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ADHD vs. ODD: Similarities and Differences

Medically Reviewed by Smitha Bhandari, MD on May 25, 2022

If your child has attention-deficit hyperactivity disorder (ADHD), it’s not unusual for them to have other conditions at the same time. These are called comorbidities. Oppositional defiant disorder (ODD) is one such condition. In fact, ODD is the most common comorbidity with ADHD. Experts believe that about four out of 10 kids with ADHD also have ODD.

Here’s a look at what happens when your child has ADHD and ODD at the same time.

What Are ADHD and ODD?

ADHD is a type of brain disorder that affects millions of American children and often lasts well into adulthood. If your child has ADHD, it may cause a combination of problems such as:

  • Lack of attention
  • Hyperactivity
  • Impulsive behavior

ODD is a type of behavior disorder that’s mostly diagnosed in childhood. If your child has ODD, they tend to be:

  • Uncooperative
  • Defiant
  • Aggressive

The two conditions may appear similar because some of the symptoms can overlap. But the causes are usually different. For example, ADHD is mostly a genetic condition and is often passed down from family members. Kids with ADHD find it difficult to control their behavior.

In contrast, ODD is often a learned behavior or stems from developmental issues. If your child loses their temper quickly, argues too much, destroys property, or purposely annoys others, it’s often a sign of a more serious condition linked with antisocial behavior.

What Are the Similarities?

Both conditions involve changes in brain chemistry that cause such symptoms as uncontrolled, impulsive, or aggressive behavior. Both conditions are more common in boys than in girls.

Your child’s symptoms must last for at least 6 months before a doctor can diagnose them with ADHD or ODD.

It’s easy to confuse both ADHD and ODD as normal behaviors in young children or adolescents and ignore them. But kids with these conditions don’t tend to “grow out” of these phases as easily as their peers. Some of the symptoms may ease with age, especially if the condition is mild to begin with. But for some kids with severe forms of ADHD and ODD, these behaviors may never go away.

ADHD symptoms may include:

  • Short attention span
  • Being easily distracted
  • Making careless mistakes
  • Being forgetful
  • Trouble focusing on time-consuming or demanding tasks
  • A hard time organizing
  • Can’t sit still
  • Constantly fidgeting
  • Talking a lot or interrupting conversations
  • Having little to no sense of danger
  • Acting without thinking

Common ODD symptoms include:

  • Frequent temper tantrums
  • Arguing with adults
  • Refusing to do what an adult or authority figure asks
  • Always questioning rules
  • Refusing to follow rules
  • Doing things to annoy or upset others
  • Blaming others for misbehaviors or mistakes
  • Becoming easily annoyed by others
  • Acting angry
  • Speaking harshly or unkindly
  • Seeking revenge

These symptoms may lead to low self-esteem and make it harder for your child to make and keep friends. They may also perform poorly at school. Children with ODD may act out against other children, parents, teachers, and anyone they see as an authority figure.

If your kid has both ADHD and ODD, it’s possible they have some or all of the symptoms of either disorder. If you’re not sure or you’re confused about what might be going on, talk to your child’s doctor.

What Are the Differences?

The key difference is that with ADHD, your child usually has trouble paying attention and they’re hyperactive. With ODD, your child is defiant, cranky, and angry.

ADHD symptoms tend to show up when your child is 12 or younger. For some, it can start as early as 3 years old. But ODD symptoms show up a lot earlier – usually before they’re 8, and often when they’re toddlers. But your child may also show symptoms when they’re in their teens.

For the most part, ADHD is genetic. That means if your child has ADHD, chances are a close relative has it, too. It’s important to note that poor parenting or too much screen time doesn’t cause ADHD.

But experts believe ODD happens because of developmental issues or that it can be a learned attitude. This means your child may have ODD because they mirror negative behaviors such as inconsistent or harsh disciplining from authority figures like parents and teachers. They may do this to get attention or a reaction from you.

Your child may also be more likely to have ODD if they have a chaotic family life and a family history of mental disorders and substance abuse.

Can You Have ADHD and ODD Together?

Yes. Whether your child has ADHD or ODD, it’s common to have the other condition at the same time. While experts aren’t sure why this happens, they note that if your child has ADHD, it makes their ODD symptoms worse, and vice versa.

This is because when ODD symptoms like defiance and aggressive behavior are mixed with ADHD issues like lack of focus, impulsivity, and hyperactivity, the behaviors can build on one another and become potent. If your child has both conditions, they might also be harder to treat. But if you address the symptoms as soon as possible, it can lead to better outcomes in the long run.

What Causes You to Have ADHD and ODD Together?

Experts aren’t sure why the two conditions are so often linked. But they have certain common risk factors such as:

  • Genetics
  • Learned behaviors
  • Psychological issues
  • Development issues your child may have when they’re toddlers
  • Problems with home life

How Are ADHD and ODD Diagnosed?

There’s no specific test to diagnose both ADHD and ODD. But if your child displays symptoms from both conditions for more than 6 months, talk to their doctor about it.

They will run lab tests and blood tests, and do a detailed medical exam to rule out any medical illness, injury, or medication side effects. If the doctor isn’t able to find a physical cause for your child’s symptoms, they may refer your child to a licensed mental health professional such as a psychiatrist or psychologist. These health care professionals are specially trained to diagnose and treat mental health issues in children and teens.

They may use special interviews and questionnaires to observe and evaluate your child’s overall behavior and attitude. You or other authority figures in your child’s life, such as teachers or coaches, may also need to give a report of anything you’ve noticed. This can help experts provide an accurate diagnosis.

ADHD and ODD: Treatment Options

If your child has been diagnosed with both ADHD and ODD, you’re no longer treating only one problem. The doctor may recommend treatment as early as possible and suggest multiple approaches. This may include:

Parent training. This is where you’re taught how to strengthen your relationship with your child, and learn helpful ways to manage their behavior. This is usually the first line of treatment. This may include:

  • Positive reinforcement methods
  • When to ignore your child’s demands or behaviors
  • How to use rewards effectively
  • Appropriate methods for timeout or punishments

You may notice your child’s behavior improving within 3-6 years after you start these.

Collaborative problem solving (CPS). This helps children with ADHD and ODD learn how to be more flexible, handle frustration, and adapt more easily. Through CPS, you and your child can learn to come up with solutions or negotiate decisions that both of you agree on. This can help solve conflicts and ease difficult behaviors.

Family therapy. When your child has both ADHD and ODD, it can affect your entire family. Going to therapy together can help everyone cope with the realities of raising a child with developmental issues, and work together to find solutions.

Behavioral support at school. Schools may offer collaborative programs to provide behavioral support for your kid. This can include:

  • Clear and consistent rules and consequences for inappropriate behaviors
  • Positive rewards for good behavior
  • A collaborative approach between teachers, school staff, and parents, especially if your child has severe behavioral issues

One-on-one tutoring. Research shows one-on-one tutoring over classroom learning can help lessen ADHD and ODD symptoms.

Medication. Studies show that ADHD medications, often known as psychostimulants, are effective at treating both ADHD and ODD symptoms, especially when they occur together. They can help your child become more attentive and less antisocial and aggressive.

Medications are not a cure, but they can help improve your child’s day-to-day life. Experts have found that a combination of medications used to treat hyperactivity, impulsivity, and behavioral issues are effective in the long run, and that unwanted side effects don’t last too long.

If you notice side effects, let your doctor know.

What’s the Takeaway?

If your child shows symptoms of ADHD and ODD, early medical help is key. Don’t wait to get help, or to start your child on the therapy or medications their doctor recommends. Getting help early is essential for the happiness and well-being of your entire household.

Both conditions can last well into adulthood, but treatment may help ease some of the symptoms and help your child manage them, too. Educate yourself as much as possible. This can help you learn tips and tricks to improve your child’s life as well as your relationship with them.

If you feel overwhelmed, reach out to a support group. This way, you can connect with other parents or caregivers of children with ADHD and ODD who have similar experiences. They can lend a sense of community.

Show Sources

SOURCES:

ADHD: “Comorbidity in Children and Adolescents with ADHD.”

American Academy of Family Physicians: “Common Questions About Oppositional Defiant Disorder.”

CDC: “Other Concerns and Conditions with ADHD.”

Children and Adults with Attention-Deficit/Hyperactivity Disorder: “What to Do When ADHD and ODD Co-Occur,” “ADHD and Disruptive Behavior Disorders,” “Grow Out of ADHD? Not Likely.”

Child and Adolescent Psychiatry and Mental Health: “ADHD characteristics: I. Concurrent co-morbidity patterns in children & adolescents.”

Child Mind Institute: “What Is Oppositional Defiant Disorder?”

Cleveland Clinic: “Oppositional Defiant Disorder,” “Attention-Deficit/Hyperactivity Disorder (ADHD).”

Clinical Child and Family Psychology Review: “Antisocial Behavior, Psychopathic Features and Abnormalities in Reward and Punishment Processing in Youth.”

Johns Hopkins Medicine: “Oppositional Defiant Disorder (ODD) in Children,” “Oppositional Behavior in the ADHD Patient.”

Mayo Clinic: “Attention-deficit/hyperactivity disorder (ADHD) in children.”

National Health Service (U.K.): “Attention deficit hyperactivity disorder (ADHD).”

ScienceDirect: “Externalizing Disorder.”

University of Massachusetts Amherst: “Early Development of ADHD and ODD Symptoms From the Toddler to Preschool Years.”

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