Evidence-based assessment/Oppositional defiant disorder (disorder portfolio)

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What is a "portfolio"?

 * For background information on what assessment portfolios are, click the link in the heading above.
 * Want even 'more' information about this topic? There's an extended version of this page here.

Diagnostic criteria for oppositional defiant disorder
ICD-11 Diagnostic Criteria General Description: Oppositional defiant disorder is a persistent pattern (e.g., 6 months or more) of markedly defiant, disobedient, provocative or spiteful behaviour that occurs more frequently than is typically observed in individuals of comparable age and developmental level and that is not restricted to interaction with siblings. Oppositional defiant disorder may be manifest in prevailing, persistent angry or irritable mood, often accompanied by severe temper outbursts or in headstrong, argumentative and defiant behaviour. The behavior pattern is of sufficient severity to result in significant impairment in personal, family, social, educational, occupational or other important areas of functioning Oppositional Defiant Disorder With Chronic Irritability-Anger: All definitional requirements for oppositional defiant disorder are met. This form of oppositional defiant disorder is characterized by prevailing, persistent angry or irritable mood that may be present independent of any apparent provocation. The negative mood is often accompanied by regularly occurring severe temper outbursts that are grossly out of proportion in intensity or duration to the provocation. Chronic irritability and anger are characteristic of the individual’s functioning nearly every day, are observable across multiple settings or domains of functioning (e.g., home, school, social relationships), and are not restricted to the individual’s relationship with his/her parents or guardians. The pattern of chronic irritability and anger is not limited to occasional episodes (e.g., developmentally typical irritability) or discrete periods (e.g., irritable mood in the context of manic or depressive episodes). Oppositional Defiant Disorder Without Chronic Irritability-Anger: Meets all definitional requirements for oppositional defiant disorder. This form of oppositional defiant disorder is not characterized by prevailing, persistent, angry or irritable mood, but does feature headstrong, argumentative, and defiant behavior. Changes in DSM-5 The diagnostic criteria for ODD changed slightly from DSM-IV to DSM-5. See the changes here.
 * Note: The ICD-11 lists 3 additional subcategories of oppositional defiant disorder with chronic irritability-anger (i.e., with limited prosocial emotions, with typical prosocial emotions, and unspecified). They can be found here.
 * Note: The ICD-11 lists 3 additional subcategories of oppositional defiant disorder without chronic irritability-anger (i.e., with limited prosocial emotions, with typical prosocial emotions, and unspecified). They can be found here.

Base rates of ODD in different clinical settings
This section describes the demographic setting of the population(s) sampled, base rates of diagnosis, country/region sampled and the diagnostic method that was used. Using this information, clinicians will be able to anchor the rate of ODD that they are likely to see in their clinical practice.


 * To see prevalence rates across multiple disorders, click here.

p Parent interviewed as part of diagnostic assessment; y youth interviewed as part of diagnostic assessment, r adult interviewed for retrospective report as part of diagnostic assessment

Note: Mash and Barkley note that prevalence rates of ODD must be qualified, because the definition of ODD has changed at a fast rate, the rates adolescents meeting criteria in any cross-sectional evaluation may be misleading because of the developmental progressions with and between ODD and Conduct Disorder, and categorical definitions of aggressive patterns may reflect arbitrary numbers of constituent estimates. These factors may lead to misleading prevalence rates. In addition, few studies have investigated the prevalence of ODD in preschool-aged children, and early onset of these behaviors is associated with more severe and stable impairment.

Prediction phase
The following section contains a list of screening and diagnostic instruments for ODD. The section includes administration information, psychometric data, and PDFs or links to the screenings.
 * Screenings are used as part of the prediction phase of assessment; for more information on interpretation of this data, or how screenings fit in to the assessment process, click here.
 * For a list of more broadly reaching screening instruments, click here.

Note: Reliability and validity are included in the extended version. This table includes measures with Good or Excellent ratings.

Likelihood ratios and AUCs of screening instruments for ODD

 * For a list of the likelihood ratios for more broadly reaching screening instruments, click here.

Note: “LR+” refers to the change in likelihood ratio associated with a positive test score, and “LR-” is the likelihood ratio for a low score. Likelihood ratios of 1 indicate that the test result did not change impressions at all. LRs larger than 10 or smaller than .10 are frequently clinically decisive; 5 or .20 are helpful, and between 2.0 and .5 are small enough that they rarely result in clinically meaningful changes of formulation.

Search terms: [Oppositional Defiant Disorder] AND [sensitivity OR specificity] in GoogleScholar and PsychINFO;

Interpreting ODD screening measure scores

 * For information on interpreting screening measure scores, click here.

Gold standard diagnostic interviews

 * For a list of broad reaching diagnostic interviews sortable by disorder with PDFs (if applicable), click here.

Recommended diagnostic instruments for ODD
Note: Reliability and validity are included in the extended version. This table includes measures with Good or Excellent ratings.

Process phase
The following section contains a list of process and outcome measures for oppositional defiant disorder. The section includes benchmarks based on published norms for several outcome and severity measures, as well as information about commonly used process measures. Process and outcome measures are used as part of the process phase of assessment. For more information of differences between process and outcome measures, see the page on the process phase of assessment.

Outcome and severity measures

 * This table includes clinically significant benchmarks for generalized anxiety disorder specific outcome measures
 * Information on how to interpret this table can be found here.
 * Additionally, these vignettes might be helpful resources for understanding appropriate adaptation of outcome measures in practice.
 *  For clinically significant change benchmarks for the CBCL, YSR, and TRF total, externalizing, internalizing, and attention benchmarks,  see here.

Note: “A” = Away from the clinical range, “B” = Back into the nonclinical range, “C” = Closer to the nonclinical than clinical mean.

Process measures
See Section 1.1 for overview of evidence-based measures to use depending on etiology and symptomatology of Oppositional Defiant Disorder.

Behavioral parent training
Behavioral Parent Training is considered the most effective treatment for childhood disruptive behavior disorders (e.g., Oppositional Defiant Disorder), especially for younger children (i.e., 3-8 year-olds). See http://effectivechildtherapy.org/concerns-symptoms-disorders/disorders/rule-breaking-defiance-and-acting-out/ a website sponsored by The Society for Child and Adolescent Psychology (APA, Division 53) and the Association for Behavioral and Cognitive Therapies (ABCT), for current summary of evidence-based treatments.

Overview of recommendations for assessment and treatment
See the National Institute for Health and Care Excellence (NICE) Practice Guidelines for Childhood Conduct Disorders, for an overview of recommendations for both assessment and treatment of Oppositional Defiant Disorder.