Does Your Child Have Oppositional Defiant Disorder?

By Dr. Mary Rooney, Ph.D.

Kids with ADHD are often labeled as having “behavior challenges,” which usually means that their behavior is more difficult for teachers, parents, and peers to cope with than it is for kids without ADHD. In reality, not all kids with ADHD have truly challenging behavior. Some kids with primarily inattentive symptoms of ADHD have very few behavior challenges. Their difficulties only show up when they need to follow through on instructions, stay focused on a task, or organize their materials. Kids with ADHD who have hyperactive or impulsive symptoms do display some challenging behaviors at home or at school. These behaviors are primarily related to acting without thinking or struggling to control their overly active bodies. While frustrating, these behaviors don’t often truly cross over into the realm of being oppositional or defiant. When a child with ADHD is regularly oppositional or becomes so defiant that they experience problems in their relationships with family and friends, then ADHD may not be the only culprit. They may also have Oppositional Defiant Disorder (or ODD). In fact, up to 40% of kids with ADHD also meet diagnostic criteria for ODD.    

What is ODD?
ODD is characterized by a persistent angry and irritable mood, behaving in ways that are spiteful or vindictive, and argumentative and defiant behavior that often includes lashing out at others, blaming others for their own mistakes, deliberately annoying other people, and refusing to follow instructions from adults. These symptoms represent a persistent pattern of behavior in kids with ODD and aren’t something that only show up occasionally when they are tired or have had a bad day. Unlike ADHD, which causes challenges at home and at school, ODD may only be a problem in one of these settings. For example, it’s not uncommon for kids with ODD to display symptoms at home, but not at school.

How is ODD Diagnosed?
Like ADHD, ODD can only be diagnosed by a licensed clinical psychologist or medical doctor (usually a psychiatrist or a pediatrician). Making a diagnosis of ODD can be difficult in some cases, because symptoms of depression, anxiety, or trauma can lead to similar oppositional behavior in kids. So it’s important that the provider evaluate a child’s complete history and symptom profile before making a diagnosis.

How is ODD Treated?
Treatment for ODD is typically focused on behavioral interventions. Medication can be helpful if poor impulse control or other symptoms related to ADHD or a mood disorder are contributing to the oppositional behavior.  One of the most effective behavioral interventions for ODD is Parent Child Interaction Therapy (or PCIT). Typically used with kids between the ages of 3-6 years old, PCIT involves therapy sessions that include live coaching which walks parents through the use of effective behavior strategies focused both on child-directed interactions (where the child takes the lead and the parent follows) and parent-directed interactions (where the parent gives instructions and the child follows). Many parents who participate in PCIT find that it truly transforms their relationship with their child. Some practitioners have also adapted PCIT for use with children over the age of 6. In addition to PCIT, behavioral parent training, similar to the behavioral parent training used for ADHD, has been found to help with ODD and can be used with kids of all ages. Collaborative Problem Solving, where kids and parents learn specific strategies that can be applied to solving problems that come up in daily life, can also be effective.

What should you do if you suspect that your child may have ODD?
If you suspect that your child may have ODD, reach out to your child’s pediatrician or therapist as soon as possible and request a referral for a full evaluation. Like many mental health challenges, the sooner you begin treating ODD, the better the long-term prognosis for your child.



Mary Rooney, Ph.D., is a licensed clinical psychologist in the Department of Psychiatry at the University of California San Francisco. Dr Rooney is a researcher and clinician specializing in the evaluation and treatment of ADHD and co-occurring behavioral, anxiety, and mood disorders. A strong advocate for those with attention and behavior problems, Dr. Rooney is committed to developing and providing comprehensive, cutting edge treatments tailored to meet the unique needs of each child and adolescent. Dr. Rooney's clinical interventions and research avenues emphasize working closely with parents and teachers to create supportive, structured home and school environments that enable children and adolescents to reach their full potential. In addition, Dr. Rooney serves as a consultant and ADHD expert to Huntington Learning Centers.


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This website does not provide medical advice, diagnosis, or treatment. The material on this site is provided for educational purposes only.

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