Oppositional Defiant Disorder

Could Positive Parenting Decrease the Risk for Oppositional Defiant Disorder?

Why do some children with ADHD also show signs of oppositional defiant disorder — disrespecting authority, picking fights, and refusing to comply with adults? The answer is complicated and still unfolding, but an inverse relationship appears to exist between a positive, nurturing parenting style and a child’s defiant behaviors.

Shadows silhouettes of mother and son pulling her hand on summer promenade in sepia black and white
Shadows silhouettes of mother and son pulling her hand on summer promenade in sepia black and white

Oppositional defiant disorder (ODD) is a psychiatric diagnosis given to children who are easily frustrated and difficult to manage, especially when compared to other children of the same age. The diagnosis does not describe a specific neurological condition, but instead describes a pattern of behavior that persists over time, as observed by adults in the environment.

Among children with attention deficit hyperactivity disorder (ADHD or ADD), the prevalence of ODD is higher than it is in the general population, but some children do receive a diagnosis of ODD without showing signs of ADHD. So, if these are two different issues, why do they overlap so much? How are they similar and how are they different?

The percentage of children with ADHD is roughly 10%, and the same is true for ODD. However, approximately 50% of children diagnosed with one of these disorders will also meet criteria for the other. Evidently, there must be some relationship between ADHD and ODD, but what explains the connections and gaps between them?

Similarities Between ADHD and ODD

  • Children with ADHD who are impulsive and easily distracted may appear “defiant” when they fail to follow adult instructions
  • Parents may use more harsh and avoidant strategies to manage children with ADHD, and the use of these strategies is associated with a greater risk of ODD
  • Children who have difficulty focusing due to ADHD may try to avoid tasks that require concentration and persistence
  • Interruptions and outbursts are common to children with impulsive ADHD, and may be interpreted by adults as a lack of respect for authority
  • Both children diagnosed with ADHD and those with ODD may be especially persistent and determined when they are motivated to achieve a goal, whether the adults agree or not
  • ADHD and ODD are both more likely when there is a family history of similar diagnoses, and when there are environmental factors such as pre-natal smoking or alcohol use

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Differences Between ADHD and ODD

  • Unlike ADHD, ODD has no known physical markers
  • The diagnosis of ODD describes a relationship between a child and authority figures, while ADHD is evident in a child’s behavior even when they are alone
  • While ADHD is usually a life-long condition, the majority of children diagnosed with ODD will lose their diagnosis as they grow up (though a percentage of children diagnosed with ODD will eventually be diagnosed with the more severe Conduct Disorder)
  • Children with ODD (but not ADHD) do not demonstrate a measurable deficit in tests of executive functioning (when measured under normal conditions)

ODD and Executive Functioning: A Missing Link

Though children diagnosed with ODD (without ADHD) tend to score as well as their neurotypical peers do on tests of executive functioning, one study found an important difference between these groups of children. In the experiment, the children were given a measurement of their executive functioning skills, and then told to play some games. Some of the games were designed to include an unexpected but challenging element such as an interruption, a long wait, or social exclusion. After the children in the experiment had played the frustrating games, the experimenters tested their executive functions again, and found that children diagnosed with ODD were more likely to score lower than their peers. In other words, children with ODD may be less able to plan, problem-solve, and apply logic when they encounter a frustrating situation.

Lowering the Risk of ODD for Children with ADHD

Another study examined a group of children diagnosed with ADHD to try to answer an important question: Why do some children with ADHD exhibit challenging behaviors and receive a diagnosis of ODD, while other children with ADHD manage without finding themselves constantly in conflict with authority?

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The study looked at differences in family history and parenting style to explore potentially significant factors. The researchers found that children who experienced adverse events (such as divorce and family violence) were more likely to be diagnosed with ODD later on. Also, parents who used a negative, emotion-dismissing parenting style were more likely to raise children with both ADHD and ODD. However, when parents used a warm and responsive parenting style, the children were better able to cope with adverse events and less likely to be diagnosed with ODD later on.

Friendships also help to lower (or increase) the risk of an ODD diagnosis for children with ADHD. If children are rejected by their peers, or if they spend more time with children who are exhibiting “deviant” behaviors (such as breaking rules or harming others), then disruptive and socially inappropriate behavior can help to secure their social approval in that peer group. Children who are monitored closely by their parents and find acceptance among their typical peers are more likely to follow social norms and are less likely to be diagnosed later with ODD or Conduct Disorder.

More research is needed to better understand children with challenging behavior — and the most effective social, emotional, and cognitive supports. Children with ADHD do face challenges when it comes to socialization and adhering to group norms, but research confirms that a nurturing environment can help to offset these challenges. Instead of blaming a child’s disruptive behavior on an ADHD diagnosis, parents and teachers may be encouraged to learn that children with ADHD do benefit from positivity, and can grow up to find acceptance and success in their communities.

Oppositional Defiant Disorder: Next Steps


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Updated on September 11, 2020

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