Most people experience days where they’re more aggressive than usual — possibly because of a difficult day at school or work, or perhaps they just woke up on the wrong side of the bed. However, those feelings typically disappear after taking time to calm down and re-assess the situation… unless there’s something deeper affecting their mood and demeanor.
For some children and adults, their defiant behaviors cause problems at work, school, and home. If it's persistent, children may be diagnosed with oppositional defiant disorder (ODD); but what about adults?
Can adults have ODD? Let's examine the symptoms and causes of ODD, and determine whether ADHD adults can have the condition.
What is oppositional defiant disorder?
Oppositional defiant disorder (ODD) is a behavioral disorder often found in young children under age 12. Children with ODD tend to be defiant, and frequently express anger and hostility towards loved ones, friends, and authority.
Put simply, ODD is a temperament and behavioral disorder that affects a child's ability to develop healthy relationships with others.1
ODD is a commonly diagnosed behavioral disorder in children. It’s estimated that 1-16% of adolescents will develop ODD,2 with boys diagnosed more commonly than girls. However, this gender imbalance in diagnoses is most likely due to the typical gender differences in ODD presentations, which will be discussed later on.
The transition from childhood to adulthood ODD
ODD arises in early adolescence and lasts anywhere from a few months to an entire lifetime. Before ODD was added to the DSM in 1980*, those displaying ODD symptoms were typically diagnosed with psychiatric conditions like attention-deficit/hyperactivity disorder (ADHD), conduct disorder (CD), depression, or anxiety.
ODD is more commonly found in adults with ADHD as opposed to those without ADHD.
43% of people with ADHD report a childhood history of oppositional defiance.3 Like children, ODD adults display behavioral patterns of aggression, hostility, and defiance towards others.
*when ODD was first added to the DSM III, it was oppositional disorder (OD); in 1987, the DSM III-R was published, where the name of the condition was changed to ODD
What causes Oppositional Defiant Disorder?
Currently, there's no apparent cause of ODD, but research suggests that factors4 such as genetics, biology, environment, and personality can contribute to the development of ODD.
Genetic and biological factors
Genetics plays a significant role in the development of ODD; a parent with ODD has a higher chance of having children with ODD compared to parents without ODD. In addition, family history of behavioral, cognitive, or mood disorders — ADHD, conduct disorder, bipolar disorder, substance use disorders (SUDs) — increases the chances of someone developing ODD.
Traumatic brain injury (TBI)
When a traumatic brain injury occurs, the brain is rattled within the skull, causing permanent damage. The most common cause of TBI is motor vehicle crashes (car accidents). While TBI is its own diagnosis, it's also connected to the development of conditions like ADHD and ODD.5
Environment and upbringing
A child’s home and school environment can also increase susceptibility to ODD.
- Troubled family relationships
- Abuse or neglect by caregiver
- Bullied by peers
- Difficulty making friends
Unconfirmed causes of ODD
Additional possible causes of oppositional defiant disorder include nicotine exposure, as well as a low supply of vitamins in utero during pregnancy. Research has not yet confirmed these possibilities.
What does ODD look like?
ODD presentation varies depending on the individual, but the most common signs of ODD in adults and children include:
Attitude and behavioral traits
- Vindictive behavior
- Frequent tantrums or emotional outbursts
- Refusing to follow rules; testing limits
- Blaming others for inappropriate behavior
- Uncooperative with authority
- Offensive language or behavior in public
- Deliberately ruining personal and professional relationships
- Argumentative with adults
- Difficulty concentrating
- Low frustration tolerance and persistent irritability6
- Repetitive negative thoughts
- Low self-esteem
- Emotional dysregulation
- Substance or alcohol abuse
Gender differences in ODD children and adolescents
In general, boys with ODD are more likely to exhibit typical aggressive behaviors, such as fighting and arguing. Girls tend to forego physical violence and may be more secretive about their behaviors through 'relational aggression'.
Relational aggression is a type of bullying where individuals attempt to cause mental and emotional harm by damaging their target’s reputation, social status, and relationships.7 Unfortunately, it’s often difficult for parents and teachers to detect relational aggression due to the aggressor's concealed behaviors.
How does ODD affect adults with Attention-Deficit/ Hyperactivity Disorder?
ODD is more likely to persist for longer if ADHD is also present,8 likely due to the executive functioning deficits common among ADHDers. These deficits can create challenges with regulating oneself; for example, people with ADHD are often impulsive and commonly struggle with emotional dysregulation.
Put simply, executive dysfunction can prolong ODD symptoms for longer than is usually observed.
Untreated ODD can lead to behavioral, cognitive, and psychosocial effects in ADHD adults,9 which are similar to ODD symptoms in children. When untreated, adults have an increased likelihood of the following:
- Substance and alcohol abuse
- Domestic violence
How is ODD diagnosed?
Currently, there are few resources available for adult ODD diagnostic criteria. However, many tools are accessible to the families of children struggling with ODD.
If a caregiver is concerned about the possibility of oppositional defiance, they can seek various testing methods for a proper diagnosis. For example, an appropriate healthcare provider — therapists, child psychiatrists —may request an interview with the child. Younger children who cannot comprehend interviews are often placed in a playroom, sometimes with family members and/or other children.
There, clinicians observe how the child interacts with others — ultimately watching for signs of ODD.10
Can Oppositional Defiant Disorder be treated or cured?
There are several treatment methods available to children and adults with ODD. A mental health professional can prescribe treatment options that fit the patient’s lifestyle, age, behaviors, and environment.
Therapy for oppositional defiance
- Peer group therapy
- Cognitive behavioral therapy (CBT)
- Family therapy with collaborate problem-solving (CPS) techniques
- Parent-child Interaction therapy (PCIT)
Medication for ODD
Currently, there aren’t any FDA-approved medications for ODD. However, in cases of severe aggression or a comorbid psychological condition (like ADHD) that also needs treatment,11 healthcare professionals may prescribe low doses of:
- Psychostimulants: Adderall, Vyvanse, Ritalin, Concerta
- Antipsychotics: Abilify, Risperdal, Seroquel
- Antidepressants: Zoloft, Lexapro, Wellbutrin, Celexa
Two atypical antipsychotics — aripiprazole (Abilify) and risperidone (Risperdal) — are effective in treating ODD and ADHD. However, benefits may not outweigh negative side effects of the medications.12
Frequently asked questions about ODD and ADHD
Can ADHD cause oppositional defiant disorder (ODD)?
Experts believe that ODD symptoms are tied to ADHD impulsivity, but that’s saying that ADHD directly causes the development of ODD. The truth is, any child can develop ODD; it’s recognized more quickly in ADHD children because it’s a comorbidity that medical professionals have grown to anticipate.13
However, experts believe that children with ODD are more likely to develop a conduct disorder (CD) than children without ODD.8
Does ADHD medication help with ODD symptoms?
ADHD medication is recommended for ODD treatment if the patient has been diagnosed with ADHD. Certain medications — Adderall, Wellbutrin, Ritalin — are often prescribed to children with both ADHD and ODD.
How is ODD different from ADHD?
The main difference between ADHD and ODD is a person’s demeanor and intentions (or lack thereof) for certain behaviors. For example, when someone with ADHD has an emotional outburst, it’s likely due to dysregulated emotional processing.
When someone with ODD has an outburst, it’s more likely to be coupled with intense anger and may have a harmful underlying motive.
What are the symptoms of oppositional defiant disorder in adults?
- Frequently instigating arguments or 'drama'
- Short temper; prone to adult 'temper tantrums'
- Blaming others for their socially unacceptable behavior
- Intentionally using harmful words to upset others
- Physical aggression
- Bullying (physical, emotional, cyber, relational aggression7)
Can someone outgrow oppositional defiant disorder, or is it lifelong?
Children diagnosed with ODD between the ages of three and five are more likely to continue to have ODD symptoms in later childhood, especially in the case of a comorbid ADHD diagnosis later on.14
Unfortunately, there's not enough research available to determine the prevalence of long-term ODD, though anecdotal evidence shows a possibility of lifelong symptoms.