Is There a Connection Between ADHD and ODD?

By Cindy Goldrich, Ed.M., ACAC February 29, 2016

A mental health counselor and board-certified ADHD coach explains the correlation between attention-deficit/hyperactivity disorder and oppositional defiant disorder.

The core components of attention-deficit/hyperactivity disorder are inattentiveness, hyperactivity, and impulsivity. Yet, very often I receive calls from parents who are confused and concerned that the behavior of their child, who is diagnosed with ADHD, is becoming combative and rebellious.

Oppositional defiant disorder (ODD) is characterized by excessive anger, frustration, arguing, stubbornness, and defiance. The correlation rate for a child being diagnosed with both ADHD and ODD is staggering, ranging between 60-80 percent. It is the most common co-existing condition associated with ADHD, and people with ADHD are 11 times more likely to be diagnosed with ODD than the general population.

Is there a connection between ADHD and the development of oppositional behavior?

There absolutely is a link between being diagnosed with ADHD and developing ODD, according to Russell Barkley, Ph.D., clinical professor of psychiatry at the Medical University of South Carolina and world-renowned clinical scientist and researcher in the field of ADHD. In fact, Dr. Barkley believes that if a child is diagnosed with ADHD, she will have a propensity for developing ODD from the start.

Why? He believes that ADHD involves one more vital component that has been left out of the clinical diagnosis for ADHD: emotional dysregulation, or difficulty in inhibiting and regulating emotions.

What does this mean for parenting a child with ADHD?

First and foremost, as I always say, you must parent the child you have. If your child is having difficulty managing his emotions, you must understand, without judgment, that emotional dysregulation is an inherent part of his diagnosis. “The single biggest predictor of social rejection among children and adults with ADHD is not distractibility, inattentiveness, not completing their goals, [nor] their hyperactivity,” Dr. Barkley states. “It is their inability to regulate their frustration, impatience, hostility, and anger.”

In addition to helping children learn to regulate their emotions, there is a second implication in Dr. Barkley’s findings related to the strong link between ADHD and the development of ODD. He states, “The single best predictor of who will develop diagnosable ODD is parenting.”

What does this mean for parents? We must recognize the tremendous stakes involved in how we parent our children with ADHD. ODD has two main components: emotional regulation and social conflict. The social conflict component of ODD has to do with being argumentative, defiant, and stubborn. It seems that the social conflict component is a learned behavior. “The way parents manage the emotional gambits of the child may make the emotions of the child better or worse, and may teach the child that emotions are a tool to use on others. This is known as coercion theory,” Dr. Barkley states.

By being inconsistent in how we react to a child’s emotions and actions, both emotionally and actionably, we leave the door open for children to use negative emotions to coerce others into doing conforming to the child’s desires.

It is not easy parenting a challenging child. Love and logic are not always enough when parenting kids diagnosed with ADHD. Specific education, tips, tools and strategies are extremely valuable. More than with other children, you must gain clarity on your rules and expectations, strengthen your resolve when you are secure in your decisions, and remain consistent in your parenting. This must at all times be adjusted as your child matures and seeks greater need for independence and inclusion in decision-making. Helping your child gain the tools of collaboration and proper decision-making will ultimately help her learn to regulate her emotions more than punishment and restriction will.

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