Oppositional defiant disorder (ODD) is common in children with ADHD, with anywhere from one-half to one-third of children with ADHD exhibiting signs of ODD . Those with combined type ADHD (hyperactive and inattentive) are more at risk of developing ODD. Males with ADHD also have ODD more frequently than girls with ADHD. Children of divorced parents and low socioeconomic homes also have a greater incidence rate of ODD.
ODD is a chronic condition which usually begins before the age of eight and can develop as early as four or five years old. It is thought to be caused by a combination of biological, psychological and social factors. The main symptoms of ODD include:
- Frequent outbursts of anger
- Easily annoyed or angered
- Argumentative, especially with adults and authority figures
- Not following rules or requests from adults
- Blames others for mistakes
- Often in trouble at school and at home
- Seeks revenge or is resentful
Children with ODD often have few friends and when they do make a friend, their behavior frequently drives away the other person. Without treatment, ODD can develop into conduct disorder.
There is no medication which can treat ODD, however, with consistent treatment, many children improve - although improvement can be slow with some children taking two or three years to show healthier behaviors. If your child is showing symptoms of ODD, your doctor might suggest a complete psychological assessment. If your child is not taking medications for ADHD, the doctor might suggest a trial of medication to treat ADHD as this can sometimes improve symptoms of ODD. Your child might also benefit from behavioral modification techniques; a therapist can help you set up behavioral programs for your home and to be used in school. Some experts also suggest parent training to learn how to manage ODD.
Impulsiveness vs. Aggressiveness
Children with ADHD are often impulsive, that is, they act without thinking. Usually these behaviors are not malicious. However, in children with ODD, acting out can be purposeful. In his article, "Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD) in Children and Adolescents: Diagnosis and Treatment," Dr. James Chandler gives the example of a child with ADHD impulsively pushing a child too hard on a swing and causing their friend to fall off the swing. The child with ADHD would feel bad. However, a child with ODD might push the swing too hard because he wants the other child to fall off the swing. Instead of feeling bad, he might laugh.
Short Temper vs. Frustration
Children with ADHD can easily become frustrated because of the difficulties caused by ADHD symptoms. This can often appear as anger or defiance. They might "act out" as a way of coping with their frustration. For children with ODD, the same type of behaviors can occur, however, they are often intentional. "Acting out" is more of a way of life rather than a way of handling frustration.
Not Following Instructions vs. Defiance
Parents of children with ADHD often say, "he just doesn't seem to listen. I can ask him to do something three times and yet he still doesn't do it." Children with ODD are often defiant and refuse to follow rules. While the behaviors can be similar, the reasons behind the behaviors are different. In children with ADHD, not listening could be a sign of inattention, where he actually heard you but simply forgot what to do. Or, it could be a sign of hyperattention, when involved in something highly interesting. It isn't usually an act of defiance. Children with ODD, however, often refuse to follow rules and are argumentative toward adults and people in a position of authority (babysitter, older sibling). They refuse to be cooperative with others. This can be intentional.
Difficulty with Friendships
Children with ADHD frequently have a hard time socially. They may miss social cues, interrupt others when talking or be rejected because of ADHD symptoms. According to the U.S. Centers for Disease Control and Prevention (CDC), children with ADHD are almost 10 times more likely to have difficulties that interfere with friendships. Children with ODD also have trouble making and keeping friends. This is usually because of the way they treat the people around them. They want to be annoying, they want to make others mad. They are argumentative and disagreeable. They often lie or act maliciously toward others. Their classmates don't want to be around them.
Although externally, the results of ADHD and ODD can look similar, the reasons are completely different. Fortunately, about one-half of children with ODD as preschoolers grow out of it by the time they reach eight years old. For others, treating other conditions, such as ADHD or depression can help reduce symptoms of ODD. Some may develop other conditions, such as anxiety and depression. Some, however, will develop conduct disorder and may have trouble throughout their teen and adult years.
If you have concerns that your child's behaviors are beyond the scope of ADHD are are malicious or intentional, you should talk with your doctor. He or she would be able to refer you to specialists in your area who can help you create a treatment plan and help with parent training so your family can better deal with the symptoms of ODD.
"ADHD and Coexisting Conditions," Date Unknown, Staff Writer, National Alliance on Mental Illness
 "ADHD and Coexisting Conditions: Disruptive Behavior Disorders (WWK 5B), Updated 2008, Feb, Staff Writer, Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD)
"Oppositional Defiant Disorder," Updated 2014, Feb 24, Updated by Fred K. Berger, MD, A.D.A.M. Medical Encyclopedia
"Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD) in Children and Adolescents: Diagnosis and Treatment," Date Unknown, Jim Chandler, M.D., F.R.C.P.C., klis.com