonly diagnosed together.
- Oppositional defiant disorder. In: Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. 4th ed. Arlington, Va.: American Psychiatric Association; 2000. http://www.psychiatryonline.com. Accessed Oct. 25, 2011.
- Nurcombe B. Oppositional defiant disorder and conduct disorder. In: Ebert MH, et al, eds. Current Diagnosis and Treatment: Psychiatry. 2nd ed. New York, N.Y.: The McGraw-Hill Companies; 2011. http://www.accessmedicine.com/content.aspx?aID=3290408. Accessed Oct. 25, 2011.
- Disruptive behavioral disorders. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merckmanuals.com/professional/pediatrics/mental_disorders_in_children_and_adolescents/disruptive_behavioral_disorders.html#v1106068. Accessed Oct. 25, 2011.
- Hamilton SS. Oppositional defiant disorder. American Family Physician. 2008;78:861.
- Children with oppositional defiant disorder. American Academy of Child and Adolescent Psychiatry. http://www.aacap.org/cs/root/facts_for_families/children_with_oppositional_defiant_disorder. Accessed Oct. 25, 2011.
- Steiner H. Practice parameter for the assessment and treatment of children and adolescents with oppositional defiant disorder. Journal of the American Academy of Child and Adolescent Psychiatry. 2007;46:126.
- Loeber R, et al. Perspectives on oppositional defiant, conduct disorder, and psychopathic features. Journal of Child Psychology and Psychiatry. 2009;50:133.
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