Navigating life with ADHD and ODD

If you’re a parent, you might hear attention-deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) in the same sentence before. But why? 

Both ADHD and ODD are mental health conditions that commonly occur together (known as comorbidity). In fact, some research suggests that around 30% to 50% of children with ADHD may also have ODD.    

Having either ADHD or ODD alone can be challenging, and co-occurring conditions can make it even harder. But there’s support for children with these mental health conditions, and many can learn to manage their symptoms in healthy ways.

ODD vs ADHD: What’s the difference?

Like the condition’s name suggests, kids with ADHD can have issues with focus, hyperactivity, and impulsivity. There are three subtypes of ADHD: inattentive, hyperactive-impulsive, and combined (a child with this type displays symptoms from both inattentive and hyperactive-impulsive ADHD).

On the other hand, ODD is characterized by a frequent and consistent pattern of uncooperative, angry, and sometimes hostile behavior directed at authority, like parents and teachers. It can also extend to a child seeking revenge against someone. 

What do symptoms of ADHD and ODD look like?

No two kids with ADHD or ODD behave the exact same way. But there are some signs you can look for that may signal that your child might have one of these conditions.

ADHD can look like:

• Being easily distracted
• Avoiding or complaining about activities or chores that require sustained effort
• Interrupting people frequently or talking a lot
• Making frequent mistakes, like with schoolwork
• Fidgeting or squirming frequently

On the other hand, ODD can look like:

• Having frequent temper tantrums
• Blaming other kids for their own mistakes
• Arguing with adults constantly
• Speaking in an unkind tone
• Questioning rules
• Intentionally annoying someone 
• Acting in a vindictive way, like getting back at someone they think wronged them

While ADHD and ODD are distinct conditions, they can share some behaviors. For example, both ADHD and ODD can make it hard to follow rules, patiently listen, pay attention, and self-regulate. 

But just because a child may exhibit some of these behaviors doesn’t mean they have ADHD or ODD. A qualified health provider, like a psychologist, psychiatrist, or pediatrician, can diagnose your child. 

For ADHD, a child younger than 16 must display six or more symptoms of inattention and/or hyperactivity-impulsivity. If older than 17 or an adult, five or more symptoms of inattention or hyperactivity-impulsivity must be present for a diagnosis. 

For ODD, a qualified health provider must determine a pattern of angry or irritable mood, argumentative or defiant behavior, or vindictiveness with a family member who isn’t a sibling that lasts at least six months. 

What can cause ADHD and ODD?  

While experts don’t definitively know what causes ODD, it’s thought that some children may be more susceptible to the condition than others. For example, if ODD runs in your family, your child has a higher chance of developing ODD. Similarly, mood disorders like depression and bipolar disorder in a family can increase the risk of a child being diagnosed with ODD.

The brains of children with ODD may show differences in the areas that control reasoning, judgment, and impulse control. Studies also show lower levels of the stress hormone cortisol in boys with ODD when they’re stressed. This can lead to more aggression.  

ADHD can also cause aggression in children. This can happen because of the issues with impulsivity and emotional regulation that can arise with ADHD. 

Like with ODD, if a family member has ADHD, a child in the family is more likely to have it too. Brain differences can also play a role. Dopamine levels are lower in kids with ADHD, which can affect motivation.

Studies also suggest that exposure to substances like alcohol and nicotine can contribute to oppositional defiance behavior and ADHD.

Parenting a child with co-occurring ADHD and ODD

Co-occurring ADHD and ODD can be tough to deal with — for both kids and parents alike. There are many changes you can make in your child’s life to support them in managing their symptoms. 

Here are some ways to start: 

• Build routine and structure. Kids with both ADHD and ODD often benefit from routine and structure. You might create a schedule for your child, helping them organize their day-to-day life from school to homework and chores to free time. While it might feel strange to be overly strict with your child, it’s often essential for kids with ADHD and ODD.  
• Get teachers and other adults involved. Helping your child receive the best support at school with their peers and teachers can create a safe and positive environment for them. Request an IEP so the important people in your child’s life are on the same page with interventions and support to set them up for success. 
• Model positive behaviors. Even if it doesn’t always feel like it, children see their parents as examples. Modeling the behavior you want your child to practice, like waiting your turn or not reacting to inconveniences with anger, can influence your child. 
• Practice self-care. Parenting can be stressful, and even more so with challenging mental health conditions like ADHD and ODD. So it’s important you’re taking care of yourself, so you can show up for your family in the best way possible. Make sure you’re taking time to recharge, prioritizing sleep and good eating habits, and looping in your support system.

Treatment for ODD and ADHD

Both ADHD and ODD are treatable conditions. Identifying the signs of each condition early and working with a mental health professional can prevent symptoms from worsening and set your child up for success. 

About two in three kids with ADHD meet the ADHD diagnostic criteria as adults. But those symptoms can change and improve — especially with interventions. 

Children with ODD can outgrow it. For around 67% of kids with the condition, the symptoms do go away. Though, around 30% can develop conduct disorder (CD), which is a mental health condition that may include hurting people or animals, usually without remorse for the behavior.  

While conduct disorder is serious, you have options to reduce the risk of your child’s ODD progressing into CD. Here are some options:

Parent training

This can help you improve your relationship with your child, set expectations, enforce effective consequences when those expectations aren’t met, and praise your child when they behave positively. 

Parent training can also be effective for kids younger than six with ADHD. For kids older than six, experts recommend parent training in combination with medication. Make sure to talk with your provider to determine if medication is right for your child. 

Social skills training 

For kids with ODD, it might seem like other children instinctively know how to make friends and keep them. Social skills training can help children with ODD learn essential life skills, like how to share toys, apologize, handle conflicts, and listen to others. 

Kids with ADHD can also benefit from social skills training. They can learn how to behave appropriately in contexts like the classroom. For example, they might learn how to combat the impulse to interrupt a teacher or talk excessively.  This can reduce the redirection from teachers or behavioral referrals.

Therapy

There are different kinds of therapy your child might find useful. Talk therapy is one. It can give your child an outlet to talk about their difficult emotions and also learn healthier ways to express those feelings. 

Parent-child interaction therapy is another option. Imagine that you could have someone in your ear to help your interactions with your child go smoother. With this kind of therapy, that’s exactly what happens. Typically, a therapist will observe you and your child via a one-way mirror. You’ll wear a “bug-in-the-ear” device so the therapist can coach you on how to respond to your child’s behavior. The first phase of treatment focuses on building warmth in your relationship with your child. The second phase focuses on proven strategies for discipline.  

Find care with Rula

Parenting can feel like an uphill battle, especially when your child has ADHD, ODD, or a combination of both. But know that you’re not alone, and help is available. Getting your child an accurate diagnosis of ADHD or ODD can be the first step to getting them the right care. 

This is where Rula comes in. Rula’s diverse network of therapists and psychiatrists offers specialized care, like for a child with both ADHD and ODD. You can schedule your first appointment for as soon as tomorrow.

Find a therapist with Rula