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“Should We Drop the ODD Label?”

Should we stop using the oppositional defiant disorder (ODD) label to describe children with ADHD who are extremely argumentative and inflexible? Are these behaviors just a part of the ADHD puzzle for some? Can they be addressed without pathologizing kids?

Teen boy with oppositional defiant disorder and ADHD

How We Pathologize ADHD Behaviors

The mental health field does a lot of pathologizing of kids with ADHD with various labels, including oppositional defiant disorder (ODD). I want to move ADHD away from being so pathologized in the mental health field, and part of that is changing the language around it. We need to keep using ADHD, of course, because it is a neurodevelopmental challenge, but I think we need to drop the ODD label and here is why.

Why We Should Stop Using ODD to Describe Children

ODD is a description of behaviors; it is not a standalone diagnosis and it is not a neurodevelopmental challenge like ADHD. Those behaviors associated with ODD are rooted in inflexibility, which is an aspect of executive function; or they are rooted in anxiety; or they are rooted in a need for control, which is common among kids with adverse childhood experiences.

When you say your child has ADHD and ODD, it’s just pathologizing them because it’s adding another label to describe an aspect of his ADHD profile that has no biological basis that we know of.

What to Say Instead

Instead of saying, “My child has ADHD and ODD,” say “My child has ADHD and he has a propensity to be inflexible.” Or “My child has ADHD and he’s argumentative a lot.” What that is doing is looking at ADHD more holistically and using terms that describe the behaviors as part of ADHD, which is what I think they are.

Do you agree? Share your viewpoint in the Comments section below.


ODD and ADHD: Next Steps

1. Understand: What is Oppositional Defiant Disorder?
2. Research: Treatment Options for Oppositional Defiant Disorder
3. Video: Do Kids Outgrow Oppositional Defiant Disorder?

Ask your question about ADHD in boys here!

Ryan Wexelblatt, LCSW is the facilitator of the ADHD Dude Facebook Group and YouTube channel.

6 Comments & Reviews

  1. I absolutely agree! I have two kids with ADD and the one who has sensory processing disorder I did not understand and thought she had ODD until I stumbled upon a YouTube video suggesting to her go to an occupational therapist first and check for sensory processing disorder. Very, very happy I did. The OT is so effective and I personally feel is the better helper/approach than a therapist for their emotional health.

  2. Sometimes I like labels, and ODD is one I’ve adopted because it explains a few challenges I’ve had when being seen as “difficult for the sake of being difficult” which is not a positive employment trait (I think when we restrict ODD to children we miss similar characteristics in adults only because it is assumed that children must be answerable to those in authority).

    But I would take your argument further viewing it as a child who is inflexible or argumentative because that still presumes that the child has a social problem. We need to look at what the child is often doing when questioning or defying authority – if we take a slightly different view (and I’ve seen this with some of my coaching prospects) and see that the questioning is largely around wanting to understand an instruction and its perceived value. We often need more refined details, the why and the how in a more chunkable format so that we can process the appropriate approach to a task. Unlike our NT compatriots telling us to just do something with no additional data makes the instruction seem insurmountable leading to the anxiety and ultimate “acting out”.

    ODD needs to be viewed as the response to our natural need to know more about why we are being asked to do what we are being told to do. The challenge is that it is seen as questioning authority and therein lies the social challenge – are we defiant or are “they” inflexible?

    Just some thoughts.

  3. In the absence of an edit function (post hastily reread own text) a final thought (at least in text) is that the reason ODD is often seen as primarily a “boy” affliction could also be seen through the same social lens. Boys have license (used loosely) to question authority, girls traditionally were less likely to be expected to “question authority”. Boys are rebels, girls are troubled – and there is a valence that comes with the difference.

  4. I feel that the ODD label is too quickly used and once a child is labeled with it it is hard for others to look past it. As a School Nurse, form psych nurse and, a mother of 2 daughters with ADHD the ODD label is a great concern to me. My youngest daughter, 10, is argumentative, but what she really wants is more details and to be heard. I will not allow the label of ODD to be placed her. In the education systems once labeled ODD then that is all they are concerned with and how to control the child’s behavior not to understand where it is coming from. I’m not saying it is easy at home and I do get frustrated but that is more of me learning to adapt to her and me teaching my daughter better coping and executive function skills. I also see once labeled with ODD more and stronger meds are pushed on these children. Antipsychotics for young children scares me. There are too many devastating side effects. It’s not that I don’t believe that medications have their place, but they are not the end all be all and I believe that many parents do not fully understand what they are giving their children. ODD attributes of weak executive functioning skills, let but more emphasis on developing the needed life skills for those with ADHD issues and our own impatience working with people who think and act differently.

  5. The statement that ODD has no biological basis and, therefore, can be disregarded as a real condition is just plain wrong.
    There is ample evidence for a very significant genetic component (Hudziak JJ, Derks EM, Althoff RR, Copeland W, Boomsma DI. (2005) The Genetic and Environmental Contributions to Oppositional Defiant Behavior: A Multi-informant Twin Study. Journal of the American Academy of Child and Adolescent Psychiatry, 44(9):907–914) and even a biological marker in the plasma and cerebral spinal fluid for ODD(Van Goozen SH, et al. Plasma monoamine metabolites and aggression: two studies of normal and oppositional defiant disorder children. European Neuropsychopharmacology 1999. 9(1-2): 141-7.)
    No other mental health condition has a “blood test” the way that ODD does.
    For a more thorough review of the genetic and biological underpinnings of the diagnosis see the review by the Am. Acad. of Child and Adolescent Psychiatry from 2007 (Practice Parameter for the Assessment and Treatment of Children and Adolescents With Oppositional Defiant Disorder (2007) Journal of the American Academy of Child and Adolescent Psychiatry;46(1):126Y141.)

    Finally, the often dramatic response of ODD behaviors to medications clearly points toward a biologic and neurologic etiology.

    This is not a false dichotomy that the response to extreme oppositional and even violent behavior must be one way or the other. These families are truly suffering and all too often end up broken beyond repair. In such situations we must use everything available to us to be helpful. Delegitimizing ODD as being less than real or merely being a misunderstanding within a family system is not helpful.
    It is not a service to the people who read opinion pieces to make fundamental assertions that are not accurate.

  6. Many of the labels being applied, contain plenty of gray areas, because everyone exhibits many of the symptoms to some level, and it may end up being the experience, exposure, and education of the individual that is translating the actions to a label which causes confusion.

    If ODD frequently exists without ADHD, then there is certainly merit to the label. However, if it crosses too many boundaries of other disorders, perhaps the practice needs to consider a more accurate assessment of where it belongs. Is it simply and ADHD symptom, or is it something different, and why?

    In regards to @bdodson, I would suggest that violent behavior exceeds the realm of ODD, and needs to be labeled as such. Are the angry tantrums of a a teenager with ADHD considered violent? I can tell you that if you’ve witnessed some, you may label them this way.

    The more we can link the biological to the actions resulting from the effect, the better. If we can measure ADHD and ODD as separate phenomenons, then they should be placed in separate “buckets”. If not, ADHD it is. If it’s violent, then we go a step or two further…

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