How Are ADHD and ODD Connected?

Around half of the children diagnosed with attention-deficit/hyperactivity disorder (ADHD) also have oppositional defiant disorder (ODD).¹ Oppositional defiant disorder is considered a childhood disorder and is a hard diagnosis to grasp, so here I will address a few of my own questions about the condition: What is ODD? How does it develop? What is ODD's connection to ADHD? Can it occur in adults? Most importantly, how can it be treated?

What Is Oppositional Defiant Disorder?

Oppositional defiant disorder develops from a mixture of genetic and environmental factors. For example, a toddler might be particularly emotional, stubborn, and defiant. Oppositional defiant disorder could eventually develop due to inconsistent, abusive, or neglectful parenting and negative life events. Between 60-70 percent of children seem to grow out of their ODD symptoms, but ODD can develop into a conduct disorder or antisocial personality disorder (APD), both of which are considered more severe than ODD.

Many with ODD almost always feel angry.² They are often impatient, frustrated, and emotionally reactive. Symptoms include being very argumentative, vindictive, and quick to anger. Those with ODD struggle with taking responsibility and following rules, instead blaming and acting aggressively towards others. Some feel oppressed and disliked, reacting to these feelings by purposefully annoying others or breaking rules.

There are many qualifications for this diagnosis. These symptoms must be fairly pervasive and exist for at least six months. Though ODD occurs with numerous other conditions, including learning disabilities, anxiety, and depression, these behavioral problems cannot exclusively occur due to mood disorders, bipolar episodes, psychosis, or substance abuse.³ In addition, the person has to have neither conduct disorder nor APD.⁴

Why Do ADHD and ODD Often Overlap?

Those with ADHD experience intense emotions and have a hard hard time regulating their feelings. They also tend to be impulsive (Adult ADHD and Urgency: Dealing With a Now or Never Impulse). Being unable to curb angry impulses can lead to aggressive and contrary behavior as seen in ODD. Being expected to follow instructions and rules that are very difficult for those with ADHD can cause frustration. Further challenges can result in anger at the world, others, and themselves. It is also possible that ADHDers’ sensitivity and fear of rejection lead to the kind of paranoia that is seen in ODD (Dealing with Rejection Sensitive Dysphoria (RSD) and ADHD). Without sufficient support, it is easy to see how these conditions could combine to create oppositional defiant disorder.

Treating ODD and Comorbid Disorders Like ADHD

Most advice out there is directed toward the parents of children who have ODD, but some of that advice can be used by those who suffer from ODD themselves. Experts suggest family, group, and individual therapy, particularly cognitive behavioral therapy. For children with ODD, the focus is on helping the adults develop appropriate parenting skills, but adults with ODD can develop their own skills by learning how to meditate and taking anger management courses.

Crucially, one must treat conditions that occur with ODD. Treating ADHD and other diagnoses with appropriate medication and therapy often lessens ODD symptoms. Other helpful steps include forming habits to relieve stress, such as running or journaling, and working to develop a sense of autonomy and responsibility.³

If you have ADHD, have you struggled with rules and authority figures? Do you have a bad temper and find yourself getting into frequent conflicts? Let me know in the comments about your experiences and advice.

Sources

1. ADDitude. Why am I so angry all the time? Russell Barkley.
2. ADDitude. What Does Oppositional Defiant Disorder Look Like in Adults? Janice Rodden.
3. Healthline. What Is Oppositional Defiant Disorder?
4. Community Psychiatric Centers. Oppositional Defiant Disorder or “O.D.D.”