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.
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.
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.
Early intervention can help lower these risks.
What Causes ADHD and ODD?
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, 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:
- Cognitive behavioral therapy (CBT)
- Parent training
- 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.
Effect of Diet on ADHD and ODD
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:
- Breath focus
- Guided imagery
- Mindfulness meditation
Some of the many resources available include:
- Lives in the Balance
- Transforming the Difficult Child
- Teens with Problems
- ADDitude Magazine
- National Resource Center on AD/HD
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?
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.