Oppositional defiant disorder (ODD) requires a comprehensive evaluation. A physician will likely perform a complete physical examination and compile a thorough medical history. Since teens who abuse drugs display a wide variety of behavioral problems, a urine or blood toxicology screen may be obtained.

Patients with ODD are frequently diagnosed with other concurrent disorders, such as attention deficit hyperactivity disorder (ADHD), anxiety, mood disorders (e.g., depression), learning disabilities and communication disorders. Oftentimes, it can be difficult to distinguish whether symptoms are the result of ODD or one of these associated disorders. Therefore, children who present with ODD symptoms are usually referred to a child and adolescent psychiatrist, who can diagnose and treat ODD and any coexisting psychiatric condition. Other specialists may be consulted, including child development professionals and other behavioral experts. 

The physician may use questionnaires or interviews with parents, teachers, babysitters, coaches and others who may describe behaviors typically associated with the condition.

To meet the criteria for diagnosis of ODD as established by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM), a child must exhibit abnormal, negative, hostile, defiant and annoying behavior that lasts at least six months and seriously interferes with day-to-day functioning. The diagnosis also requires at least four of the following:

• Frequent loss of temper
• Frequent arguments with adults
• Defiance or refusal to comply with adult requests or rules
• Deliberate provocation of others
• Blaming of others for own mistakes or misbehavior
• Easily annoyed by others
• Anger and resentment
• Spitefulness or vindictiveness

In addition, the behavioral disturbance must cause a clinically significant impairment to social, academic or occupational functioning and must not occur during the course of a psychotic disorder or mood disorder. Finally, the patient’s behavior must not meet the criteria for conduct disorder or – if the patient is 18 or older – for antisocial personality disorder.