• arguing with adults
• loss of temper
• angry and resentful of others
• actively defies adults' requests
• spiteful or vindictive behavior
• blames others for their own mistakes
• is touchy or easily annoyed
• few or no friends or loss of previous friends
• constant trouble in school

The pattern of behaviors must be distinguished from what is commonly observed in other children of similar age and developmental level, and must result in significant social or academic problems.

Evaluation by a psychiatrist or psychologist may be recommended. In children and adolescents, depression and attention-deficit /hyperactivity disorder (ADHD) may cause similar disturbances in behavior, and should be considered as alternate or additional diagnoses.