Managing oppositional defiant disorder and autism

As a parent or caregiver of someone on the autism spectrum, you may be used to meltdowns and big emotions. Each person with autism spectrum disorder (ASD) has their own unique way of interacting with the world, and these behaviors may be your child’s way of processing an upsetting or overwhelming experience.

For some autistic children, however, symptoms like irritability and disobedience may be associated with a condition called oppositional defiant disorder (ODD). In fact, research suggests that one in four children and adolescents with autism are living with a disruptive behavior disorder, like ODD.

If you’re concerned that a child in your life is acting disruptively more often than not, consider meeting with a mental health professional. Whether it’s autism, ODD, or both, early intervention and treatment can help them understand their emotions and manage their distress in healthy ways.

Signs of autism versus oppositional defiant disorder

Autism is a neurodevelopmental disorder that affects how people learn, behave, and communicate. Most people with autism show signs before they turn 2 years old and receive a diagnosis around age 5 (although many people are diagnosed much later). 

Some common signs of autism in children include:

• Strong preference for familiar routines 
• Developmental delays, such as with speech or language development
• Trouble understanding other people’s feelings or perspectives
• Sensory processing issues, such as sensitivity to sounds, smells, lights, and tastes
• Trouble managing emotions, which can lead to frequent outbursts

ODD is a behavioral disorder characterized by persistent patterns of defiant and uncooperative behavior, irritable mood, and vindictiveness. It’s typically diagnosed during childhood or adolescence but can continue into adulthood without access to treatment and support. 

Some common ODD symptoms in children include:

• Being unusually angry, irritable, or vindictive
• Frequently arguing with adults 
• Intentionally upsetting other people 
• Speaking in a rude or unkind tone
• Blaming other people for their mistakes or misbehaviors

Although they are two different conditions, it’s not uncommon for children on the autism spectrum to also experience symptoms of ODD. An autistic child may have co-occurring ODD if they intentionally argue with adults, refuse to follow rules, or upset other people for no valid reason.

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Distinguishing between autism and ODD

ODD and autism are both associated with disruptive behaviors and dysregulated emotions, but for different reasons. Children and adolescents with ODD are prone to angry, defiant, and even vindictive behaviors. They may intentionally try to create conflict or upset other people.

Conversely, children and adolescents with autism may be more likely to act out when they feel uncomfortable or misunderstood. When they’re defiant or noncompliant, it may be because they’re having trouble adjusting to new situations or feel anxious in certain social settings. 

So how can you tell if your child’s behavior is related to autism or ODD? The answer typically relates to motivation. Here’s an example:

You take your child to lunch at a busy restaurant, and they have a loud meltdown while you wait for the table. You know children get cranky when they’re hungry, but you’re wondering if that reaction was really necessary. 

Here are two ways to understand what’s going on behind the behavior:

1. For a child with autism, the restaurant’s lights, noises, and smells might be too overwhelming. They weren’t intentionally acting out, but they didn’t have another way to express their frustration. 
2. On the other hand, a child with ODD may cause a commotion for no clear reason. They may be intentionally rude to you or the waitstaff just to be defiant.

Four strategies for managing ODD in autism

Being a parent or caregiver can have its challenging moments — especially when your child is acting out. Big emotional reactions, frequent tantrums, and refusing to follow directions can leave you wondering how to best support your child’s needs. 

Below are four strategies for managing co-occurring autism and ODD.

1. Study your child. Autistic children often benefit from consistent schedules and routines. If you notice that your child is prone to meltdowns in the afternoon or is triggered by certain sounds, make a point to create an environment that accommodates their unique needs. By avoiding external stressors, you can help reduce frustration and prevent outbursts and other disruptive behaviors. 
2. Acknowledge positive behaviors. Positive reinforcement is a strategy used to help children with autism learn and maintain new skills. When you offer praise and positive reinforcement for positive behaviors, such as cooperating, children may be more likely to continue these behaviors. It’s also considered an effective way to encourage children with ODD to follow the rules and adopt more appropriate behaviors.
3. Focus on solutions. Research suggests that collaborative problem solving is an effective strategy for children with ODD. With collaborative problem solving, parents and children address their problems in a supportive and nonconfrontational way. This allows parents to empathize with their child’s struggles while proactively working with them to explore solutions.
4. Be patient and consistent. It can be frustrating when your child refuses to cooperate or respect your rules, but remember that patience is essential to helping them manage these behaviors. By creating a consistent environment for your child, you can help reinforce positive behaviors. 

Treatment for autism and ODD together

According to the American Academy of Pediatrics, autism interventions should be individualized, intensive, and developmentally appropriate. Treatment typically focuses on nurturing people’s strengths while also managing their challenges. 

By addressing issues like limited communication skills or dysregulated emotions, children may naturally learn to manage disruptive behaviors. With ODD, treatment focuses on helping people reduce or resolve symptoms. Children who don’t receive support may be more likely to develop conduct disorder later in life. 

Managing co-occurring autism and ODD may include a combination of tools, including individual therapy, group therapy, and social skills training. Applied behavior analysis (ABA) is a flexible treatment approach that allows providers to adapt their interventions to each person’s specific needs and symptoms. For example, it can teach children with co-occurring autism and ODD how to develop new communication skills and reduce disruptive behaviors. 

Cognitive behavioral therapy (CBT) is another effective solution for children and adolescents who engage in disruptive behaviors. CBT focuses on the connection between people’s thoughts, feelings, and behaviors. With CBT, children and their families can discover what’s driving learned behavior patterns so they can focus on more positive behaviors moving forward.

Find care with Rula

If disruptive behaviors are impacting your child’s well-being or potential for success, know that help is available. Meeting with a mental health professional can help you understand what’s driving these behaviors and how to create more positive habits moving forward.

At Rula, we’re committed to delivering a comprehensive behavioral health experience that helps people feel seen and understood so they can get back to feeling their best. 

Rula makes it easier to find a licensed therapist or psychiatric provider who accepts your insurance so you don’t have to choose between affordable care and excellent care. With a diverse network of more than 10,000 providers, 24/7 crisis support, and appointments available as soon as tomorrow, we’re here to help you make progress — wherever you are on your mental health journey.

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