Oppositional Defiant Disorder

Why Is My Child So Angry?!

Beaten down by your child’s defiant behavior? Wondering why she’s always in a rage? It could be oppositional defiant disorder, or ODD, a condition that frequently occurs alongside ADHD. Stop the madness — and the violent outbursts — with these strategies for change.

Portrait of sad ADHD girl with mother in background at home
Portrait of sad ADHD girl with mother in background at home

Anne dreads waking up in the morning. Her son, Sam, who is nine, is unpredictable. Sometimes he just goes along with the morning routine. Other times, he’ll lash out at the smallest thing — a request to get dressed, an unplanned stop on the way to school, or a simple “No” to a request for pizza for dinner.

“On any given day, I never know what to expect from him,” says Anne, a public relations manager for an independent high school in New England. “He’ll start yelling and kicking when anything doesn’t go his way.”

Sam was diagnosed with attention deficit disorder (ADHD or ADD) at five, and while that explained some of his difficulties in school, it never explained his aggressive and defiant temperament. It wasn’t until the beginning of this school year that Anne sought additional help for her son’s behavior, which was becoming stressful to her family. The pediatrician determined that Sam was suffering from ADHD and ODD (oppositional defiant disorder).

How Do You Recognize ODD in a Child with ADHD?

Children with ODD have a pattern of angry, violent, and disruptive behaviors toward parents, caretakers, and other authority figures. Before puberty, ODD is more common in boys, but, after puberty, it is equally common in both genders. Sam is not alone in his dual diagnosis of ADHD and ODD; up to 40 percent of children with ADHD are estimated to have ODD.

Every child will act out and test his boundaries from time to time, and ODD seems like typical adolescent behavior: arguing, anger, and aggression. The first step to fixing a child’s problematic behavior is recognizing ODD. How do you know whether your child is just being a child or if he needs professional help?

[Self Test: Oppositional Defiant Disorder in Children]

There is no clear line between “normal defiance” and ODD, says Ross Greene, Ph.D., associate clinical professor of psychiatry at Harvard Medical School and author of The Explosive Child. The lack of clear criteria explains why professionals often disagree as to whether a child should be diagnosed with ODD.

Greene emphasizes that it is up to parents to decide when to get help for a defiant child. “If you’re struggling with your child’s behavior, and it is causing unpleasant interactions at home or at school, then you’ve easily met the criteria for having a problem,” says Greene. “And I’d suggest you seek professional help.”

Anne had never heard of ODD when she called a cognitive behavioral therapist to discuss coping strategies for her son’s erratic behavior. After spending some time in the family’s home, observing Sam and his interactions with his mother, the therapist saw signs of ODD. “I didn’t know what she was talking about,” says Anne. At Sam’s next doctor’s visit, Anne asked whether ODD could explain Sam’s behavior, and the physician said yes.

“When I thought about it, the diagnosis made sense,” says Anne. “Nothing I used with my older daughter – like counting down to some set consequence before punishing her – to control her behavior ever worked for Sam.”

[Free Download: How to Recognize & Treat ODD in Kids]

Another mother, Jane Gazdag, an accountant from New York, began noticing troubling behavior in her son, Seamus Brady, now eight, when he was four. “He would scream for two or three hours over the smallest thing,” says Jane. “He fought everything.”

When Jane realized that she had stopped trying to do fun things with her son, like spending the day in Manhattan, because they were too stressful for her, she suspected that he had ODD and spoke to her pediatrician about it. Seamus was diagnosed as having it.

Signs of ODD can be seen in a child’s behavior toward his primary caregiver. The defiant behavior may spread to a secondary caregiver and to teachers or other authority figures, but if it appears in a child with ADHD, ODD will appear within two years of an ADHD diagnosis.

If a child does start to become defiant, there is an easy way to tell whether that behavior is a consequence of ADHD or is a sign of ODD. “ADHD isn’t a problem with starting a task, it’s a problem with finishing a task,” says Russell Barkley, Ph.D., a clinical professor of psychiatry and pediatrics at the Medical University of South Carolina. “If a child can’t start a task, that’s ODD.”

The Impulsive/Defiant Link: How ADHD and ODD Overlap

Understanding why ODD is found so frequently in children with ADHD is to understand the two dimensions of the disorder – the emotional and social components, says Barkley. Frustration, impatience, and anger are part of the emotional component. Arguing and outright defiance are part of the social aspect.

Most children with ADHD are impulsive, and this drives the emotional component of ODD. “For people with ADHD, emotions are expressed quickly, whereas others are able to contain their feelings,” says Barkley. This is why the small subset of children who have the inattentive type of ADHD is less likely to develop ODD. Children who have ADHD, along with intense impulsivity, are likely to be diagnosed with ODD.

Anger and frustration are hard to manage in a child with ODD and ADHD, but it is defiance that exacerbates the family stress caused by ODD. The surprising thing is that parents fuel the defiance. If a parent is quick to give in when a child has a tantrum, the child learns that she can manipulate situations by getting angry and putting up a fight. This aspect of ODD is a learned behavior, but it can be unlearned through behavioral therapy.

How Should Parents Treat ADHD and ODD?

Before tackling a child’s ODD, it is important that his ADHD be controlled. “When we reduce a child’s hyperactivity, impulsiveness, and inattention, perhaps through medication, we see simultaneous improvement in oppositional behavior,” says Greene.

The traditional stimulant medications are the initial drugs of choice because they have been shown to decrease the impairments of ADHD, as well as ODD, by up to 50 percent in more than 25 published studies, says William Dodson, M.D., who specializes in the treatment of ADHD, in Greenwood, Colorado. Non-stimulant medications may also help. In one study, researchers found that the drug atomoxetine, the generic form of the active ingredient found in Strattera, significantly reduces ODD and ADHD symptoms. The researchers note in the study, published in the Journal of the American Academy of Child and Adolescent Psychiatry, in March 2005, that higher doses of the medication were needed to control symptoms in children who were diagnosed with both conditions.

Strattera helped Seamus control his emotions, reducing the number and intensity of his tantrums. “It made a big difference,” says Jane. For some, medication is not enough, and after a child’s ADHD symptoms are under control, it’s time to address ODD behaviors.

Although there is little evidence to show that any treatment is effective in treating ODD, most professionals agree that behavioral therapy has the most potential to help. There are many forms of behavioral therapy, but the general approach is to reward good behavior and provide consistent consequences for inappropriate actions and behaviors.

Behavioral therapy programs don’t start with the child; they start with the adult. Because a child with ODD usually has a caretaker who gives in to tantrums and violent behavior, or offers inconsistent punishment for bad behavior, the child thinks that acting out will get him what he wants. Therefore, a child’s primary caretaker has to be educated to effectively respond to a child with ODD. Another part of parental training is to consider whether ADHD has gone undiagnosed in the parent; adults with the condition are likely to be inconsistent in managing a child’s behavior.

Implementing consistent punishment is only one part of a behavioral therapy program; a parent must learn to use positive reinforcement when a child behaves himself.

How Long Will It Take to Improve ODD Behaviors?

A behavioral therapist works with parent and child together to reduce troubling behaviors. At the top of Anne’s list was her son’s “Shut up,” which he shouted at anyone. Anne kept a tally sheet to list the number of times her son would shout it in a day. At the end of the day, Anne and her son looked at the total together. If the number was under the set goal for the day, she gave him a small reward, a toy or time spent playing video games. Day by day, Sam tried to reduce the number of times he said “shut up,” and Anne tried to be consistent in her punishments.

All of a child’s caregivers should participate in the program. Grandparents, teachers, nannies, and other adults who spend time alone with your child must understand that the need for consistency in behavioral therapy extends to them as well.

“ODD has a deleterious effect on relationships and communication between kids and adults,” says Greene. “You want to start improving things as soon as you can.”

Anne believes that her diligence will pay off. “We hope that all the work we’ve done will one day click for Sam,” she says.

[The Facts About Oppositional Defiant Disorder (ODD) and ADHD]



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  1. This article is very good. The only thing I have a hard time identifying with is the statement: ““ADHD isn’t a problem with starting a task, it’s a problem with finishing a task”. I find the only tasks that are easy for me to start are the ones that are new and/or exciting to me.
    All the other ones are hard to start. It doesn’t matter what, paying bills, brushing my teeth, getting dressed in the morning, tidying my room: I have to really fight with myself to get started. I haven’t found any really good strategies that work on that yet.

    Matter of fact, once I have started a task, I can manage my ADD by using strategies that work for me to keep my attention on it. I have more of those. So it’s only actually hard to finish tasks if they get interrupted. Then I have to find a way to get myself started on it again….*smile*

    So actually, for me, getting started is harder than keeping at it. It’s one of my greatest challenges.

    Does anyone else have those kind of difficulties?
    Does anyone else feel that way?

  2. I had the same thought about starting a task and then realized that they are talking about children who have not yet gone through the countless frustrations of starting a task and never finishing one. So yes, if you have had ADHD for awhile, you could have problems starting a task.

  3. I have read a decent bit of Russell Barkley’s work and have great respect for him, yet, I, too, am confused by this same quote in the article. (“ADHD isn’t a problem with starting a task, it’s a problem with finishing a task… If a child can’t start a task, that’s ODD.”) Barkley’s statement is problematic because it ignores the role weak executive functioning skills found in ADHD play, such as struggling with task initiation, not knowing how to begin, plan, prioritize or proceed. This article is very informative but this seems a flagrant contradiction noted by multiple readers; it would be wonderful to have Barkley respond to clear up this point.

  4. I can definitely see everyone’s point about the seeming contradiction because I am the exact same way, however, when I read the article, searching for help with my son, who has ADHD and ODD, it made perfect sense. I have two children with ADHD. The one who does not have ODD doesn’t have as much of a problem starting the tasks, but gets lost or distracted so I can only give him one set of instructions at a time, i.e., “Take your socks to your drawer.” My middle son, who has both, will just outright NOT do it, out of defiance to me, and it is not the same thing as the trouble I have starting a meaningless task, such as the pile of dishes in the sink. He is just very independent and defies pretty much any demand. Does that make sense to anyone?

    1. This makes a lot of sense. I have inattentive ADHD along with my twins but my youngest son has ODD (getting ADDD testing but I’m positive he has it). I can tell my twins to do something and five minutes later it won’t be done because they got distracted by something on the way to do the task. They also just legitimately forget. They can also be redirected without a fight. That isn’t the case with my son who is ODD. He just instantly refuses and only wants to start on his own terms. Once my ODD’er does begin, thats when the ADHD comes into play, causing boredom or distraction. Once that boredom or distraction has become a factor, and I attempt at redirecting him to complete the task, ODD steps in right where it left off.

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