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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 …