OPPOSITIONAL DEFIANT DISORDER
Many people assume that children with ADHD are destined for an adolescence of delinquency, promiscuity, and substance abuse. To the contrary, numerous researchers have shown that children with ADHD are no more likely to defy authority or to become delinquents than is the general population of children.
The DSM-IV draws a distinction between ADHD and a separate disruptive behavioral disorder known as Oppositional Defiant Disorder. ODD is defined as:
A pattern of negativistic, hostile, and defiant behavior, during which four (or more) of the following are present:
1. Often loses temper
2. Often argues with adults
3. Often actively defies or refuses to comply with adults' requests or rules
4. Often deliberately annoys people
5. Often blames others for his or her mistakes or misbehavior
6. Is often touchy or easily annoyed by others
7. Is often angry and resentful
8. Is often spiteful or vindictive
Most clinicians feel that ODD does not occur in isolation, but always accompanies another, usually longstanding, condition affecting interpersonal relations (in children, usually ADHD or Dysthymia). However, ODD is not an inevitable outgrowth of having ADHD or Dysthymia; rather, it is a comorbid disorder that may or may not develop in children with these conditions.
All of us have children in our practice who clearly do have both ADHD and ODD. These children can be unpleasant and frustrating. It is important to remember that all patients with ADHD are not oppositional or defiant. Barkley and others have closely examined the question of why some children with ADHD exhibit ODD and some do not. The key seems to be the health of the family environment. Children with ADHD who have stable, supportive families are less likely to develop ODD; children from chaotic, inconsistent, or otherwise disruptive homes frequently do.
Stimulant medications are only partially successful in treating ODD. They often ameliorate the impulsive component of ODD, but do not address these children's interpersonal deficits. Physicians should know that ODD is frequently amenable to psychotherapy (specifically, a combination of behavior management and parenting counseling), especially in younger children.
