Diagnostic features (high level)

• Pattern of angry/irritable mood, argumentative/defiant behaviour, or vindictiveness lasting at least 6 months.
• Behaviours are more frequent/severe than developmental norms and occur across settings (home, school, peers).
• Must cause clinically significant impairment in social, educational or other areas of functioning.

Common symptoms

• Often loses temper, easily annoyed, resentful.
• Argues with authority figures, actively defies or refuses to comply with requests.
• Deliberately annoys others, blames others for mistakes, spiteful/vindictive behaviour.

Assessment checklist

1. Obtain developmental and family history; note onset, frequency, triggers and context of behaviours.
2. Gather collateral from parents, teachers and school reports; use rating scales (e.g., Conners, CBCL) where available.
3. Screen for comorbidity: ADHD, learning difficulties, ASD, mood disorders, trauma, and substance use in adolescents.
4. Assess family stressors, parenting practices, and exposure to violence or adverse childhood experiences.
5. Risk assessment: aggression, weapon access, school exclusion, and legal involvement.

Evidence‑based management

Parent & family interventions (first‑line)

• Parent Management Training (PMT): target consistent discipline, positive reinforcement, clear expectations and predictable consequences.
• Parent–Child Interaction Therapy (PCIT): live coaching to improve parent–child relationship and behaviour management.

School interventions

• Collaborate with schools for behaviour plans, individualized education supports, consistent consequences, and reintegration strategies.

Child/adolescent therapies

• CBT focusing on anger management, problem‑solving and social skills for older children and adolescents.
• Family therapy to address systemic issues and improve communication.

Pharmacotherapy

• No medication specifically for ODD; treat comorbid conditions (e.g., stimulants for ADHD) which often reduce oppositional behaviour.
• Short‑term antipsychotics may be considered under specialist guidance for severe aggression but require careful monitoring.

When to refer

• Severe or escalating aggression, risk to others, school exclusion or legal issues.
• Complex comorbidity (ASD, intellectual disability, trauma) requiring multidisciplinary input.
• Failure to respond to structured parent‑ and school‑based interventions.

Key takeaways

• Use family‑focused interventions (PMT, PCIT) and school collaboration as first‑line strategies.
• Assess and treat comorbid conditions (ADHD, learning difficulties) which often reduce oppositional symptoms.
• Refer for specialist care when aggression is severe, persistent or when community interventions fail.