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.
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.
Some symptoms of ADHD in children include:
ODD symptoms in children include:
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.
ADHD begins in childhood, but often persists into adulthood, though the symptoms can change over time.
Adults with ADHD may:
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.
Early intervention can help lower these risks.
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.
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, 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.
Individual, family, and peer group therapy can be helpful for ADHD and/or ODD. This can include:
Parenting a child with ADHD and/or ODD can be daunting, but there are effective strategies:
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.
Practices that have a calming effect for children and adults include:
Some of the many resources available 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.
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.
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.
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.
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.