Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that is characterized by impulsive and hyperactive behaviors and/or inattentive behaviors.
Oppositional defiant disorder (ODD) is a behavior disorder marked by behaviors, particularly those directed towards authority figures, that are uncooperative, defiant, negativistic, irritable, and deliberately annoying.
While they are separate conditions, they often occur together. Some research suggests that as many as 40% of children with ADHD also meet the criteria for an ODD diagnosis.
This article will look at why ODD often occurs with ADHD, how the conditions are treated and managed, and coping strategies for parents and children.
Can You Have Both ADHD and ODD?
It's common for people with ADHD to also have ODD. According to Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD), between one-third and one-half of children with ADHD also have ODD.
In Children
Some symptoms of ADHD in children include:
Inattentive symptoms: Such as being easily distracted, making "careless" mistakes, and having difficulty with the planning, organization, and follow-through of tasks
Hyperactive symptoms: Such as fidgeting, being constantly "on the go," and having difficulty staying seated
Impulsive symptoms: Such as interrupting, acting without thinking, and risk-taking
ODD symptoms in children include:
Excessive arguing
Refusing to comply with appropriate requests
Constantly questioning rules and refusing to follow them
Intentionally annoying or upsetting others with their behavior
Blaming others for their behavior or mistakes
Being easily annoyed by others
Frequently showing an angry attitude
All of these behaviors happen sometimes with every child, but for children with ODD, they occur much more frequently and interfere with their learning and relationships.
In Adults
ADHD begins in childhood, but often persists into adulthood, though the symptoms can change over time.
Adults with ADHD may:
Feel frequently restless
Have poor planning and organizational skills
Be forgetful, miss appointments and deadlines, and misplace items
Have difficulty focusing on and finishing tasks
Have trouble with time management
Other behaviors related to hyperactivity, impulsivity, and inattentiveness
As with ADHD, ODD is usually diagnosed in childhood (typically in preschool, while ADHD is diagnosed primarily in school-age children). ODD usually resolves by age 18 but can persist into adulthood both on its own or along with ADHD.
Adults and adolescents with ODD are at high risk (90% chance) of being diagnosed with another mental illness in their lifetime. They are also at higher risk for social and emotional problems as adults, mood disorders (such as anxiety, depression, and bipolar disorder), conduct disorder, and substance use disorders.
The exact causes of ADHD and ODD are not known, but both are believed to have a genetic link and are likely influenced by multiple factors.
Several studies suggest that ODD may be caused by parental influences such as insecure attachment, harsh parenting, inconsistent parenting, or abuse. It is important to note that while this correlation exists, children who have a loving, supportive, and consistent home environment can also develop ODD.
Diagnosis and Treatment at a Glance
ADHD and ODD both have distinct criteria outlined in the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5). While they may occur together, they are diagnosed separately according to their individual criteria.
Diagnosis typically begins with a visit to a healthcare provider who can perform a physical exam, ask about symptoms and family history, and make referrals as necessary.
ODD is usually diagnosed in early childhood. ADHD is typically diagnosed by age 12, but it's not uncommon for adults to be diagnosed with ADHD that was missed in childhood, particularly in women.
Treatment often involves addressing each condition separately when they occur together, but there can be overlap.
Medication
Medication, particularly stimulants, are a first line treatment for ADHD and can be quite effective at managing ADHD symptoms.
There is no medication specifically for ODD, but when ODD occurs with ADHD, stimulant medication can help manage the ADHD symptoms, allowing for more effective treatment for ODD using other measures.
Therapy
Individual, family, and peer group therapy can be helpful for ADHD and/or ODD. This can include:
Cognitive behavioral therapy (CBT)
Parent training
Psychoeducation
Social skills training
Other broad and targeted therapies
Parenting and Disciplining Kids With ADHD and ODD
Parenting a child with ADHD and/or ODD can be daunting, but there are effective strategies:
Routine: Develop and stick to a routine. This helps kids know what to expect and what is expected of them
Stay calm: Frequent yelling can cause children to become used to it and tune it out, making it less effective
Be clear: Say exactly what you want your child to do, set boundaries, and communicate what will happen if they break them
Be consistent: Enforce the consequences you have laid out in a fair and consistent manner
Be generous with praise: Effective praise is important, both as positive reinforcement and to mitigate the frequent negative feedback children often receive
Help them manage emotions: Label emotions and talk through them with your child. Show them how to express emotions in acceptable ways. Modeling can help
Pick your battles: Prioritize what is important and then follow through on it
Avoid power struggles and arguments: Calmly and firmly state the consequence without getting into a back and forth. Step away and take a break if you feel yourself escalating
Spend quality time together: Find activities you and your child can enjoy together. Building a relationship outside of rules and consequences is important
Seek support: In addition to professional support for your child, it may be helpful to find a support group of other parents who understand what you are going through. Having time and interests outside of your child is beneficial too
Safety Tips to Avoid Injury
Having a safe space where children can go to calm down without hurting themselves or others can help them express their big emotions safely.
Consider providing a space with soft seating, pillows, stuffed animals, play dough and other safe sensory items. Supervision is important even in this safe space, but spending an appropriate amount of time in this environment can give space for your child (and you) to reset.
Try to ensure this space is used for self-regulation, not punishment. Recognize when you are reaching your limit. Allow another adult to step in if possible, or make sure your child is safe and walk away for a moment to calm down.
Foods do not cause or cure ADHD or ODD. There is limited evidence to support special diets as a method of treatment, and studies have conflicting results.
More research is needed into the relationship between diet and ADHD and/or ODD.
Calming Techniques for Better Mental Health
Practices that have a calming effect for children and adults include:
ADHD and ODD are separate conditions but often occur together. ADHD is a psychodevelopmental disorder, while ODD is a behavior disorder.
Medication is often helpful for ADHD but rarely used for ODD alone. Several forms of therapy are useful for both disorders. Early intervention is associated with more successful treatment. Routine, consistency, and clear expectations and consequences are key to parenting children with ADHD and/or ODD.
A Word From Verywell
Parenting a child with ADHD, ODD, or both, can be daunting, but resources are available to help both you and your child.
If your child is showing signs of either or both conditions, see your healthcare provider to determine the next steps.
Frequently Asked Questions
Are ADHD and ODD considered disabilities?
In the United States, ADHD and ODD may be considered disabilities in terms of benefits under certain conditions, such as related to severity and ability to work or function in certain capacities.
Learn More:Is ADHD a Disability?
Can children get expelled from school due to aggressive ODD behavior?
Children can be expelled for behavior associated with ODD. It's important to work with your child's school and make them aware of your child's diagnosis and challenges.
Does ODD in kids get better with age?
Most children with ODD will outgrow it by adulthood. Treatment during childhood is still important to meet their current needs and mitigate the risks if they continue to have ODD in the future.
How can a parent help their child make friends?
Parents can help their children make friends by helping them build their social skills, having supervised play dates, and practicing appropriate play and socializing with them.
Individual and family therapy that may include social skills training or cognitive problem-solving skills training is another important tool. Medication is not usually effective in treating ODD alone, but when ODD co-occurs with ADHD, stimulants are still an effective ADHD treatment option.
Doctors, mental health professionals and child development experts can help. Behavioral treatment of ODD involves learning skills to help build positive family interactions and to manage problematic behaviors. Additional therapy, and possibly medications, may be needed to treat related mental health disorders.
These are called comorbidities. Oppositional defiant disorder (ODD) is one such condition. In fact, ODD is the most common comorbidity with ADHD. Experts believe that about four out of 10 kids with ADHD also have ODD.
Be sensitive to self-esteem issues. Provide feedback to your student with ODD in private, and avoid asking the student to perform difficult tasks in front of classmates. It can be helpful to praise positive behaviors, such as staying seated, not calling out, taking turns, and being respectful.
Conclusions: Evidence indicates that psychostimulants, alpha-2 agonists, and atomoxetine can be beneficial for disruptive and aggressive behaviours in addition to core ADHD symptoms; however, psychostimulants generally provide the most benefit.
Lack of structure or parental supervision, inconsistent discipline practices, and exposure to abuse or community violence have also been identified as factors which may contribute to the development of ODD.
Symptoms usually remain stable between the ages of 5 and 10 and typically, but not always, decline afterward. The symptoms are often apparent in multiple settings but may be more noticeable at home or school. Signs and symptoms of ODD can be grouped into three categories: Anger and irritability.
Some children with ODD will eventually outgrow the disorder. Symptoms may disappear as they age. However, as much as 30 percent of children with ODD eventually develop a conduct disorder. About 10 percent of children with ODD may eventually develop a personality disorder, like antisocial personality disorder.
If your child has been diagnosed with ADHD, or ADD, he or she can qualify for Supplemental Security Income (SSI) disability benefits if the severity of the child's ADHD meets the Social Security Administration's childhood impairment listing for neurodevelopmental disorders (listing 112.11).
If your child has ODD and it has affected their ability to function, they may be eligible for disability benefits through the Supplemental Security Income (SSI) program.
When children act out persistently so that it causes serious problems at home, in school, or with peers, they may be diagnosed with Oppositional Defiant Disorder (ODD). ODD usually starts before 8 years of age, but no later than by about 12 years of age.
The treatment of choice for ODD is parent management training. Parents are taught to change their reactions to a child's behavior — good and bad. Training involves using carrots and sticks — giving well-defined rewards and praise when your child cooperates, and consequences for misbehavior.
ODD and CD are diagnosed more often in boys than in girls. If not managed promptly, ODD can progress to CD, which can then transition to antisocial personality disorder.
The preferred ODD treatment is a combination of individual and family behavioral therapy. When therapy alone does not resolve symptoms, medication for ODD can sometimes help.
Factors such as a chaotic home life, inconsistent discipline by parents, and being exposed to abuse, neglect, or trauma at an early age can all lead to the onset of ODD symptoms. Risk Factors: Family history of mental illness. Witnessing violent or aggressive behaviors.
The good news is that psychotherapy and medication are both effective treatments for getting symptoms of ODD under control. If any of the following symptoms seem familiar over the last six months or longer, take the results of this screener to a mental health professional for an evaluation.
These students can appear defiant, disobedient, angry and irritable. They might argue with parents, teachers and other students. They may find it hard to follow teachers' instructions. They may lose their temper if they feel like something isn't going their way.
The symptoms of ODD may look different in girls and boys, for whom the condition is more common. Boys with ODD tend to be more physically aggressive and have explosive anger while girls often lie, refuse to cooperate, and express symptoms in other indirect ways.
Oppositional defiant disorder (ODD) is a childhood behavior disorder defined by a persistent pattern of hostile, vindictive, and defiant behavior toward authority figures. Children with ODD are frequently irritable, argumentative, and disobedient. ODD may be diagnosed if this behavior lasts 6 months or longer.
Oppositional defiant behavior tends to run in families. Studies show that the development of the condition is more heavily influenced by genes than it is by environmental factors. A child diagnosed with ODD quite frequently has a first-degree relative with ODD.
Only a medical doctor or suitably qualified mental health professional can diagnose ODD. They will likely want to talk to both you and your child, and may also want to assess your child at school and speak to your child's teachers, in order to help them understand as fully as possible what may be going on.
Oppositional defiant disorder (ODD) is a type of disruptive behavior disorder in which children frequently defy authority with hostility, leading to serious disturbances in their daily life.
Why ODD can be misdiagnosed. When we're making mental health diagnoses, the thing that strikes me is that the last criteria for ODD listed in the DSM-5 diagnostic manual is almost always “not better explained by something else”. In other words, there's not another condition that better explains the patient's symptoms.
ODD does not stand alone and generally has a high comorbidity rate with other mental health conditions. Common co-occurring mental health conditions in children and adolescents with ODD are: Depression. Anxiety disorders.
What causes ADHD and ODD? The exact cause of these conditions is unknown. But it's believed that genetics and environmental influences may play a role. For example, a child may develop both conditions if ADHD runs in their family.
Research shows that children with ODD have trouble controlling impulses and emotional behavior. Scientists believe that these children may have underdeveloped prefrontal cortexes—or, the part of the brain that is in charge of executive functioning and managing impulsive behavior.
Autism spectrum disorder and ADHD are related in several ways. ADHD is not on the autism spectrum, but they have some of the same symptoms. And having one of these conditions increases the chances of having the other. Experts have changed the way they think about how autism and ADHD are related.
However, ADHD falls under the category “Other Health Impaired” and not under “Specific Learning Disabilities.” Individuals with ADHD can also qualify for accommodations under the ADA and Section 504 if their ADHD impacts a major life function such as learning.
ODD is one of a group of behavioural disorders known collectively as disruptive behaviour disorders, which include conduct disorder (CD) and attention deficit hyperactivity disorder (ADHD).
Children with ODD are uncooperative, defiant, and hostile toward peers, parents, teachers, and other authority figures. They are more troubling to others than they are to themselves.
ADHD tends to run in families and, in most cases, it's thought the genes you inherit from your parents are a significant factor in developing the condition. Research shows that parents and siblings of someone with ADHD are more likely to have ADHD themselves.
In girls, ODD is associated with depressive and anxiety disorders and internalizing symptoms (anxiety, depression and somatic complaints). These results suggest that therapeutic approaches with boys and girls with ODD should include different elements.
ODD and CD are diagnosed more often in boys than in girls. If not managed promptly, ODD can progress to CD, which can then transition to antisocial personality disorder.
If your child has been diagnosed with ADHD, or ADD, he or she can qualify for Supplemental Security Income (SSI) disability benefits if the severity of the child's ADHD meets the Social Security Administration's childhood impairment listing for neurodevelopmental disorders (listing 112.11).
If your child has ODD and it has affected their ability to function, they may be eligible for disability benefits through the Supplemental Security Income (SSI) program.
The key difference between ADHD and ODD is that children with ADHD are easily distracted and disorganized, while children with ODD are angry and defiant. For example, a child with ADHD may impulsively push another child and later regret it.
Lack of structure or parental supervision, inconsistent discipline practices, and exposure to abuse or community violence have also been identified as factors which may contribute to the development of ODD.
Some of the common foods that can cause ADHD reactions include milk, chocolate, soy, wheat, eggs, beans, corn, tomatoes, grapes, and oranges. If you suspect a food sensitivity may be contributing to your child's ADHD symptoms, talk to your ADHD dietitian or doctor about trying an elimination diet.
What causes ADHD and ODD? The exact cause of these conditions is unknown. But it's believed that genetics and environmental influences may play a role. For example, a child may develop both conditions if ADHD runs in their family.
Research shows that children with ODD have trouble controlling impulses and emotional behavior. Scientists believe that these children may have underdeveloped prefrontal cortexes—or, the part of the brain that is in charge of executive functioning and managing impulsive behavior.
Some children with ODD will eventually outgrow the disorder. Symptoms may disappear as they age. However, as much as 30 percent of children with ODD eventually develop a conduct disorder. About 10 percent of children with ODD may eventually develop a personality disorder, like antisocial personality disorder.
Factors such as a chaotic home life, inconsistent discipline by parents, and being exposed to abuse, neglect, or trauma at an early age can all lead to the onset of ODD symptoms.
Genetic: It has been shown that ODD is likely a hereditary condition and that if an individual has a close relative with this mental illness, they have a predisposition to the development of oppositional defiant disorder.
When children act out persistently so that it causes serious problems at home, in school, or with peers, they may be diagnosed with Oppositional Defiant Disorder (ODD). ODD usually starts before 8 years of age, but no later than by about 12 years of age.
Only a medical doctor or suitably qualified mental health professional can diagnose ODD. They will likely want to talk to both you and your child, and may also want to assess your child at school and speak to your child's teachers, in order to help them understand as fully as possible what may be going on.
Introduction: My name is Mr. See Jast, I am a open, jolly, gorgeous, courageous, inexpensive, friendly, homely person who loves writing and wants to share my knowledge and understanding with you.
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