ADHD and Oppositional Defiant Disorder – Is There A Connection?

Everyone acts out at some point or the other during their childhood. Acting out every now and then does not automatically mean that your child has a behavioral disorder. However, some children do have a pattern of disruptive behavior that can indicate an underlying medical problem. This may eventually also lead to a diagnosis of attention deficit hyperactivity disorder (ADHD) or oppositional defiant disorder (ODD). While most people are aware of attention deficit hyperactivity disorder because it has become quite common in recent years, not many know what is oppositional defiant disorder. Children with ADHD tend to be easily distracted, disorganized, and more likely to be fidgety, having difficulty in sitting still. Children with oppositional defiant disorder are known to be defiant, angry, and even vindictive. It is estimated that nearly 40 percent of children with ADHD also have ODD. Read on to learn more about ADHD and oppositional Defiant Disorder and is there a connection.

Overview of Attention Deficit Hyperactivity Disorder and Oppositional Defiant Disorder

Attention deficit hyperactivity disorder (ADHD) is a type of mental health disorder that gets diagnosed in childhood.(1,2,3) The condition can lead to above-normal levels of impulsive and hyperactive behavior in children. Children with ADHD are known to have trouble focusing their attention on any one task or sitting still for a long period of time. Adults can also have ADHD, but it is usually diagnosed in childhood.(4,5,6)

On the other hand, oppositional defiant disorder is a type of behavioral disorder that causes anger and defiance against authority.(7,8,9) It is known to affect a person’s school, work, and social life, along with their relationships. This condition is known to affect between 1 to 16 percent of school-going children. The condition is more commonly observed in boys than in girls. Most children start to exhibit the symptoms of ODD between the ages of six to eight years of age.(10) However, this does not mean that ODD does not affect adults. Oppositional defiant disorder also occurs in adults, and adults with this condition who were not diagnosed in their childhood are more likely to go undiagnosed.(11)

It is estimated that 40 percent of children who have attention deficit hyperactivity disorder also have oppositional defiant disorder or some other related conduct disorder. (12,13)

What Happens When A Child Has ADHD and ODD Together?

Oppositional defiant disorder is associated with a child’s conduct and the manner in which they interact with their family, friends, teachers, and any other relationship in their lives. Meanwhile, attention deficit hyperactivity disorder is a neurodevelopmental disorder. Even though the two conditions are different, but they can occur together in a child.

There are some symptoms that may be related to the impulsivity that occurs in attention deficit hyperactivity disorder. It is believed that nearly 40 percent of children who have been diagnosed with attention deficit hyperactivity disorder also have oppositional defiant disorder.(14) At the same time, though, not all children who are diagnosed with ODD have ADHD and vice versa.

A child who only has attention deficit hyperactivity disorder is likely to be full of extra energy or get overly excited while playing with other children. This can sometimes cause unintended harm to others. Children with this condition are also more prone to throw tantrums, but it is not a typical symptom of ADHD. Instead, the tantrum is more often an impulse outburst because of boredom or frustration.

If the same child also has oppositional defiant disorder, not only are they going to have issues with impulse control, but they also have an irritable or angry mood, which can cause further physical aggression. These children have tantrums due to the inability to control their anger and temper. They are also likely to be spiteful and try to upset others on purpose while blaming others for their own mistakes. Apart from being overly excited and causing harm to a classmate while playing, they may also lash out and accuse their classmates. They may even refuse to apologize.

It is important to remember that the signs and traits of attention deficit hyperactivity disorder and oppositional defiant disorder can also occur with other conduct disorders and learning disabilities. A doctor who is in the position of diagnosing a child with multiple conditions needs to take into account the bigger picture or the overall symptoms before they make a diagnosis.(15)

Other types of conduct disorders can also include symptoms like stealing, stealing, aggression towards animals or people, destroying property, and even serious violations of rules, like truancy from school or running away from school.

It is believed that nearly one out of three children with attention deficit hyperactivity disorder also experience symptoms of anxiety and may even have depression.(16)

What Are The Causes Of ADHD and ODD?

The exact cause of both these conditions, ADHD and ODD, remains unknown. However, it is believed that genetics combined with certain environmental factors may play a role in determining which child develops both the conditions. For example, a child is more likely to develop both the conditions if attention deficit hyperactivity disorder runs in their family.

It has been found that exposure to lead is one of the environmental factors that increase the risk for attention deficit hyperactivity disorder. A child is also more at risk for developing oppositional defiant disorder if there is a history of abuse, harsh discipline, or neglect at home.

Recognizing the Symptoms of ADHD and ODD

When attention deficit hyperactivity disorder and oppositional defiant disorder occur together in a child, they may display symptoms of both these behavioral and neurodevelopmental conditions. Symptoms of both the disorders need to be present for at least six months in order for a doctor to make a diagnosis. Here are some of the symptoms of these disorder to watch out for: (17)

Symptoms of Attention Deficit Hyperactivity Disorder

  • Difficulty focusing
  • Inability to pay attention, especially at school and on school work
  • Unorganized
  • Trouble listening to and following directions
  • Easily distracted
  • Frequently misplacing their things
  • Non-stop fidgeting
  • Forgetting daily chores or assignments
  • Talking too much
  • Frequently interrupting conversations
  • Blurting out answers in class

Symptoms of Oppositional Defiant Disorder

  • Angry and resentful
  • Easily loses temper or gets annoyed easily
  • Refuses to comply with directions or requests
  • Shows hostility, especially towards authoritative people
  • Blames others for their mistakes
  • Purposely upsetting or annoying others.

Diagnosing ADHD and ODD Together

It is essential to keep in mind that a child does not necessarily need to show all the symptoms of attention deficit hyperactivity disorder and oppositional defiant disorder in order to receive a diagnosis of having both these conditions.(18) After all, there is no single diagnostic test to help diagnose both ADHD and ODD. Usually, your doctor will make a diagnosis after carrying out a full medical examination along with a psychological evaluation to rule out any other conditions, including depression or any learning disability.(19)

To help with diagnosing both these conditions, doctors may request for a child’s family and personal medical history and may also schedule an interview with your child’s teacher, babysitter, or anybody else with who the child has frequent contact and day-to-day interaction with.

Are There Any Treatments Available for ADHD and ODD?

In children who have both these conditions together, treatments focus on prescribing medications that help decrease hyperactivity and improve their ability to pay attention. They are also put in therapy for treating defiant behavior.

For treating attention deficit hyperactivity disorder, stimulants may be used that work by balancing certain chemicals in the brain. These are fast-acting medications, but it may take some time and some trial and error to determine the correct dosage for your child.(20,21)

It is important to know that some stimulants are associated with heart-related deaths in children who have congenital and any other type of heart defects. Before prescribing these stimulant drugs, your doctor will order an electrocardiogram, a test that measures the electrical activity in your child’s heart and determines if there are any possible heart problems.(22)

There are other anti-hypertensive drugs, cognitive-enhancing drugs, and even antidepressants that are prescribed for the treatment of attention deficit hyperactivity disorder. It has been found that many children greatly benefit from taking family therapy, behavioral therapy, and training in social skills.

When it comes to treating oppositional defiant disorder, medications are not prescribed unless there are some other symptoms that need to be treated. At present, there are no medications that have been approved by the US Food and Drug Administration (FDA) for the treatment of oppositional defiant disorder. Treatment usually focuses on individual and family therapy. Family therapy is important in that it can help improve the communication and interaction between parent and child.(23)

Some children also benefit from taking cognitive problem-solving training. This training helps these children overcome and correct the negative thought patterns that often lead to the behavioral problems. Some children also undertake social skills training to learn about the correct way of interacting with their classmates and other people.

Conclusion

When a child starts exhibiting the symptoms of oppositional defiant disorder or attention deficit hyperactivity disorder, it is crucial to get an early diagnosis to begin treatment. Treatment will involve a combination of psychotherapy and medication to help alleviate the symptoms and focus on correcting the negative thought patterns.

Even with the success of therapy, some children will continue to need ongoing treatment to manage their conditions and keep their symptoms under control. It is important that you seek help and talk to your child’s doctor about any concerns you may have.

References:

  1. Barkley, R.A., 1998. Attention-deficit hyperactivity disorder. Scientific American, 279(3), pp.66-71.
  2. Swanson, J.M., Volkow, N.D., Newcorn, J., Casey, B.J., Moyzis, R., Grandy, D. and Posner, M., 2006. Attention deficit hyperactivity disorder. Encyclopedia of Cognitive Science.
  3. Barkley, R.A., 2006. Attention-Deficit/Hyperactivity Disorder. Guilford Publications.
  4. Barkley, R.A. and Murphy, K.R., 2006. Attention-deficit hyperactivity disorder: A clinical workbook. Guilford Press.
  5. Biederman, J., 2005. Attention-deficit/hyperactivity disorder: a selective overview. Biological psychiatry, 57(11), pp.1215-1220.
  6. Barkley, R.A., 2003. Issues in the diagnosis of attention-deficit/hyperactivity disorder in children. Brain and development, 25(2), pp.77-83.
  7. Hamilton, S. and Armando, J., 2008. Oppositional defiant disorder. American family physician, 78(7), pp.861-866.
  8. Rey, J.M., 1993. Oppositional defiant disorder. The American journal of psychiatry.
  9. Cavanagh, M., Quinn, D., Duncan, D., Graham, T. and Balbuena, L., 2017. Oppositional defiant disorder is better conceptualized as a disorder of emotional regulation. Journal of attention disorders, 21(5), pp.381-389.
  10. 2021. Oppositional Defiant Disorder (ODD) in Children. [online] Available at: <https://www.hopkinsmedicine.org/health/conditions-and-diseases/oppositional-defiant-disorder> [Accessed 18 February 2021].
  11. Reimherr, F.W., Marchant, B.K., Olsen, J.L., Wender, P.H. and Robison, R.J., 2013. Oppositional defiant disorder in adults with ADHD. Journal of Attention Disorders, 17(2), pp.102-113.
  12. Connor, D.F. and Doerfler, L.A., 2008. ADHD with comorbid oppositional defiant disorder or conduct disorder: discrete or nondistinct disruptive behavior disorders?. Journal of attention disorders, 12(2), pp.126-134.
  13. Biederman, J., Faraone, S.V., Milberger, S., Jetton, J.G., Chen, L., Mick, E., Greene, R.W. and Russell, R.L., 1996. Is childhood oppositional defiant disorder a precursor to adolescent conduct disorder? Findings from a four-year follow-up study of children with ADHD. Journal of the American Academy of Child & Adolescent Psychiatry, 35(9), pp.1193-1204.
  14. A-Z, T., 2021. ADHD and Behavior Problems. [online] Child Mind Institute. Available at: <https://childmind.org/article/adhd-behavior-problems/> [Accessed 18 February 2021].
  15. Nadder, T.S., Rutter, M., Silberg, J.L., Maes, H.H. and Eaves, L.J., 2002. Genetic effects on the variation and covariation of attention deficit-hyperactivity disorder (ADHD) and oppositional-defiant disorder/conduct disorder (ODD/CD) symptomatologies across informant and occasion of measurement. Psychological medicine, 32(1), pp.39-53.
  16. Centers for Disease Control and Prevention. 2021. Data and Statistics About ADHD | CDC. [online] Available at: <https://www.cdc.gov/ncbddd/adhd/data.html> [Accessed 18 February 2021].
  17. Evans, S.W., Brady, C.E., Harrison, J.R., Bunford, N., Kern, L., State, T. and Andrews, C., 2013. Measuring ADHD and ODD symptoms and impairment using high school teachers’ ratings. Journal of Clinical Child & Adolescent Psychology, 42(2), pp.197-207.
  18. Ballentine, K.L., 2019. Understanding racial differences in diagnosing ODD versus ADHD using critical race theory. Families in Society, 100(3), pp.282-292.
  19. Tahillioğlu, A., Dogan, N., Ercan, E.S. and Rohde, L.A., 2020. Helping Clinicians to Detect ODD in Children with ADHD in Clinical Settings. Psychiatric Quarterly, pp.1-12.
  20. Arnsten, A.F., 2006. Stimulants: therapeutic actions in ADHD. Neuropsychopharmacology, 31(11), pp.2376-2383.
  21. Wilens, T.E. and Biederman, J., 1992. The stimulants. Psychiatric Clinics, 15(1), pp.191-222.
  22. Nissen, S.E., 2006. ADHD drugs and cardiovascular risk. New England Journal of Medicine, 354(14), pp.1445-1448.
  23. Steiner, H. and Remsing, L., 2007. Practice parameter for the assessment and treatment of children and adolescents with oppositional defiant disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 46(1), pp.126-141.

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