Diagnosing ODD (Oppositional Defiant Disorder) in a Child With ADHD

Oppositional defiant disorder is one of the most common comorbidities of ADHD.  It occurs in 40% of people diagnosed with ADHD and ADHD occurs in 16-40% of patients with ODD.  While signs often develop in early childhood, it can develop as late as the adolescent years. 

What are the symptoms of ODD?

ODD (Oppositional Defiant Disorder), according to the DSM-5 is “a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting for 6 months or more”.    Examples include: frequent temper tantrums (which should be clearly beyond normal for age), being easily angered or irritated by things that would normally not touch someone else off (sometimes family reports feeling like they are “always walking on eggshells” due to not knowing what will set the patient off next), arguing with authority figures, actively defying rules, and deliberately annoying others.  People with ODD usually do not realize that they have a problem and will blame others for their anger and feelings of resentment.

How is ODD diagnosed?

There are no objective tests available for ODD.  That means, no MRI, EEG, blood test, or x-ray can tell for sure if ODD is present or absent.  However, some of the same questionnaires used to diagnose ADHD (Conners and Vanderbilt) are used to screen for ODD. 

There are many other disorders where a patient might have tantrums, be non-compliant, or show difficulty with anger.     A diagnosing professional will want to know about the following in order to distinguish ODD from other problems such as depression and anxiety:

1)      Is defiance present only in settings where sitting still or paying attention is required?

2)      Is the patient aggressive towards animals or other people?

3)      Does the person deliberately destroy property, steal things, or tell frequent lies?

4)      How severe are the temper tantrums and how frequent are they?

5)      Are there signs that the person may not understand or cannot hear you?

6)      Is there any suspicion that the person is afraid or anxious?  For example, are temper outbursts only around certain predictable issues?

Why is diagnosis important?

ODD can lead to serious complications.  Most patients with ODD go on to develop other problems such as anxiety, depression, and substance abuse.   Violent and criminal behavior can result in children whose ODD continues amid other social stressors such as family hostility and instability.  

Patients who undergo treatment with their families can often avert these disastrous consequences, or at least, they can access help as other issues arise.

References:

Riley, Margaret, Sana Ahmed, and Amy Locke. "Common Questions About Oppositional Defiant Disorder." American Family Physician 93.7 (2016): 586-91. Print.

This article is one in a series about ODD, including: Diagnosis, Treatment, and Prevention

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