ADHD Comorbidities & Related Conditions

Oppositional Defiant Disorder: Overview and Facts

Research shows that anywhere from 25 percent of boys with ADHD and 10 percent of girls with ADHD will develop ODD. Here is what parents need to know.

Oppositional defiant disorder (ODD) is characterized by disruptive behavior, disobedience, hostility, and defiant behavior towards authority figures. It is far more extreme than tantrums or disobeyed orders, and it impacts anywhere between 1 and 16 percent of children and adolescents.

Children with ODD exhibit a consistent pattern of angry and aggressive behavior that lasts for six months or more. A mental health professional, like a family therapist or counselor with ODD expertise, is often needed to diagnose and treat the condition. A psychiatrist is needed to recommend and prescribe medication.

ODD is more common in boys than it is in girls. Additionally, the condition may look different for boys and girls. Boys may be more physically aggressive, while girls become verbally aggressive. Girls with ODD may lie and refuse to cooperate – showing symptoms more indirectly – while boys more commonly argue with adults outright and have explosions of anger. ODD symptoms often manifest in early childhood, and some children outgrow the condition by age eight or nine. In cases of adolescent-onset ODD, symptoms show up later and persist through the child’s middle and high school years.

Researchers believe ODD is caused by psychological, social, and biological factors – not bad parenting. Children of parents with attention deficit hyperactivity disorder (ADHD), ODD, conduct disorder (CD), depression, bipolar disorder, or substance abuse problems are more likely to develop ODD. Additional biological risk factors include prenatal smoke exposure, toxin exposure, or poor nutrition. Family trauma can trigger ODD, like a neglectful or abusive parent.

Early intervention and treatment can help children overcome ODD, and prevent it from progressing into a more serious condition like CD. Treatment typically consists of therapies – both individual and family – and medication. Treatment plans must be tailored to the specific behavior issues, age, and any coexisting conditions.

Adults can have oppositional defiant disorder, too. The condition can persist for a lifetime just as often as it spontaneously disappears. In about 40 percent of cases, adults with ODD become progressively worse, and end up developing antisocial personality disorder, the diagnostic term for criminals. Even when the condition doesn’t worsen, ODD in adults can cause problems in relationships, marriage, and work. Rate of substance abuse, divorce, and employment problems is higher in this population. ODD adults can bring behavior under control with similar treatment strategies, including therapy and medication.

Updated on November 3, 2019

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