Attention And Misconduct: Exploring ADHD And ODD

The trend of more accurate diagnosing of attention-deficit/hyperactivity disorder (ADHD) has created a broader awareness of the disorder and how it affects individuals and families. This increase in awareness is beneficial for everyone. People with ADHD will gain greater respect and kindness when their habits, struggles, and quirks are understood as symptoms of a mental health condition rather than the false belief that they’re “lazy” or “rude.” Moreover, individuals without the disorder can better understand people with ADHD instead of taking the child's behavior personally.

While attention deficit hyperactivity disorder ADHD is widely known, oppositional defiant disorder(ODD) is a frequent comorbid condition that does not garner as much attention or awareness. This article will look at ADHD and ODD, what the differences are between these disorders, what their symptoms look like, and ways you can help your child manage them.

What is ODD?

Oppositional defiant disorder (ODD), is a behavior disorder characterized by consistent, unexplained behavioral outbursts, typically toward authority figures. According to the Child Mind Institute, ODD symptoms may include being vindictive, being easily annoyed, being unusually irritable, deliberately annoying people, and blaming others for their own mistakes. They may argue with adults refusing to do what is asked of them.

Oppositional defiant disorder is particularly alarming and problematic for families because children with oppositional defiant disorder may pose a safety hazard for themselves and those around them, including other children, other parents, or family members. Children with oppositional defiant disorder are often physically, emotionally, and verbally violent, and they may attack others without warning. These children might also throw items, run away from parents or caregivers, and refuse to attend to necessary tasks, which can lead to danger, decreased self-esteem, and familial discord. ODD often occurs with other disorders, including mood disorders, an anxiety disorder, or ADHD.

Diagnosis: Attention deficit hyperactivity disorder vs. oppositional defiant disorder

An ADHD diagnosis is typically completed in a clinical setting by a psychologist or psychiatrist. Your child's doctor can also diagnose ADHD, and teachers can help children by observing ADHD-specific behaviors, such as ADHD stimming or trouble paying attention, in educational settings. According to the National Health Service, “Symptoms of ADHD tend to be noticed at an early age and may become more noticeable when a child's circumstances change, such as when they start school.” An ADHD diagnosis can be given in a single sitting and sometimes involves more parental reporting or self-reporting than actual observation of behaviors and symptoms. 

Conversely, an oppositional defiant disorder diagnosis is usually a more involved process and can take weeks (or longer). Like ADHD, there is no specific test to diagnose oppositional defiant disorder, and because ODD diagnoses require observation in addition to self-reports or parental reports, the process can be longer and more complex. Teachers may need to make note of any behavioral difficulties experienced during school hours, parents may need to record or demonstrate difficulties, and clinicians may need to observe behaviors associated with ODD. Moreover, a diagnosis may not as readily guarantee services like early intervention in school or elsewhere compared to ADHD since the condition is still largely unknown.

Causes: ADHD vs. ODD

ADHD causes are primarily unknown. Although there are risk factors, such as family history and existing developmental delays, none of these definitively act as the root of ADHD. Comorbid conditions provide possible insights into the mechanisms behind ADHD more than they provide answers as to why the condition exists in the first place. ADHD can also be traced to cognitive development and possible genetic triggers.

ODD causes, on the other hand, are thought to be one of two possibilities: behaviors learned as a result of developmental impairments and parental influence and emotional and attachment issues resulting in the improper development of emotional reactions and social behavior. Each of these explanations and root causes comes with its own set of problems. For instance, if oppositional defiant disorder is simply a series of learned behaviors or the result of growing up in a home with substance abuse, poor parenting behaviors, or other family dysfunction, replacing those behaviors will take enormous effort and dedication and a lot of positive reinforcement on the part of many people. However, if ODD is a result of emotional and developmental immaturity, then therapy is likely needed to learn healthy emotional ties and boundaries and to grow developmentally.

Existing together: ADHD and ODD symptoms

ADHD and ODD can be comorbid conditions, and each interacts negatively with the other. To effectively treat oppositional defiant disorder, children must be able to focus and attend to a task and actively engage with a therapist or caregiver. With ADHD symptoms, focus and engagement are difficult, which can make treating either of the conditions uniquely problematic. As many as 40% of children with ADHD will go on to develop oppositional defiant disorder, rendering treatment necessary and challenging.

Interventions for both ADHD and oppositional defiant disorder typically include some form of cognitive therapy. Cognitive therapy seeks to alter the ways in which the brain functions, including self-esteem, outward behavioral patterns, and methods of expression. Because some of the symptoms of oppositional defiant disorder may be related to unhealthy expressions of emotion, learning to replace these forms of expression is pivotal in laying the groundwork for recovery from ODD. Unhealthy expressions of anger and frustration are often borne of ADHD, as the limitations children might experience with ADHD can cause extreme frustration and even self-hatred. These can be overwhelming emotions for a child to process.

Medication may be necessary for a time when treating these conditions. The symptoms of each of these conditions can impede healing enough that pharmaceutical intervention may be necessary while behavior patterns are broken down and rebuilt. These medications might include stimulants to encourage focus for ADHD or sedative medications to ease some of the more aggressive or violent behaviors in children with ODD.

Parental involvement in ODD

Although implementing therapy at home is useful for ADHD, it is far more imperative to the success of ODD treatment for parents to be on board and actively implement therapeutic strategies. ODD, regardless of cause, requires parents to change parenting strategies to accommodate the unique behavioral needs of children with oppositional defiant disorder. 

Because this disorder is often accompanied by the willful desire to annoy, frustrate, or cause a dramatic reaction in others, parents must work particularly hard to avoid extreme reactions and demonstrate patience both inside and outside the home.

Parents may be encouraged to enroll children in therapy to improve emotional expression, but they may also be encouraged to enlist in therapeutic interventions themselves. Children with oppositional defiant disorder are far more likely to internalize and mimic parents' extreme reactions and unhealthy expressions of anger, upset, or frustration. If present, these parental behaviors will likely compound the symptoms of ODD in a child.

Educational involvement: ADHD and ODD

The involvement of the child's school and other educational institutions is an important treatment consideration for children with these conditions. In ODD, consistency with discipline and expectations is extremely important, so educators should be included in any disciplinary or therapeutic interventions being used at home or in therapy. As a diagnosed condition, ODD should warrant an IEP (Individual Education Program) or 504 plan from educators. 

Similarly, education systems should be on board with any interventions engaged by parents to help with the symptoms of ADHD. These interventions might be small, such as minimizing exposure to stimulants and sensory distractions, or they may be more significant, including a pharmaceutical regimen and a series of behavioral and cognitive therapies, for instance.

Enlisting routine: Treating ADHD and ODD

One of the best at-home strategies for both ADHD and oppositional defiant disorder is routine. Routines are useful for parents, as they provide a framework in which to design a child's day and can be powerful interventions for children who struggle with various aspects of everyday functioning. This is because they enable children - young humans with very little control over their lives - to know what to expect hour-to-hour or day-to-day. Knowing what to expect and what is expected of them can help children with both conditions more effectively with their moods and emotional responses to environmental influences.

For children experiencing both disorders, handling emotions and mood is important in condition management overall. If mood can be kept at a stable, balanced level, the likelihood of emotional outbursts is lowered, and comfort is maintained for both the child and the people in the child's immediate environment. 

Seeking therapy for ODD

Because of the disruptive behaviors associated with oppositional defiant disorder, parents are sometimes hesitant to take school age children or younger to in-person appointments. They may fear their child acting out, or they may experience anxiety when introducing their children to new people and situations. This is understandable, and online therapy represents a feasible alternative. With internet-based counseling, families affected by ODD can meet with a qualified therapist from the comfort and safety of their homes, and parents can learn how to help their child manage their ODD symptoms.

The effectiveness of online treatments for oppositional defiant disorder is well-documented. One recent study showed positive outcomes associated with an internet-based intervention for parents of children with ODD.