Oppositional Defiant Disorder (ODD) is characterized by a recurrent pattern of angry/irritable emotional lability, argumentative/defiant behavior, and vindictiveness. Previous studies indicated that ODD typically might originate within a maladaptive family environment, or was at least maintained within such an environment. As such, the present review summarized pertinent research from the last 20 years that focused on the pathways connecting family risk factors to the development of child ODD symptoms. A systematic search of electronic databases was completed in August 2020, resulting in the inclusion of 62 studies in the review. The review established a multi-level framework to describe the mechanisms underlying the pathway from familial factors to ODD psychopathological symptoms: (a) the system level that is affected by the family’s socioeconomic status and family dysfunction; (b) the dyadic level that is affected by conflict within the marital dyad and parent–child interactions; and (c) the individual level that is affected by parent and child factors. Additionally, from the perspective of family systems theory, we pay special attention to the interactions among and between the various levels of the pathway (moderation and mediation) that might be associated with the occurrence and severity of ODD symptoms. Considering future prevention and intervention efforts, this three-level model emphasizes the necessity of focusing on familial risk factors at multiple levels and the mechanisms underlying the proposed pathways.