Sex Differences in the Prevalence of Oppositional Defiant Disorder During Middle Childhood: a Meta-Analysis

Abstract

This review provides a meta-analysed male:female prevalence ratio of oppositional defiant disorder (ODD) during middle childhood in non-referred children. It also analyses sex differences in prevalence across cultures and over time. A systematic search for studies via the following sources was conducted: PsycInfo, Web of Knowledge, Medline Complete, Scopus, EMBASE, InfoRMIT, Psychological and Behavioural Sciences Collection, Cochrane Library, PubMed and ProQuest Health. The studies presented in two previous systematic reviews were also added to the search results. Inclusion/exclusion criteria were then applied and final studies were appraised for their methodological quality. Nineteen independent effect sizes met full inclusion criteria (aggregated sample N = 44,107). Overall, the prevalence of ODD was significantly higher in boys than girls (RR = 1.59, 95 % CI [1.36, 1.86], p < 0.001), with the male:female prevalence ratio found to be 1.59:1. Sex differences in prevalence were significant in Western (RR = 1.80, 95 % CI [1.55, 2.10], p < 0.001) but not non-Western cultures (RR = 1.08, 95 % CI [0.76-1.53], p > 0.05). Sex differences in prevalence were significant in studies published prior to and post the year 2000 (RR = 1.57, 95 % CI [1.22, 2.02], p < 0.001; RR = 1.64, 95 % CI [1.35, 2.00], p < 0.001), and were consistent between these two periods (Q, 1 = 0.36, p = > 0.05). The sex differences in ODD prevalence are discussed within the context of (i) predominant theories of sex differences in externalising behaviours, and (ii) departure from the sex-differences pattern found for other disruptive behavioural disorders.

Lifetime prevalence, sociodemographic predictors, and comorbidities of oppositional defiant disorder: the National Epidemiology of Iranian Child and Adolescent Psychiatric disorders (IRCAP)

“…However, gender differences in ODD are not considered similar to those in conduct disorder or ADHD. 3,8,18 In contrast with previous studies, ODD was significantly more common in late adolescence than childhood. 9,19 However, Nock et al 9 reported that ODD has an ascending trend with increased age.…”

“…[5][6][7] The ODD prevalence rate has been reported as 1.4-16% in population-based samples and 28-50% in clinical samples. 2,6,8 ODD is more common in boys than in girls 3,6,8 and is more prevalent among younger participants; ODD prevalence decreases in late childhood and adolescence in both genders. 3,9 Moreover, ODD is the most prevalent psychiatric disorder in Iran, with reported rates of 4.45% among children and adolescents in five populous provinces.…”

Psychopathological and neuropsychological endophenotypes of children with disruptive behaviour

“…Population prevalence estimates of DBDs range from 1.4% up to 12.3% (Demmer, Hooley, Sheen, McGillivray, & Lum, 2017), with some of the variability between studies attributed to non-representative samples and inconsistent diagnostic criteria (Nock, Kazdin, Hiripi, & Kessler, 2007). In addition to heterogeneity within clinical presentation and symptomology, comorbidity is the rule, rather than the exception, with some estimates as high as 94.4% that a child with a DBD will meet criteria for at least one other disorder in their lifetime (Frick & Nigg, 2012;Nock et al, 2007).…”

“…In addition to heterogeneity within clinical presentation and symptomology, comorbidity is the rule, rather than the exception, with some estimates as high as 94.4% that a child with a DBD will meet criteria for at least one other disorder in their lifetime (Frick & Nigg, 2012;Nock et al, 2007). Boys tend to be overrepresented in samples of children with DBDs, with studies citing prevalence ratios between 2:1 and 3:1 (boys:girls); however, part of this disparity may be attributable to the differences in externalizing disorder presentation in boys and girls (e.g., boys are often more rambunctious and overtly disruptive (Demmer et al, 2017)). Left untreated, DBDs also place an enormous lifetime financial burden on public expenditures such as healthcare, education, and the criminal justice system, with estimates that up to $2-million can be saved for each high-risk individual who receives early intervention and support (Christenson, Crane, Malloy, & Parker, 2016).…”

Reciprocity Between Parental Psychopathology and Oppositional Symptoms From Preschool to Middle Childhood

“…ODD is a common disorder in preschool children, with prevalence rates varying between 6.9% and 13.4% (Ezpeleta, de la Osa, & Doménech, 2014;Lavigne, Lebailly, Hopkins, Gouze, & Binns, 2009). Prevalence is similar in boys and girls at an early age (Ezpeleta, de la Osa, Granero, & Trepat, 2014), but in older children, more boys than girls are affected (Demmer, Hooley, Sheen, McGillivray, & Lum, 2016;Munkvold, Lundervold, & Manger, 2011). Evidence has shown that the presence of ODD symptoms is associated with higher impairment in boys than in girls (Ezpeleta, de la Osa, Granero, et al, 2014), and, for example, the combination with conduct disorders (CDs) is stronger for boys and the association with emotional disorders is stronger for girls (Rowe, Maughan, Pickles, Costello, & Angold, 2002).…”