As adults, we’ve all experienced moments that allowed us to see the defiant side of children – the so-called “terrible twos” and early teen years being amongst some of the most difficult times to navigate. They may express this defiance by talking back, disobeying or arguing with their parents, teachers or other adult figures. And while on the surface this doesn’t present too unmanageable of a problem, when this behavior lasts longer than six months (as is deemed excessive compared to what is usual for the child’s age), it could mean the child is suffering from a type of behavior malfunction known as Oppositional Defiant Disorder (ODD).
ODD defines a condition in which a child displays an ongoing pattern of uncooperative, defiant, hostile and downright irritating behavior toward authority figures, behavior that often disrupts the child’s normal daily activities including those within the family and at school. What’s interesting – and challenging to educators at the same time – is that plenty of children and teens exhibiting symptoms of ODD also have other behavioral problems including ADHD, learning disabilities, mood disorders (such as depression) and anxiety disorders. In extreme cases, some children with ODD go on to develop a more serious behavioral diagnosis known as Conduct Disorder.
Here, we’re going to take a focused look at the ODD symptoms parents and educators should be aware of in a child diagnosed with ADHD.
Let’s begin with a quick overview of general ODD symptoms; these can include:
• Chronic aggression
• Frequent outbursts
• Tendency to argue
• Tendency to ignore requests
• Tendency to engage in intentionally annoying behavior
• About half of all preschoolers diagnosed with ODD outgrow the problem by age eight.
• If left untreated, oppositional behavior can evolve into conduct disorder and more serious behavioral problems.
What’s interesting is that 40% of children with ADHD also develop Oppositional Defiant Disorder, with many experts suggesting that ODD may be tied to ADHD-related impulsivity. In fact, here’s one thought as shared by Carol Brady, Ph.D., a Houston-based child psychologist: “Many ADHD kids who are diagnosed with ODD are showing oppositional characteristics by default. They misbehave not because they’re intentionally oppositional, but because they can’t control their impulses.”
Frustration and Emotional Turmoil
Still other experts suggest that ODD is a coping mechanism for kids dealing with the frustration and emotional turmoil associated with having ADHD. Important to note here is that parental management training – that is, when parents learn to change the way they react to their child’s behavior – is often highly effective as a treatment strategy against ODD. Between weekly sessions, the parents practice what they have learned from a therapist and report back on their progress.
At the forefront of all this is an alarming and noteworthy sentiment shared by many ADHD and behavioral professionals, one which stresses the importance of knowing that children with ADHD are always at an increased risk of developing other types of behavior disorders – including ODD. This is so vitally important because when this occurs, the long-term outcomes for children are likely to be much worse than for a child suffering from ADHD alone. Differentiating between ODD and ADHD symptoms is at the forefront of many institutions’ agendas, one of the most important ones being that no ADHD symptom involves behavior that is considered to be “deliberate” and “willful” – in other words, though children with ADHD often engage in behavior that annoys others and fails to satisfy requests, such behavior is generally not deliberately and willfully initiated.
Difficulties Associated with Oppositional Defiant Disorder
Critically important to bring under the control – as soon as possible – are the types of difficulties associated with ODD. Why the urgency? Such behavior becomes formidably entrenched and difficult to alter the longer it persists. What’s more, children with ODD are at significant risk for the development of more severe kinds of behavioral disturbance characteristic of Conduct Disorder… and the long-term outcomes for children with Conduct Disorder have become especially worrisome to educators and medical professionals.
In a recent example of what child behavior experts have been dealing with in attempting to isolate the connections between ADHD and ODD, a five-year-old was diagnosed with ADHD, which explained some of his difficulties in school. However, it never justified his aggressive and defiant temperament, and it was not until the beginning of the current school year that his mother sought additional help for her son’s behavior – which was, suffice to say, becoming stressful to her family. The pediatrician treating the boy determined that he was suffering from Oppositional Defiant Disorder.
Therein lies the central element of our discussion: Children with ODD exhibit a pattern of angry, violent and disruptive behaviors toward parents, teachers, caretakers and other figures of authority, and the aforementioned five-year-old boy is far from alone in his “dual diagnosis” of ADHD and ODD. As we mentioned before, up to 40-percent of children with ADHD are estimated to also suffer with ODD.
Here’s an interesting observation: Signs of ODD can clearly be observed in a child’s attitude towards his or her primary caregiver, with this defiant behavior possibly spreading to a secondary caregiver and to teachers or, as we mentioned, other authority figures. But if it appears in a child with ADHD, ODD will appear within two years of an ADHD diagnosis.
According to experts like Russell Barkley, Ph.D., a clinical professor of psychiatry and pediatrics at the Medical University of South Carolina, if a child does begin to exhibit signs of defiance, there is an easy way to tell whether that behavior is a consequence of ADHD or is a sign of ODD.
By Barkley’s estimation, ADHD is not a problem that focuses on starting a task, it is a problem related to finishing a task – and so if a child can’t seem to start a task, it’s a clear sign of ODD. Further, say experts like Barkley, understanding why ODD is found so frequently in children with ADHD is to fully grasp the two fundamental dimensions of the disorder: The emotional and social components. Frustration, impatience and anger are all part of the emotional component, while arguing and outright defiance define the social aspect.
Most children with ADHD tend to be impulsive, thus driving the emotional component of ODD; for people suffering with ADHD, emotions are expressed in a rapid fashion, whereas others are able to contain their feelings. This is why, say experts such as Berkley, the small subset of kids who exhibit the inattentive type of ADHD is less likely to develop ODD. Children who have ADHD, along with intense impulsivity, are likely to be diagnosed with ODD.
Whomever a child’s caregivers happen to be – grandparents, teachers, nannies and other adults that spend time with them – it is imperative they participate in getting the child the treatment they require. They must understand that the need for consistency in behavioral therapy extends to them as well, as ODD in particular has a deleterious effect on relationships and communication between kids and adults. The need to begin improving things as soon as possible is critical under these circumstances.