40% of children who have an attention deficit hyperactivity disorder (ADHD) diagnosis also develop oppositional defiant disorder (ODD.) Many of these children demonstrate consistently angry, aggressive and disruptive behaviors toward adults such as teachers, parents or other authority figures. ODD is more common in boys prior to puberty age. After puberty, it is equally common in both genders. About 50% of preschoolers diagnosed with ODD will outgrow the problem by the age of eight. Older children diagnosed are less likely to outgrow the disorder. 
A child’s oppositional behaviors are typically not intentional when he has ADHD. Experts believe that ODD is linked to intense impulsivity. When a child is not being able to control impulses, combined with the stress and frustration of trying to manage ADHD symptoms every day, lead some children to lash out, physically and verbally. Every child will act out and test their boundaries with authorities. It may be hard to know whether a child is normally defiant or has ODD. Consult a therapist trained in childhood behavioral problems to assist you with this tricky task. A therapist should also screen for other undercurrent diagnoses like anxiety, depression and bipolar disorder, each of which may cause oppositional behavior. Leaving ODD untreated can evolve into conduct disorder, a more serious behavioral problem.
Treating ODD begins with controlling ADHD symptoms. When a child’s hyperactivity, impulsiveness, and inattention are reduced, there is typically an improvement seen in ODD symptoms. Stimulant medications have been shown to be successful in reducing ADHD symptoms, as well as those of ODD, by up to 50 percent. However, you want to closely monitor your child’s behavioral reactions to such medication as some children with an underlying anxiety disorder can experience an increase in anxiety symptoms. If this occurs, some doctors prescribe non-stimulants to help manage symptoms.
The treatment of choice for ODD is parent-management training. Parents are taught to change their reactions to a child’s behavior, good and bad. Training involves giving well-defined reward and praise when your child cooperate and consequences for misbehavior. Therapists will also work with a parent and child together to strategize specific challenges. ODD experts find the following strategy to be effective for parents managing their child’s opposition. First ask your child calmly to do something. If he does not respond to you in two minutes, gently tell him, “I’m asking you a second time. Do you know what I’m asking you to do and the consequences if you don’t? Please make a smart decision.” If you have to ask a third time, then you give him the pre-arranged consequence, for example no TV or video games for an hour.
It is important to get everyone in your child’s life on the same page. For behavior therapy to work, the child’s parents, grandparents, teachers and anyone else caring for him should use the same discipline strategies that you do. Consistency in the use of the same program you are using is the key to the success of your child. If one of the caregivers gives into your child’s negative behavior, it can undermine the entire discipline program. It is a challenge for a parent to remain calm when a child is verbally abusing them, but do not overreact. Yelling or spanking may worsen a child’s oppositional behaviors. Stay calm and emotionally neutral amid your child’s defiance. Oppositional kids have the ability to pick up adult hostility. If they sense your anger, they are going to match it.
Helping parents learn to praise good behavior is one of the most challenging things therapists face. Many parents are so focused on the bad that they stop reinforcing the positive behaviors. A few tips, specify the praiseworthy behavior, be enthusiastic while not overdoing it, and finish up with a non-verbal gesture like a kiss on the cheek of a hug. The more creative you are with your program of rewards and punishments to your child’s specific abilities and needs, the better. His needs change as he grows. Being creative is important, but consistency is more important to have success. Consistency in the way you treat your child – setting rules, conveying expectations – is the key to managing your child’s ODD. When dealing with angry children, it helps to remember that a lot of misbehavior stems from a strong emotion.
