Over a third of children with ADHD have a second psychiatric diagnosis, and one of the most common diagnoses to be found with ADHD is oppositional defiant disorder (ODD). This diagnosis causes a lot of frustration for parents, teachers and the children themselves. The disorder is lumped together with ADHD, in part because they occur together so often, but there are several differences in these diagnoses, and I feel that sometimes parents have expectations about the management of this disorder that set them up for disappointment. In this entry I'll talk about some key ideas to keep in mind about ODD and what you can expect as a parent.
First, there is no drug that works on ODD as well as the drugs that treat ADHD. Medications that are used to treat ADHD can improve symptoms substantially with the first dose, and can continue to work for many years. There is no medication like this for ODD. Medications are used, but usually when other therapies aren't working. When medications are used in a child with ODD, they are usually used to treat a different psychiatric disorder, like ADHD, an anxiety disorder or a depressive disorder.
Second, ODD should be considered a chronic disease, like heart disease, high blood pressure or diabetes. Its symptoms linger for a long time, and treatment require patience on everyone's part. That being said, parents shouldn't be satisfied if no progress is being made. About two-thirds of children with ODD have substantially improved within three years of being diagnosed with the disorder, so if you don't see any progress within this time frame, maybe it's time to look for another therapist and psychiatrist to treat your child.
Third, parents are involved. The most credible science I've read strongly suggests that the most successful approach to treating ODD in children involves improving parent-child interactions, improving parental skills and management of psychiatric disorders in parents. This is not saying that the diagnosis is the parent's fault; I'm saying that how healthy the parents are and how the parents interact with their children has a strong impact on the children's well being. Parental depression is a significant risk factor for ODD in children, and treatment of the depression should be part of the overall treatment plan.
Lastly, environment matters. The more exposure a child has with deviant peers, violence in the media, home, neighborhood and school, the greater the chances that a child will develop ODD and be among the 10 percent of the children who go on to develop lasting personality disorders later in life.