Oppositional Defiant Disorder

“Why Is My Child So Angry?”

A whopping 40 percent of children with ADHD also develop oppositional defiant disorder — a condition marked by chronic aggression, frequent outbursts, and a tendency to argue, ignore requests, and engage in intentionally annoying behavior.

Boy with ADHD and Oppositional Defiant Disorder laying on rugby field with face paint on making angry face
Boy with ADHD and Oppositional Defiant Disorder laying on rugby field with face paint on making angry face

Did you know that 40 percent of children with ADHD also develop oppositional defiant disorder (ODD) — a condition marked by chronic aggression, frequent outbursts, and a tendency to argue, ignore requests, and engage in intentionally annoying behavior.

“These children are most comfortable when they’re in the middle of a conflict,” says Douglas Riley, Ph.D., author of The Defiant Child and a child psychologist in Newport News, Virginia. “As soon as you begin arguing with them, you’re on their turf. They keep throwing out the bait, and their parents keep taking it — until the parents end up with the kid in family therapy, wondering where they’ve gone wrong.” Learn more about oppositional defiant disorder here.

Looking for Links

No one knows why so many children with ADHD exhibit oppositional behavior, but some experts suggest that ODD may be tied to ADHD-related impulsivity.

“Many kids with ADHD who are diagnosed with ODD are showing oppositional characteristics by default,” says Houston-based child psychologist Carol Brady, Ph.D. “They misbehave not because they’re intentionally oppositional, but because they can’t control their impulses.”

Other experts suggest that ODD is a way for kids to cope with the frustration and emotional pain associated with having ADHD.

About half of all preschoolers diagnosed with ODD outgrow the problem by age 8, while older kids with ODD are less likely to do so. If left untreated, oppositional behavior can evolve into conduct disorder and more serious behavioral problems.

Getting Treatment

The first step in managing ODD is making sure that the child’s ADHD is under control. Typically, a doctor will put a child on a regimen of ADHD medication, which, in some cases, can also reduce ODD symptoms. Most children with ODD also use behavior modification techniques to help manage the condition. In severe cases, a child may need to see a family therapist trained in childhood behavior problems.

It’s a good idea for the therapist to also screen your child for anxiety, depression, and bipolar disorder, all of which can cause ODD.

Treatment of Choice

Parent management training — in which parents learn to change the way they react to their child’s behavior — is often highly effective in treating ODD. Between weekly sessions, the parents practice what they’ve learned from the therapist and report back on their progress.

“It’s carrots and sticks,” says Brady. “On the carrot end, you work on giving your child praise and rewards for cooperating. On the stick end, you lay out clear consequences for misbehavior.”

Keep the following in mind when starting a parent management training program:

1) Accentuate the Positive

Many parents of oppositional children are so focused on bad behaviors that they have trouble reinforcing positive ones. Yet positive reinforcement is the heart and soul of parent management training.

Instead of yelling at or spanking a child for bad behavior, parents are taught to take a different tack. “The parents are asked by the therapist what to do if they want their child to stop screaming, slamming the door, or throwing breakable objects,” says Alan Kazdin, Ph.D., in Parent Management Training, a manual for therapists. “The answers involve reinforcing talking quietly, closing the door gently, and handling objects with care and not throwing them.”

2) Enthusiasm Counts

Parents should be enthusiastic when praising their ODD child. Specify the praiseworthy behavior and, ideally, include some non-verbal gesture. For example, you might say, “It was wonderful the way you played so quietly while I was on the phone!” and then give your child a kiss.

Tailoring rewards and punishments to your child’s specific abilities and needs is important. But consistency in the way you treat your child — the way you set rules and convey expectations — is the key to cleaning up an ODD child’s act.

Above all, never lose sight of the fact that oppositional kids have a great deal to offer, once their behavior is under control. They’re often bright and engaging, with their own way of looking at the world.

“Once you work through their defiance, there’s a lot there to like,” says Riley.

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