Case history
Case history
An 8-year-old girl is brought to the clinic by her father, who reports that the child has a long history of trouble controlling her temper, leading to angry and hostile outbursts both at home and at school. He also expresses concerns about her relationships with peers, and notes that she often appears to be angry even when not having an outburst, stating that everyone has to "walk on eggshells" around her. He feels that these difficulties have worsened over the past several months, and now occur around 4 times per week. The child lives at home with both parents and her older sister. All developmental milestones have been met in a timely fashion; she is of average intelligence and is generally healthy. She has no relevant drug history. Her interactions with adults and with her peers are typified with resistance and noncompliance when it involves something that she does not want to do; often ignoring directives or arguing, which sometimes escalates to shouting, stomping, or crying. She has had problems with noncompliance to directives since she was a toddler. She is rarely physically aggressive, but does sometimes break or throw things. She often seems annoyed and snaps at peers, and has developed a poor reputation among children at school and finds it hard to maintain friendships. She is seen as a difficult student who is easily provoked by events in the classroom even when these do not directly involve her; her teachers have raised concerns over her behavior and have to provide close supervision to manage and reduce conflicts.
Other presentations
ODD typically, but not exclusively, has a childhood onset.[6][7][8] The condition usually continues through adolescence and into adulthood. Onset in adolescence or adulthood is possible, but there is not enough robust evidence to support an estimate of how frequently this occurs.
An absence of a prior diagnosis of ODD could overlook prior subclinical levels of the disorder. Children with subclinical levels of ODD and impairment have a substantially similar course and outcomes to those who meet full criteria.[15] Likewise, within-person fluctuations throughout development show that ODD - like most psychiatric disorders - waxes and wanes in intensity.[16]
The robust evidence for functional impairment and poor prognosis associated with ODD outweighs any ambiguity regarding the frequency of de novo onset after childhood. If diagnostic criteria are met for ODD, it is recommended that the diagnosis is not discounted solely on the basis of the age of onset.
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