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Environmental factors

Unlike conduct disorder (CD), ODD has been shown to be exacerbated by certain parenting behaviors, specifically timid disciplinary behaviors (which are often a result of concern about the reactions of the child). It as well as CD have also been shown to result in worsening parenting behaviors over time.  Negative parenting practices and parent–child conflict may lead to antisocial behavior, but they may also be a reaction to the oppositional and aggressive behaviors of children. The way that parents view their child’s behavior and if they attribute it to internal and stable factors can heavily impact their child’s responsive behavior. Factors such as a family history of mental illnesses and/or substance abuse as well as a dysfunctional family and inconsistent discipline by a parent or guardian can lead to the development of behavior disorders.

Insecure parent–child attachments can also contribute to ODD, specifically with unresponsive parents. Often little internalization of parent and societal standards exists in children with conduct problems. These weak bonds with their parents may lead children to associate with delinquency and substance abuse. Hostile-coercive parenting can also lead to conduct problems in children, which often leads to resentment and anger toward parental figures.  Family instability and stress can also contribute to the development of ODD. Although the association between family factors and conduct problems is well established, the nature of this association and the possible causal role of family factors continues to be debated.

Low socioeconomic status and community violence have also been linked to increased likelihood of ODD.  However, much of this might be due to the fact that low socioeconomic is associated with poor parenting, specifically with inconsistent discipline and poor parental monitoring. This low parental monitoring has been shown to lead to increased opportunities for children to engage in aggressive and inappropriate or antisocial behaviors.  Which have then been associated with an early onset of aggression and antisocial behaviors.  It has also been shown that low SES may be related to the formation of relationships with deviant peer groups and poor neighborhood conditions which are linked to the development of conduct problems in children. 

Externalizing problems are reported to be more frequent among minority-status youth, a finding that is likely related to economic hardship, limited employment opportunities, and living in high-risk urban neighborhoods.

Neurobiological factors

Deficits and injuries to certain areas of the brain can lead to serious behavioral problems in children. Brain imaging studies have suggested that children with ODD may have subtle differences in their frontal lobe activation, the part of the brain responsible for reasoning, judgment and impulse control. Children with ODD are thought to have an overactive behavioral activation system (BAS), and underactive behavioral inhibition system (BIS). The BAS stimulates behavior in response to signals of reward or nonpunishment. The BIS produces anxiety and inhibits ongoing behavior in the presence of novel events, innate fear stimuli, and signals of nonreward or punishment. It has also been found that compared to other children those with ODD have general underarousal, including low levels of salivary cortisol as well as different physiological heart rate responses. Children with ODD tend to have lower resting heart rate levels, but show higher elevations in heart rate when facing frustration. 

Children who are likely to develop ODD or other conduct problems often show difficult temperaments as a child, that is they have more drastic emotional, physiological and behavioral responses to stimuli at a young age. Most often this emotional reactivity is either at an extremely high level or extreme low. This extreme emotionality is usually the result of the child having difficulty regulating their emotions (ie. the child cannot properly control their negative emotions on their own), or they have low emotional arousal (ie. they have low neurological and physiological responses, such as low heart rate, which lead them to needing higher levels of stimulation to reach a normal level of arousal). 

It has also been suggested that altered neurotransmitter function, specifically noradrenergic, dopaminergic and serotonergic systems as well as cortisol and testosterone levels may be implicated in increased aggressive and defiant behaviors. This could be linked to underarousal of the hypothalamic-pituitary-adrenal (HPA) axis, which controls the body’s stress response, leading to low emotional arousal in ODD children. Neuroimaging studies have also identified structural and functional brain abnormalities in several brain regions in youths with conduct disorders. These brain regions are the amygdala, prefrontal cortex, anterior cingulate, and insula, as well as interconnected regions. In the amygdala specifically we see that these children show hypoactivity, which causes them to be unable to recognize and process emotional expressions, leading to lack of empathy.