Does My Child

Have Oppositional
Defiant Disorder?
How to Recognize and
Treat ODD in Kids

From the ADHD Experts at

ADDITUDE
Strategies and Support for ADHD & LD
 ADDITUDE
Strategies and Support for ADHD & LD
A trusted source of advice and information for families touched by attention-deficit disorder—
and a voice of inspiration to help people with ADHD find success at home, at school, and on the job.

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 Does My Child
Have Oppositional
Defiant Disorder?
How to Recognize and
Treat ODD in Kids

40 percent of children with ADHD also develop oppositional defiant dis-

order (ODD)—a condition that is defined by chronic aggression, frequent
outbursts, and a tendency to argue, ignore requests, and purposely irritate
others.1

Every parent of a child with ADHD knows what it’s like to deal with behav- It’s hard to know whether
ior problems—saying no to requests, blurting out insults, or failing to follow a child is normally defiant
through. Any child can fall into a defiant or irritating mood from time to or has ODD. Consult
time. Children with ODD, however, take the defiant behavior to an extreme. a therapist trained in
childhood behavioral
To warrant an ODD diagnosis, a child must show a pattern of angry, violent, problems.
negative, hostile, and defiant behavior toward parents, caretakers, and other
authority figures that lasts at least six months. An oppositional, defiant child
will often lose his temper, argue with adults, actively defy requests or rules
set by adults, deliberately annoy people, and blame others for misbehavior.
To be diagnosed with ODD, four (or more) of the following symptoms must
be present for at least six months:

4 Often loses temper

4 Often argues with adults

1 ADDitude Editors. “The ODD—ADHD Link in Children.” ADDitude Magazine. (2014). Web.
(http://www.additudemag.com/adhd-web/article/4646.html)

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ADDITUDE
Strategies and Support for ADHD & LD
 4 Actively defies or refuses to comply with adults’ requests or rules

4 Often deliberately annoys people

4 Often blames others for his or her mistakes or misbehavior

4 Often is easily annoyed by others

4 Often angry and resentful

4 Often spiteful or vindictive2

Two Types of ODD

There are two types of ODD. The childhood version is present from an early
age, making these children very difficult to raise. The second type is adoles-
cent-onset ODD. Once-normal and loving children become impossible to
live with. Home and school become places of almost constant conflict. RESOURCE
Your Defiant Child: Eight
Before puberty, ODD is more common in boys. After puberty, it is equally
Steps to Better Behavior by
common in both genders.
Russell A. Barkley Ph.D.
(The Guilford Press, 2013)
About half of all preschoolers diagnosed with ODD outgrow the problem
by age eight. Older kids with the condition are less likely to leave it behind
in adolescence. If it is left untreated, ODD can lead to conduct disorder or
more serious problems.3

Diagnosis
Every child will act out and test his boundaries. To know whether a child
is normally defiant or has ODD, consult a therapist trained in childhood
behavioral problems. To diagnose ODD accurately, a physician will screen
your child to rule out anxiety, depression, and bipolar disorder, which can all
cause ODD-like behaviors. These behaviors are only “symptoms” if they oc-
cur more frequently than is typically observed in individuals of comparable
age and developmental level, and if they cause clinically significant impair-
ment in social, academic, or occupational functioning. Diagnosis is time
consuming because the doctor must assess multiple sources of information.

Children with ODD seldom take responsibility for their behavior; they see
“the problem” laying with anyone but themselves. It usually takes a highly
Does My Child
2 ADDitude Editors. “A Parent’s Guide to Effective ADHD Discipline.” ADDitude Magazine. (2015): 6. Web. Have Oppositional
3 ADDitude Editors. “ODD and ADHD: Parenting Your Defiant Child” ADDitude Magazine. (2014): 6. Web. Defiant Disorder?
http://www.additudemag.com/slideshow/26/slide-2.html
from the editors of

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ADDITUDE
Strategies and Support for ADHD & LD
qualified physician to determine whether problems at school or home are
being caused by ODD.

Treatment for Oppositional and Defiant Behavior

A child’s oppositional behaviors aren’t intentional. Uncontrolled impulsiv-
ity, combined with the stress and frustration of trying to get on top of ADHD
symptoms every day can lead some children to lash out, physically and verbally.

When parenting and discipline strategies fail, ODD-specific therapies can be

a saving grace for families of defiant children.

Step One: Treatment starts with controlling ADHD symptoms with med-
ication, therapy, and/or diet and supplements. When a child’s hyperactivity,
impulsiveness, and inattention are reduced there is usually an improvement
in ODD symptoms. Stimulant medications have been shown to decrease
ADHD symptoms. If your child doesn’t respond well to stimulants, some
doctors prescribe non-stimulant atomoxetine (brand name: Strattera)

Step Two: Have your child evaluated for related conditions including The treatment of choice
anxiety, depression, and bipolar disorder—each of which can cause op- for ODD is parent-
positional behavior. management training.
Parents are taught to
Step Three: Consider behavior therapy and family training, which in-
change their reactions to
volve using well-defined rewards and praise for cooperation—and con-
a child’s behavior—good
sequences for misbehavior. In parent-management training, therapists
and bad.
work with the parent and child together to solve specific ODD-related
challenges. Parents are taught to change their reactions to their child’s
behavior—good and bad. Training involves well-defined rewards for co-
operation, and consequences for misbehavior.

Try This At Home

ODD experts find the following three-step strategy effective for parents:
Ask your child calmly to do something. If he doesn’t respond to you in two
minutes, gently tell him, “I’m asking you a second time. Do you know what
I’m asking you to do—and the consequences if you don’t? Please make a
smart decision.” If you have to ask a third time, he suffers the pre-arranged
consequence—no TV or video games for an hour.

For behavior therapy to work, the child’s caregivers should all use the same dis- Does My Child
cipline strategies: grandparents, teachers, nannies, and other adults who spend Have Oppositional
time with your child must understand which rewards and consequences work, Defiant Disorder?
and how to use them consistently to avoid undermining the discipline program. from the editors of

5
ADDITUDE
Strategies and Support for ADHD & LD
It’s hard to remain calm when a child is verbally abusing you, but don’t over-
react. Yelling or spanking may worsen a child’s oppositional behaviors. Stay
calm and emotionally neutral amid your child’s defiance. If they pick up on
your anger, they will match it.

Learn to praise good behavior. Be enthusiastic without overdoing it, and

finish up with a non-verbal gesture of support like a kiss on the cheek or a
hug. Be creative and consistent when setting rewards and punishments. Set
rules and convey expectations to clean up your child’s ODD act.

Screener: Does Your Child Have ODD?

ODD is a childhood condition marked by defiant, hostile, negative, and
uncooperative behavior toward adults and authority figures. Seek help
promptly from a qualified health professional if your child’s behavior fits the
description here.

1. Does your child commonly blame others for his or her mistakes or “Taking a positive
misbehavior? approach is more effective
than handing out angry
* Yes
ultimatums.”—Kenny
* No
Handelman, Ph.D.

2. Does your child frequently swear or use obscene language inappropriately?

* Yes
* No

3. Is your child touchy, prickly, or easily offended?

* Yes
* No

4. Does your child have frequent outbursts of anger and resentment?

* Yes
* No

5. Is your child often spiteful, vindictive, or revenge seeking?

* Yes Does My Child
* No Have Oppositional
Defiant Disorder?
from the editors of

6
ADDITUDE
Strategies and Support for ADHD & LD
6. Does your child deliberately try to annoy or upset others?
* Yes
* No

7. Does your child actively defy or refuse to comply with requests and
rules at home or at school?
* Yes
* No

8. Does your child throw repeated temper tantrums?

* Yes
* No

9. Does your child argue excessively with adults and other authority figures?
* Yes
* No

10. Does your child say cruel, mean or hateful things when upset? “Meltdowns say nothing
* Yes about your parenting
* No ability, but they do reflect
the nature of ADHD.”—
Michele Novotni, Ph.D.
11. Is your child easily frustrated or annoyed?
* Yes
* No

12. Is your child hostile, angry, or resentful?

* Yes
* No

13. Does your child justify his or her behavior as a response to unreason-
able demands?
* Yes
* No
Does My Child
Have Oppositional
Defiant Disorder?
from the editors of

7
ADDITUDE
Strategies and Support for ADHD & LD
14. Does your child persistently test limits by ignoring rules or arguing?
* Yes
* No

15. Is your child unwilling or unable to compromise, give in, or negotiate
with adults or peers?
* Yes
* No

Please see a trained health care professional if you answered yes to five or
more questions, as there is a possibility that your child may have ODD.
Without treatment, children with ODD may develop a more serious behav-
ioral disorder called conduct disorder. When started promptly, treatment is
usually very effective. Consider bringing these results with you to your ap-
pointment for further evaluation.

Oppositional Defiant Disorder is marked by behaviors described here lasting

longer than six months at a time, behavior that is excessive compared to what
is usual for your child’s age, and that significantly impairs the child’s normal
daily activities at home and at school. Symptom criteria summarized from the “The stress of parenting a
American Psychiatric Association DSM 5, 2013 child with ADHD is heavy
enough, without adding
constant discord and
yelling.”—Penny Williams

Does My Child
Have Oppositional
Defiant Disorder?
from the editors of

8
ADDITUDE
Strategies and Support for ADHD & LD
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10