Prognosis

ODD typically, but not exclusively, has a childhood onset.[6][7][8] A waxing and waning course in terms of severity from year to year is common, but developmental trajectories overall tend towards stability including during the transition from adolescence to adulthood.[7][16][58][59]

Prognosis following treatment

The immediate prognosis for ODD given treatment with behavioural interventions is good, but little evidence from long-term studies is available to describe distal outcomes after treatment. In general, the literature on treatment specific to ODD in adolescence and adulthood is limited; this may be due to the historical tendency to regard ODD as a childhood disorder. Further studies of the long-term outcomes of treatment specifically for ODD are required.

ODD can in some cases be a developmental precursor for conduct disorder; this is more commonly seen in patients with severely defiant symptoms or spiteful/vindictive behaviours.[13] Patients with ODD with features of chronic irritability and anger are at higher risk of developing depressive and anxiety-related conditions.[13]

Risk for poor outcomes

Substantial risks for poor outcomes are associated with ODD. ODD is predictive of both internalising (depression, anxiety, and suicidality) and externalising (conduct disorder, aggression) psychopathology; these issues may wax and wane during childhood as well as in the transition from childhood to adulthood and beyond.[10][11] Functional impairments may be found across interpersonal contexts, in academic achievement, workplace performance, and household income. Romantic and marital relationships may also be impacted by ODD.[11]

ODD may contribute to the risk of future parental divorce.[1][31][32] This is likely to be due to proximal and persisting increases in parental stress and interparental conflict.[103][104] In one large Norwegian community sample with repeated measurements spanning ages 4-16 years, ODD was shown to be potentially predictive of aggression between parents.[104] Importantly, ODD was not itself predicted by interparental aggression; rather, a complex developmental pathway in which ODD led to increased interparental aggression and interparental aggression led to CD was postulated.[104]

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