Oppositional Defiant Disorder is a mental disorder characterized by frequent and persistent patterns of angry or irritable moods, argumentative or defiant behavior, and vindictiveness. It can occur in just one setting (most often this is the home), but must occur regularly for at least 6 months with at least one person who isn’t a sibling.
It affects up to half of all children with ADHD — particularly boys.
To meet this diagnosis, the child’s defiance must interfere with their ability to function in school, home, or the community.
Children with ODD tend to act in ways that are stubborn and non-compliant, and may lose their temper, arguing with adults and refusing to obey rules. They may deliberately annoy people, blame others for their mistakes, be resentful, spiteful, or even vengeful.
Conduct disorder is a more serious pattern of antisocial behavior which may eventually develop in 20 to 40 percent of children with ADHD. It is defined as a pattern of behavior in which the rights of others or the social norms are violated. Symptoms include over-aggressive behavior, bullying, physical aggression, cruel behavior toward people and pets, destruction of property, lying, truancy, vandalism, and stealing.
These children are at a high risk of getting into trouble at school or with the police. They are also at high risk for experimenting with drugs, and later dependence and abuse. They need immediate help, otherwise the conduct disorder may develop into antisocial personality disorder.
Anxiety and Depression
Children with ADHD can also struggle with anxiety and/or depression. Treatment for these problems can help the child to handle their ADHD more effectively. This works the other way too – effective treatment of ADHD can reduce the child’s anxiety or depression through improved confidence and ability to concentrate.
Bipolar Disorder & Disruptive Mood Dysregulation Disorder
Because there are some symptoms which can be present both in ADHD and bipolar disorder, it is often difficult to differentiate between the two conditions. For this reason, there are no accurate statistics on how many children with ADHD also have bipolar disorder. In the latest edition of the mental disorder diagnostic reference manual, the DSM-5, children may instead be diagnosed with disruptive mood dysregulation disorder, instead of bipolar disorder.
Bipolar disorder is a condition defined by extreme moods, occurring on a spectrum from debilitating depression to unbridled mania. Between these states, the individual can experience a normal range of moods.
However, bipolar disorder in children often involves a faster cycling of the extreme mood states, even within one hour. Children may also experience the symptoms of mania and depression simultaneously. Experts describe this pattern as a chronic mood dysregulation, including irritability (and is now referred to as disruptive mood dysregulation disorder when diagnosed in children).
The symptoms which can overlap between ADHD and bipolar disorder include high levels of energy and a reduced need for sleep. But elated mood and grandiosity — an inflated sense of superiority — are distinctive signs of bipolar disorder.
Sometimes a child or teen with ADHD may have an inherited neurological disorder called Tourette syndrome. This usually appears in childhood, and is characterized by multiple physical (motor) tics and at least one vocal (phonic) tic. These nervous tics and repetitive mannerisms may include eye blinks, facial twitches, grimacing, clearing the throats frequently, snorting, sniffing, or barking out words. These symptoms can be controlled with medication.
Although this syndrome is rare, it is common for people with Tourette syndrome to have ADHD. Both disorders will require treatment.