Defiant behavior may manifest as a child easily (and frequently) losing their temper, arguing with adults because of rules, or acting out violently. Reports suggest that 40% of children with ADHD experience oppositional and/or defiant behavior. ¹

[Free Download: Why Is My Child So Defiant?]

Behavioral disorders may stem from the deficits in executive functioning so commonly seen in ADHD, which can affect individuals’ abilities to plan, prioritize, and execute. All of this impacts the individual’s life — and the lives of those around them.

Family dynamics may be caught in the crossfire as children get frustrated with their caregivers, and caregivers tire of scaffolding a routine of daily tasks that their kids have difficulty sticking to, leading to nagging, frustration, and defiant behavior.

[Free Resource: Is It More Than Just ADHD?]

Studies suggest that some parenting techniques are more effective than others in addressing defiant behavior among children with ADHD, specifically. Such techniques can be especially useful in helping parents establish routines with their children.

Prescription ADHD medication used in conjunction with behavioral parent training helps many families learn how to best stem and respond to defiant behavior, as outlined in the ADDitude article, “ Why Is My Child So Angry and Defiant? An Overview of Oppositional Defiant Disorder” and in the recent webinar, “The Power of Behavioral Parent Training .”

In a recent survey, ADDitude asked its readers whether their children with ADHD displayed defiant behaviors and, if so, how those behaviors affected family dynamics. Several respondents said have felt a significant impacted and that they are struggling to develop productive and healthy responses.

Life with My Defiant Child

“Everyday, every request is a battle. A simple request such as, ‘Please brush your teeth’ or ‘Let’s finish your homework,’ turns into a fight. We are all on edge and really dread homework time, dinner time, and bedtime.”

“Having a child with ADHD often comes with some oppositional defiance challenges. Things can be going smoothly, and then, out of nowhere, something that seems minor to you can trigger a reaction, setting off a chain of events.”

“It takes a lot of mental energy to get through the days, especially when you also have ADHD and the emotional dysregulation is tough. Your other kids suffer because you are always focused on getting the child with ADHD through the day. My daughter is nearly 18, and I think we are slowly coming out the other side. It isn’t a straight path, and we have tried many different things — different schools, sports, medication, psychiatrists, psychologists. I think you just have to hold on for the ride and get through each day.”

“It is so hard. No matter what we do, our daughter pushes us away and refuses to do simple necessary activities, like brushing her teeth and getting dressed. She’s 8 years old, and I wonder if this behavior is ever going to end. It is very taxing when everyone else is ready, and we still have a defiant child refusing to get ready.”

Parenting Techniques to Address Defiant Behavior

“Both of my ADHD kids appear defiant when they are anxious and trying to control the situation, or when they feel overwhelmed. In those circumstances, they return a reflexive ‘no’ to every question before they have the chance to think about it. This has impacted our lives far less since we learned to slow down and figure out what is happening in their heads rather than let the behavior shake us.”

“Telling them to do something will never result in it getting done. You need to gently ask and convince them to do it.”

“Almost every time I ask my son to do something, even if it is something he likes or a simple request, he instinctively says no. It took a while, but I realized I could wait a few minutes for him to actually process what I said, and then gently repeat my request. He would usually have no problem complying once given the time to mentally process and transition. This break means he can communicate his thoughts, and we can discuss with cool heads.”

“My daughter has a history of oppositional defiance since a young age. It often looks like her needing to do something opposite of what we ask for the sake of being opposite. With the help of a child psychologist, we’ve worked hard as a parenting team to praise/reinforce following rules, and this has worked well to stem this behavior.”

My Defiant Child: Next Steps

• Read: “The Parents’ Guide to Dismantling Oppositional, Defiant Behavior“
• Watch: ““From Battles to Bonding: A Parent’s Guide to Trading Defiance for Cooperation“
• Free Download: “Why Is My Child So Defiant?“

Sources

¹ Riley M, Ahmed S, Locke A. “Common Questions About Oppositional Defiant Disorder.” American Family Physician (Apr. 2016). https://www.ncbi.nlm.nih.gov/pubmed/27035043

Children and adolescents with avoidant restrictive food intake disorder (ARFID) are more likely to have comorbid neurodevelopmental and psychiatric disorders like autism, ADHD, and anxiety, according to a new study¹ published in The Journal of Child Psychology and Psychiatry.

Among the 30,795 children included in the large-scale study, those with ARFID (n=616) were 14 times more likely to have autism and nine times more likely to have ADHD than were children without ARFID. They also demonstrated an increased risk for OCD, separation anxiety, generalized anxiety disorder (GAD), depression, learning disorders, conduct disorder, and more.

These results stand out amid the relatively scarce research data on ARFID, an eating disorder added to the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5) in 2013.

“This study is one of the few large-scale epidemiological investigations of ARFID comorbidities in a general population sample,” the researchers wrote. “The findings emphasize the importance of incorporating routine screening for neurodevelopmental disorders, anxiety, and depression into ARFID assessments.”

Individuals with ARFID avoid foods based on sensory characteristics, a lack of interest in eating, and/or fear-related concerns over adverse eating experiences — not due to the body image concerns that compel other eating disorders like anorexia nervosa. ARFID is characterized by a “failure to meet appropriate nutritional and/or energy needs.”

Despite affecting 1-2% of children and adolescents², ARFID is often excluded from eating disorder discourse and clinical examinations. ARFID’s high comorbidity can complicate symptom identification, according to researchers.

“It’s important to really think about those with ADHD being at risk for a variety of eating disorder thoughts and behaviors, not just binge eating,” said Christine Peat, Ph.D., in a 2024 ADDitude webinar, “Eating Disorders Comorbid with ADHD: What You Need to Know About ARFID, Anorexia, and Others.” “In clinical contexts, ARFID and atypical anorexia nervosa may be overlooked, even in very routine eating disorder screenings.”

The study’s results emphasize the importance of identifying ARFID, the diagnosis of which may shed light on comorbidities.

“Early identification of these comorbidities can facilitate timely, targeted interventions and improve treatment outcomes,” the researchers wrote.

One ADDitude reader, Tiffany Bird, suffered decades of poor health before being diagnosed with ARFID in her late 20s. “For the first time, a doctor fully examined me and determined that I’ve been severely malnourished my entire life, no matter what ‘the numbers’ might have said. It made complete sense,” wrote Bird in an ADDitude guest blog post, “I went Over 25 Years Without Consuming a Vegetable.”

ARFID and Neurodevelopment Disorders

The study examined parent reports for 30,795 children born between 1992 and 2008, at 9 or 12 years old (depending on their cohort), from the Child and Adolescent Twin Study in Sweden. The parents rated their child using three measures of neurodevelopmental and psychiatric disorders: the A-TAC inventory, the Screen for Child Anxiety Related Emotional Disorders (SCARED), and the Short Mood and Feelings Questionnaire (SMFQ). The researchers examined the relationship between having ARFID and showing symptoms of other disorders using linear and logistic regressions.

The link between ADHD and ARFID found in the study reflects preliminary research in this area. According to Peat, one study found that 25% of adults with ARFID also had ADHD, and another reported that 10% of children and adolescents with ARFID had been diagnosed with ADHD at some point in their lives.

“We are so far from having causal explanations for this overlap,” Peat said. “But maybe kids and adults with ADHD are just sort of more biologically predisposed to have difficulty with sensory characteristics with food, so maybe that makes them more vulnerable to going on to develop something like ARFID.”

The study’s results regarding autism and ARFID also mirror prior research. One meta-analysis reported that autism was present in 16% of individuals with ARFID³.

People with ARFID are more likely to have autism than those without, and vice versa, possibly due to heightened sensory issues and inflexibility due to anxiety around change, both symptoms of autism, according to an article in ARFID Awareness UK.

ARFID and Psychiatric Disorders

According to the study, children with ARFID were four to six times more likely to have a psychiatric disorder, with OCD and anxiety presenting the greatest risks.

The most common type of anxiety found in the study was separation anxiety, which contrasts previous research that found GAD to be more common. This could be because of the younger age of onset characteristic of separation anxiety or younger age of the sample, the researchers wrote. However, they also hypothesize another reason their results differed.

“One hypothesis worth exploring is that separation anxiety is increased in ARFID because children fear separation from caregivers due to the potential for unanticipated exposure to feared foods or feeding-related situations,” the researchers wrote.

The study also found a higher rate of oppositional defiant disorder (ODD) (19.4%) than reported in previous studies, suggesting a possible overlap of symptoms between the two disorders.

“Our findings suggest that food-related conflicts may underlie the observed risk of ODD in ARFID, but further research is needed to confirm this association,” the researchers wrote.

Children with ARFID were found to face a higher risk for anxiety than depression. Depression is common among children with other eating disorders, according to the researchers. This discrepancy in comorbidities highlights the differences between ARFID and other eating disorders.

“The defining feature [of ARFID] is a persistent and pervasive eating or feeding disturbance in which someone is simply not meeting all of their nutritional needs,” Peat said. “In ARFID, these people don’t necessarily have that fear of fat or fear of weight gain.”

Gender and ARFID

Prior research may suggest that ARFID is more common in young males. However, this study found no gender-based differences in comorbidity rates associated with ARFID, meaning that the likelihood of having symptoms of another disorder in conjunction with ARFID did not significantly differ based on sex.

The results did indicate that, overall, boys had higher odds of developing a neurodevelopmental disorder, depression, and sleep problems; girls had higher rates of anxiety disorders (except for panic disorder).

“Unlike other eating disorders, the distribution of males and females with ARFID has been reported to be approximately equal,” the researchers wrote. “Given the sex differences observed in the prevalence of (neurodevelopmental disorders) and psychiatric conditions, it is important to investigate whether these sex differences are also present in individuals with ARFID.”

The study’s sample did not include transgender and nonbinary youth, a major limitation considering that transgender, nonbinary, and gender-expansive kids are at higher risk for eating disorders compared with their cisgender peers.

“There remains an urgent need to develop integrated treatment approaches that address both ARFID and its co-occurring conditions,” the researchers wrote.

Sources

¹ Nyholmer, M., Wronski, M.-L., Hog, L., Kuja-Halkola, R., Lichtenstein, P., Lundström, S., Larsson, H., Taylor, M.J., Bulik, C.M. and Dinkler, L. (2025), Neurodevelopmental and psychiatric conditions in 600 Swedish children with the avoidant/restrictive food intake disorder phenotype. J Child Psychol Psychiatr. https://doi.org/10.1111/jcpp.14134

² D’Adamo, L., Smolar, L., Balantekin, K.N., Taylor, C.B., Wilfley, D.E., & Fitzsimmons-Craft, E.E. (2023). Prevalence, characteristics, and correlates of probable avoidant/restrictive food intake disorder among adult respondents to the National Eating Disorders Association online screen: A cross-sectional study. Journal of Eating Disorders, 11, 214. https://doi.org/10.1186/s40337-023-00939-0

³ Sader M, Weston A, Buchan K, Kerr-Gaffney J, Gillespie-Smith K, Sharpe H, Duffy F. (2025) The Co-Occurrence of Autism and Avoidant/Restrictive Food Intake Disorder (ARFID): A Prevalence-Based Meta-Analysis. Int J Eat Disord. 58(3):473-488. https://doi.org/10.1002/eat.24369

Family life brings smiles and struggles, but when persistent tantrums, resistance, or negativity dominate, they can strain relationships and household harmony. In this transformative webinar, psychologist Jeffrey Bernstein, Ph.D., shares a proven program to help caregivers reduce conflict and eliminate disruptive behaviors in children, teens, and even struggling adult children.

This webinar explores the underlying causes of oppositional defiance, offering practical tools to restore peace and connection. Moving from battles to bonding will empower you to put those fruitless power struggles behind you by turning emotional reactivity into opportunities for connection and cooperation.

Critical handouts will be included for registrants in this webinar to help caregivers learn the strategies that prevent emotionally dysregulated children from becoming defiant.

In this webinar, you will learn:

• How to foster empathy by building stronger connections with children through understanding and compassion
• How to regulate your emotions and model calm responses for your child
• About the power of emotion regulation coaching to transform resistance into collaboration
• How to navigate parenting in an era of heightened anxieties and societal challenges
• About cooperative, connection-building games to foster trust, communication, and teamwork

Watch the Video Replay

Enter your email address in the box above labeled “Video Replay + Slide Access” to watch the video replay (closed captions available) and download the slide presentation.

Download or Stream the Podcast Audio

Click the play button below to listen to this episode directly in your browser, click the symbol to download to listen later, or open in your podcasts app: Apple Podcasts; Audacy; Spotify; Amazon Music; iHeartRADIO

Defusing Defiance in Children with ADHD: More Resources

• Download: 10 Rules for Parents of Defiant Kids with ADHD
• Sign Up: The ADHD Parenting Class
• Read: The Facts About ADHD vs. ODD
• Read: Two Families’ Stories of Oppositional Defiant Disorder
• eBook: The ADHD Positive Parenting Guide

Obtain a Certificate of Attendance

If you attended the live webinar on January 16, 2025, watched the video replay, or listened to the podcast, you may purchase a certificate of attendance option (cost: $10). Note: ADDitude does not offer CEU credits. Click here to purchase the certificate of attendance option »

Meet the Expert Speaker

Dr. Jeffrey Bernstein is a psychologist with more than 34 years of experience specializing in child, adolescent, couples, and family therapy. He completed his post-doctoral internship at the University of Pennsylvania Counseling Center and holds a Ph.D. in Counseling Psychology from the State University of New York at Albany. He has appeared on the Today Show, Court TV as an expert advisor, and CBS Eyewitness News Philadelphia, 10! Philadelphia — NBC and public radio.

Dr. Bernstein has authored several books, including The Anxiety, Depression, & Anger Toolbox for Teens, The Stress Survival Guide for Teens, Mindfulness for Teen Worry, 10 Days to a Less Defiant Child, 10 Days to Less Distracted Child, Liking the Child You Love, and Why Can’t You Read My Mind? He has also published the Letting Go of Anger Therapeutic Card Deck.

#CommissionsEarned As an Amazon Associate, ADDitude earns a commission from qualifying purchases made by ADDitude readers on the affiliate links we share. However, all products linked in the ADDitude Store have been independently selected by our editors and/or recommended by our readers. Prices are accurate and items in stock as of time of publication.

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The sponsor of this ADDitude webinar is…

Brain Balance helps kids, teens and adults with ADHD, learning differences, anxiety & more through our integrative cognitive development and brain wellness program. Our approach combines cognitive, physical and sensory training with nutritional guidance to strengthen and build brain connectivity without the use of medication. Stronger connections translate to improved attention, behaviors, and social-emotional well-being. | brainbalancecenters.com/additudemag

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Adolescents exhibiting comorbid ADHD and ODD (oppositional defiant disorder) symptoms face higher unemployment rates, sick days, and lower incomes in adulthood than do their neurotypical peers, suggests new research from Finland. ¹

The longitudinal study, published in the Journal of Attention Disorders, identified 6,985 participants (aged 15 to 16) from the Northern Finland Birth Cohort 1986. ² The researchers sorted participants into groups based on symptom presentation — ADHD, ODD, comorbid ADHD and ODD, or the control group. Researchers analyzed sick and unemployed days from 2006 to 2010 (when participants were 20 to 24 years old) and from 2011 to 2019 (when participants were 25 to 33).

Between the ages of 25 and 33, males from all symptomatic groups experienced more unemployment and sick days than did their neurotypical peers, but those symptoms did not directly impact their income levels. During the same age range, females with symptoms of ADHD and comorbid ADHD and ODD reported higher rates of unemployment. However, the study found that younger females (between the ages of 20 and 24) among all symptomatic groups were likelier to report sick days than the controls. (The study did not include participants identified as non-binary or transgender.)

The researchers pointed to previous studies suggesting that “symptoms of ODD and ADHD are associated with substance use disorder, different types of injuries, and an increased risk of undergoing psychiatric hospitalization during one’s life” as likely causes of increased sick leave from work. ³, ⁴, ⁵

The ADHD-ODD Link

ODD is highly comorbid with ADHD. Studies estimate that ODD co-occurs with ADHD in approximately 50% to 60% of population-based samples. ⁶, ⁷

“Oppositional defiant disorder is characterized by persistent patterns of anger and irritability, argumentative behaviors, and vindictiveness toward others,” said William Dodson, M.D., LF-APA, during the 2021 ADDitude webinar, “How Oppositional Defiant Disorder Ruptures Families — and How You Can Learn to Manage It.” “ODD is listed as a childhood disorder, but it commonly persists into adult life and continues to be highly impairing with symptoms impacting a person’s functioning and causing significant distress to family, friends, and educators.”

Income Disparities

The study also identified income disparities among the study participants. Male and female participants with comorbid ADHD and ODD consistently had lower annual incomes compared to all other symptomatic groups. Interestingly, participants with ADHD reportedly earned more than the control group between the ages of 20 and 24. Those results flipped by age 30.

“Young adults with ADHD symptoms tend to enter the labor market more quickly than their peers without ADHD symptoms, potentially explaining these results,” the researchers wrote. “Individuals without ADHD typically delay entering the workforce at 20 years of age, as they often pursue higher education.”

The results of a 2020 ADDitude survey of nearly 1,450 adults with ADHD painted a slightly different picture. Almost one-third of respondents had an annual household income of $100,000 or higher, and more than half exceeded the U.S. median income ($74,580 in 2022). Though some studies do indicate that young adults with ADHD are less likely to enroll in college, 72% of respondents completed an undergraduate degree, and more than one-third have an advanced degree.

To the researchers’ knowledge, this was the first study underscoring the importance of early recognition of ADHD and oppositional defiant disorder symptoms due to their long-term impact on employment and income in adulthood.

Many ADDitude readers said in a recent survey that they relate to the study’s results.

“I spent a lifetime failing at every job I ever tried,” said Lester, from Idaho. “I was either fired, lost interest, or was injured and had to quit.”

“I am currently unemployed and looking for gainful employment,” said Lindsey, from Indiana. “I’m a single mom with ADHD, and my kids have it, too. I had to work part-time and stay home with my kids for a few years. Now it’s harder than ever to get hired since I took time off.”

Natalie, from Texas, said, “I have had a hard time holding down a job due to my inconsistent attendance and performance. I have been driving for Uber and Lyft for the last few years. It worked out on the first year, but now I’m drowning because I have zero motivation.”

Accommodating ADHD and ODD in the Workplace

Early diagnosis and treatment of ADHD and ODD symptoms during adolescence may improve employment prospects and financial stability later in life.

It also helps when employers foster more inclusive and supportive workplace environments.

“There is plenty that companies can do right now — from shifting perspectives to changing workplace policies — to support neurodivergent employees and those with invisible differences,” said Jessica Hicksted, Ph.D., said during the 2023 ADDitude webinar “Invisible’ Disabilities at Work: How to Foster Neurodivergent Advocacy and Acceptance.”

“All employees benefit when a company embraces multiple methods and processes for getting things done,” she continued. “Whether it’s allowing employee-set schedules, remote work, or non-disruptive changes to the office environment, flexibility can make or break an employee’s experience. A company culture built on flexibility can allow neurodivergent employees to really shine and get work done without battling standards that don’t consider the non-neurotypical experience.”

Sources

¹ Seppä, S., Huikari, S., Korhonen, M., Nordström, T., Hurtig, T., & Halt, A.-H. (2024). Associations of Symptoms of ADHD and Oppositional Defiant Disorder (ODD) in Adolescence With Occupational Outcomes and Incomes in Adulthood. Journal of Attention Disorders, 28(10), 1392-1405. https://doi.org/10.1177/10870547241259329

² Miettunen, J., Haapea, M., Björnholm, L., Huhtaniska, S., Juola, T., Kinnunen, L., Nordström, T. (2019). Psychiatric Research in the Northern Finland Birth Cohort 1986 – A Systematic Review. International Journal of Circumpolar Health, 78(1). https://doi.org/10.1080/22423982.2019.1571382

³ Hurtig, T., Ebeling, H., Jokelainen, J., Koivumaa-Honkanen, H., Taanila, A. (2016). The Association Between Hospital-Treated Injuries and ADHD Symptoms in Childhood and Adolescence: A Follow-Up Study in the Northern Finland Birth Cohort 1986. Journal of Attention Disorders, 20(1), 3–10. https://doi.org/10.1177/1087054713486699

⁴ Mustonen, A., Rodriguez, A., Scott, J. G., Vuori, M., Hurtig, T., Halt, A. H., Miettunen, J., Alakokkare, A. E., Niemelä, S. (2023). Attention Deficit Hyperactivity and Oppositional Defiant Disorder Symptoms in Adolescence and Risk of Substance Use Disorders: A General Population-Based Birth Cohort Study. Acta Psychiatrica Scandinavica, 148(3), 277–287. https://doi.org/10.1111/acps.13588

⁵ Nordström, T., Hurtig, T., Moilanen, I., Taanila, A., Ebeling, H. (2013). Disruptive Behaviour Disorder with and Without Attention Deficit Hyperactivity Disorder Is a Risk of Psychiatric Hospitalization. Acta Paediatrica, International Journal of Paediatrics, 102(11), 1100–1103. https://doi.org/10.1111/apa.12383

⁶ Kessler, R. C., Adler, L. A., Berglund, P., Green, J.G., McLaughlin, K. A., Fayyad, J., Russo, L. J., Sampson, N. A., Shahly, V., Zaslavsky, A. M. (2014). The Effects of Temporally Secondary Co-Morbid Mental Disorders on the Associations of DSM-IV ADHD with Adverse Outcomes in the U.S. National Comorbidity Survey Replication Adolescent Supplement (NCS-A). Psychological Medicine, 44(8), 1779–1792. https://doi.org/10.1017/S0033291713002419

⁷ Reale, L., Bartoli, B., Cartabia, M., Zanetti, M., Costantino, M. A., Canevini, M. P., Termine, C., Bonati M. (2017). Comorbidity Prevalence and Treatment Outcome in Children and Adolescents with ADHD. European Child & Adolescent Psychiatry, 26(12), 1443–1457. https://doi.org/10.1007/s00787-017-1005-z

⁸ Kuriyan, A. B., Pelham, W. E., Jr, Molina, B. S., Waschbusch, D. A., Gnagy, E. M., Sibley, M. H., Babinski, D. E., Walther, C., Cheong, J., Yu, J., & Kent, K. M. (2013). Young Adult Educational and Vocational Outcomes of Children Diagnosed with ADHD. Journal of Abnormal Child Psychology, 41(1), 27–41. https://doi.org/10.1007/s10802-012-9658-z

Children who are quick to anger and lash out are sometimes labeled as oppositional or defiant. According to the Collaborative & Proactive Solutions (CPS) model, those concerning behaviors are best viewed as frustration responses that communicate a child is having difficulty meeting a particular expectation. In the CPS model, those expectations are called unsolved problems. Whether it’s completing chores or homework, ending video game time, or sitting at the dinner table, those problems will remain unsolved as long as caregivers use incentives and consequences to motivate adaptive behavior. Rewards and punishments don’t solve problems. What’s causing a child to be frustrated in the first place is where parents should focus.

This webinar will introduce the CPS model, and collaborative and proactive problem-solving strategies. This three-step roadmap empowers caregivers to approach a child’s concerning behavior with new understanding and new practices. Caregivers will learn:

• Why some children are more prone to act out
• About the situations that often drive children to exhibit concerning behavior
• How to be truly proactive rather than reactive
• Why rewards and punishments fail to inspire change
• The three steps involved in solving problems collaboratively and proactively

Watch the Video Replay

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Download or Stream the Podcast Audio

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PDA and ODD: More Resources

• Download: 10 Rules for Ending Confrontation & Defiance
• Read: The Facts About ODD and Attention Deficit
• Read: Back From the Brink: Two Families’ Stories of Oppositional Defiant Disorder
• eBook: The Parent’s Guide to ADHD Discipline

Obtain a Certificate of Attendance

If you attended the live webinar on July 31, 2024, watched the video replay, or listened to the podcast, you may purchase a certificate of attendance option (cost: $10). Note: ADDitude does not offer CEU credits. Click here to purchase the certificate of attendance option »

Meet the Expert Speaker

Ross W. Greene, Ph.D., is a clinical psychologist and the originator of the innovative, evidence-based approach called Collaborative & Proactive Solutions (CPS), as described in his influential books The Explosive Child, Lost at School, Lost & Found, and Raising Human Beings.

He also developed and executive produced the award-winning documentary film The Kids We Lose, released in 2018. Dr. Greene was on the faculty at Harvard Medical School for more than 20 years, and he is now founding director of the non-profit Lives in the Balance. He is also currently an adjunct professor in the Department of Psychology at Virginia Tech and adjunct professor in the Faculty of Science at the University of Technology in Sydney, Australia.

Dr. Greene has worked with several thousand kids with concerning behaviors and their caregivers, and he and his colleagues have overseen implementation and evaluation of the CPS model in countless schools, inpatient psychiatry units, and residential and juvenile detention facilities, with dramatic effect: significant reductions in recidivism, discipline referrals, detentions, suspensions, and use of restraint and seclusion. Dr. Greene lectures throughout the world. He lives in Freeport, Maine.

Listener Testimonials

“Very helpful info! Excellent speaker.”

“I use the C&PS strategies with my older son and I’m planning to start with my younger. This was just the motivation I needed.”

“Thank you for advocating for misunderstood children!”

“I can’t wait to learn more. This approach makes so much sense.”

Webinar Sponsor

The sponsor of this ADDitude webinar is…

Brain Balance helps kids, teens and adults with ADHD, learning differences, anxiety & more through our integrative cognitive development and brain wellness program. Our approach combines cognitive, physical and sensory training with nutritional guidance to strengthen and build brain connectivity without the use of medication. Stronger connections translate to improved attention, behaviors, and social-emotional well-being.
| brainbalancecenters.com/additudemag

ADDitude thanks our sponsors for supporting our webinars. Sponsorship has no influence on speaker selection or webinar content.

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Defiance is commonly associated with ADHD symptoms like weak impulse control and emotional regulation, but repetitive acts of defiance could be a sign of oppositional defiant disorder (ODD) or pathological demand avoidance (PDA). To determine the root cause of a child’s behavior, we must dig underneath inappropriate words and actions.

Why Is My Child So Defiant?

Many oppositional teens have a loud internal voice that tells them they’re a failure; they can’t do things right; no one likes them; they’re stupid. You name it.

As a parent, you’ve likely witnessed pushback resulting from this internal narrative. Your child’s defiance is an unskilled and ineffective attempt to manage some of these feelings. They’re trying to manage their external surroundings when things feel out of control on the inside.

Oppositional tweens and teens may demonstrate the following behaviors:

• lack of cooperation
• inappropriate language
• refusal to do tasks such as homework or chores
• instant anger or reactivity
• threatening behavior
• destruction of property

[Download: Free Guide to Ending Confrontations and Defiance]

Oppositional Defiant Disorder (ODD)

ODD is classified as a disorder in the DSM-V, but symptoms of ODD often present situationally. Kids with ODD who are openly resistant in one setting or with one authority figure may be completely cooperative in other areas of their life. Their behavior presents like a switch — angry one minute and fine the next.

This can be confusing to the parent of a child who acts out at home but not at school. Children with ADHD may exert authority in an area where they feel relatively secure. They may direct their defiance toward the parent who they think is most likely to take and/or forgive it. They may push back because they can.

Pathological Demand Avoidance (PDA)

Defiant behavior may signal PDA when it occurs almost without exception. This profile is characterized by an overwhelming and consistent need to avoid or resist demands. PDA is more intense and pervasive than is ODD; it is not limited to certain people or situations.

Kids with PDA are obsessive in their resistance to requests that they perceive as overly assertive. They may avoid compliance by resorting to manipulative behaviors and even turn down activities they enjoy. Parents may notice sudden changes in mood that are associated with the need to control or reject a demand.

PDA is not a standalone diagnosis in the U.S., but it falls under the umbrella of the autism spectrum diagnoses. It is seen most often in people with autism, ADHD, and high anxiety.

[ADDitude Directory: Find an ADHD Clinic]

Solutions to Address Oppositional Behavior

Parental communication style (and substance) can contribute to a child’s oppositional behavior — for better or for worse. Invitations, tag teaming, collaboration, being a body double, and noticing your child’s efforts all contribute to better cooperation. Reconsider how you ask your child to engage in a task and what happens when they fail to do so.

1. Nix Non-negotiable Words

A “no” might be a response to what your adolescent views as a demand rather than a request. The use of words such as “need,” “must,” or “will” may be triggering for kids who have PDA. These non-negotiables give them the impression that a decision has already been made.

Try the following phrases to reframe your requests:

• “Is it okay with you if…?”
• “How do you feel about…?”
• “Do you mind doing this…?”
• “If you’d be happy to, I would really appreciate…”
• “When you’ve finished with this, could you then do…?”

2. Encourage Shared Involvement

You can also encourage cooperation by using words like “us,” “we,” “let’s,” and “together.” Or give autonomy and decision-making opportunities to your child by engaging them in directed free choice. This means offering them two or three options in a situation so they feel empowered to make a decision rather than resentful or angry about being told what to do. Kids may also want to play a bigger role in the brainstorming process.

3. Plan for Patterns

ODD and PDA are repetitive patterns of behavior, so don’t treat them like isolated events. Plan for explosions. What options are available when your child acts out? What logical consequences can they expect as a result?

Maybe your teen is given one free hour of screen time a day. They can earn additional screen time after completing cooperative activities such as basic chores and homework. If they get angry, scale back on this incentive. Reduce the free screen time allotment. This teaches the lesson that “have-to” tasks are necessary to get “want-to” rewards.

4. Institute Takebacks

Lying is a social behavior that occurs between two people due to avoidance, denial, or a desire to avoid punishment. It creates comfort in the present and minimizes conflict based on something that’s happened in the past. Kids with ADHD may lie due to poor impulse control or inattention. They might not realize that they misinterpreted an event until after they’ve said it out loud.

This is when we want to give them an option to take it back. I call this the “take back of the day” or TBD approach. I did it with my kids when they were growing up and I’ve recommended it to hundreds of families as a tool to diffuse tension and bring awareness to disrespectful comments. I think it’s helpful when everyone in the family has a chance to take back something they said without risk of penalty–including adults who can model how it works.

5. Meet in the Middle

If your child is stuck, it may be that your demands are too difficult to meet. Fatigue or low energy could also be signs of sleep deprivation or depression. Technology addiction, while composed of many things, is often related to an ADHD brain hunting for dopamine. Creating a balance or flow with high dopamine and low dopamine activities helps kids with building their abilities for shifting and flexibility. If your approach is not working, ask some open-ended questions about what’s going on with your child that is interfering with their compliance (e.g. ‘What is making it tough to do this? What would make it more appealing? How can I offer you support to get through this?’), and adjust as needed.

To encourage your child to cooperate or tell the truth, you might also create ground rules that are negotiable in certain situations. Maybe your ground rule is no swearing, and your child broke that rule. Instead of imposing consequences right away, take a pause. Consider the STAR method: stop, think, act, and recover. This process includes taking a pause with a planned, self-soothing activity, coming back together to discuss what each person thinks they could have done differently occurred, what the next right action will be and doing it and then giving time and space for recovery and moving forward.

6. Acknowledge Effort

If you notice that your child’s behavior is improving, acknowledge it. “Efforting” is what I call a full-body experience for outside-the-box thinkers. It’s emotional, it’s social, it’s cognitive, and it’s physical. It’s more than simply trying. It may result in accomplishing something or it may show genuine efforts without completion. It’s the process that contributes to growth mindset. We want to acknowledge, validate, and encourage the progress that we see our kids making.

Oppositional Teen Behavior: Next Steps

• Download: 5 Ways to Improve Emotional Control at Home
• Read: You Can’t Change Your Defiant Teenager…
• Read: Two Families’ Stories of Oppositional Defiant Disorder

The content for this article was derived, in part, from the ADDitude ADHD Real-Time Support Group session titled, “Helping Oppositional Teens with ADHD” with Sharon Saline, Psy, D., which was broadcast via Facebook Live on February 10, 2023. Live support group meetings take place on Facebook most Fridays at 4 p.m. ET.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

COMORBIDITIES: What co-existing conditions should my child’s doctor consider when evaluating for ADHD?

A: ADHD rarely exists in isolation. Clinicians must properly screen for and address ADHD and its comorbidities… | Keep reading on ADDitude »

DEPRESSION: What distinguishes ADHD from depression in children?

A: Clinical depression is more than just the blues. It’s a serious illness, and it affects more young people than parents realize… | Keep reading on ADDitude »

ANXIETY: What distinguishes ADHD from anxiety in children?

A: Some anxiety disorders can be hard to spot in children because symptoms include internal thoughts and feelings that don’t always… | Keep reading on ADDitude »

OCD: What distinguishes ADHD from OCD in children?

A: Obsessive-compulsive disorder is marked by repetitive thoughts or fears (obsessions) that may turn into repetitive behaviors… | Keep reading on ADDitude »

BIPOLAR: What distinguishes ADHD from bipolar disorder in children?

A: Medical science is learning more about bipolar disorder in children and teens. But the condition is still difficult to diagnose. That’s especially true for teenagers in whom irritability and moodiness… | Keep reading on ADDitude »

DMDD: What are the symptoms of disruptive mood dysregulation disorder in children?

A: DMDD causes children to experience unstable emotions they cannot regulate, including extreme outbursts of anger, leading to temper tantrums. These outbursts often occur in response to… | Keep reading on ADDitude »

FIRST-PERSON: “How I Calmed My Daughter’s Anxiety Attack”

“It’s critical that you accept the attack as real. The dizziness, sweating, chest pain, racing heart — all of it is real. Don’t tell her that it’s just in her head or that she’s OK. So what can you do? Start by holding her close.” | Keep reading on ADDitude »

RELATED RESOURCES

SYMPTOM TEST: Generalized Anxiety Disorder in Children

Every child worries sometimes — about monsters or tests or new experiences. A child with anxiety feels anxious about nearly everything. | Take the self-test on ADDitude »

SYMPTOM TEST: Depression in Children

Does your child say they’re ‘too tired’ to do activities they used to love? Have trouble making even simple decisions? | Take the self-test on ADDitude »

8-Part Guide to ADHD Diagnosis in Children:

Q 1: How can I better understand ADHD, its causes, and its manifestations?
Q 2: How can I understand the aspects of ADHD that might be new to the doctor?
Q 3: How can I improve the odds of an accurate ADHD evaluation for my child?
Q 4: How can I find a professional to diagnose and treat my child’s ADHD?
Q 5: What should a thorough evaluation for pediatric ADHD include and exclude?
> Q 6: How can I be sure my child’s evaluation screens for psychiatric comorbidities?
Q 7: How can I be sure my child’s evaluation considers look-alike comorbidities?
Q 8: Should my child be screened for the sleep, eating, and other disorders?

DEPRESSION: What distinguishes ADHD from depression?

A: Depression is more than just an occasional case of the blues. It’s deep sadness and despair you feel every day for at least 2 weeks at a time… | Keep reading on ADDitude »

ANXIETY: What distinguishes ADHD from anxiety?

A: When you have anxiety along with ADHD, it may make some of your ADHD symptoms worse, such as feeling restless or… | Keep reading on ADDitude »

BIPOLAR: What distinguishes ADHD from bipolar disorder?

A: Approximately 20 percent of people with ADHD also suffer from bipolar disorder, characterized by depressive and manic episodes… | Keep reading on ADDitude »

MOOD DISORDERS: What distinguishes ADHD from a mood disorder?

A: Making the distinction between moodiness in ADHD, ODD, DMDD, and other disorders requires studying the mood’s intensity and… | Keep reading on ADDitude »

OCD: What distinguishes ADHD from obsessive-compulsive disorder?

A: Symptoms of OCD include recurrent, unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions)… | Keep reading on ADDitude »

ODD: What distinguishes ADHD from oppositional defiant disorder?

A: Adults with ODD are more than just aggressive and irritating from time to time. They feel mad at the world every day, and lose their temper… | Keep reading on ADDitude »

FIRST-PERSON: “ADHD: ‘I Really Fouled That Up.’ Anxiety: ‘Hold My Beer.’”

“ADHD means I can’t be productive. Anxiety means I can’t relax. ADHD won’t let me resolve problems. Anxiety makes me think I have problems I don’t actually have. ADHD makes planning difficult. Anxiety convinces me I need to plan everything down to the tiniest of detail.” | Keep reading on ADDitude »

RELATED RESOURCES

SYMPTOM TEST: Generalized Anxiety Disorder in Adults

No two people experience anxiety in the same way, however common symptoms do exist. | Take the self-test on ADDitude »

SYMPTOM TEST: Depression in Adults

Do simple tasks take forever to accomplish? Do you feel irritable all the time, or stuck in life? | Take the self-test on ADDitude »

8-Part Guide to ADHD Diagnosis in Adults:

Q 1: How can I better understand ADHD, its causes, and its manifestations?
Q 2: How can I understand the aspects of ADHD that might be new to my doctor?
Q 3: How can I improve my odds of an accurate ADHD evaluation?
Q 4: How can I find a professional to diagnose and treat my ADHD?
Q 5: What should a thorough evaluation for adult ADHD include and exclude?
> Q 6: How can I be sure my ADHD evaluation screens for psychiatric comorbidities?
Q 7: How can I be sure my ADHD evaluation considers look-alike comorbidities?
Q 8: Should I also be screened for the sleep, eating, or other disorders?

The Clinicians’ Guide to Differential Diagnosis of ADHD is a clinical compendium from Medscape, MDEdge, and ADDitude designed to guide health care providers through the difficult, important decisions they face when evaluating pediatric and adult patients for ADHD and its comorbid conditions. This guided email course will cover the following topics:

• DECISION 1: How can I better understand ADHD, its causes, and its manifestations?
• DECISION 2: What do I need to understand about ADHD that is not represented in the DSM?
• DECISION 3: How can I avoid the barriers and biases that impair ADHD diagnosis for underserved populations?
• DECISION 4: How can I best consider psychiatric comorbidities when evaluating for ADHD?
• DECISION 5: How can I differentiate ADHD from the comorbidities most likely to present at school and/or work?
• DECISION 6: How can I best consider trauma and personality disorders through the lens of ADHD?
• DECISION 7: What diagnostic criteria and tests should I perform as part of a differential diagnosis for ADHD?

NOTE: This resource is for personal use only.

A further complication: youth with ADHD are at higher risk for developing mood disorders, such as disruptive mood dysregulation disorder (DMDD) or oppositional defiant disorder.

During a recent ADDitude webinar on irritability, we asked nearly 1,000 attendees, “What is the most challenging aspect of emotion regulation for your child or patient?” Here are the answers they gave:

• Dysregulation of emotions in the moment (e.g., feelings often subjugate thinking): 37.8%
• Intensity of felt emotions (e.g., sudden, violent outbursts): 34%
• Unrelenting nature of irritability (e.g., always angry, bristly, mean): 14%
• Poor recognition of other people’s feelings (e.g., apparent and/or real lack of empathy): 7.1%
• Frequency of mood changes (e.g., dizzying emotional lability): 6.7%

Comments and questions submitted during the webinar, titled “Emotion Regulation Difficulties in Youth: ADHD Irritability vs. DMDD vs. Bipolar Disorder” provided deeper insight into how ERD impacts youth with ADHD.

Emotion Regulation Manifestation #1: Explosive Outbursts

“My child screams and breaks down over issues with friends.”

“My son is verbally aggressive and used to destroy doors and walls. It is truly hard for me to cope with his crisis.”

“My 11-year-old son’s physical and verbal aggression seems to be reserved for home. He controls himself at school but not at home, where he is very argumentative and defiant. He is easily triggered when he does not get his way (e.g., he pushes, hits, and calls us names).”

“My 14-year-old daughter keeps it together at school but is defensive, aggressive, and explosive with her 11-year-old sister and us (her parents) when we intervene.”

[Self Test: Does My Child Have Disruptive Mood Dysregulation Disorder?]

Explosive Outbursts: Next Steps

• Download: 9 Truths About ADHD and Intense Emotions
• Read: Why Is My Child So Angry?!
• Read: What Is Intermittent Explosive Disorder? 

Emotion Regulation Manifestation #2: Rejection Sensitive Dysphoria

“It is hard for my child with ADHD to not respond in a passive-aggressive, irritating way toward people she feels have rejected her. This might look like getting into others’ personal space by doing things she knows bothers them. This has gotten her in trouble with peers whom she feels are her bullies.”

“My son is 16 and has had explosive emotional outbursts due to environmental factors since he was 18 months old. The emotional outbursts have lessened substantially, but they still happen when he is super frustrated, upset, or gets his feelings hurt by his friends.”

RSD: Next Steps

• Download: Understanding Rejection Sensitive Dysphoria
• Read: How ADHD Ignites Rejection Sensitive Dysphoria
• Self-Test: Could It Be Rejection Sensitive Dysphoria? Symptom Test for ADHD Brains

Emotion Regulation Manifestation #3: Extreme Irritability

“Irritability occurs when there is a change in the child’s expectations of a situation. For example, it is not going to happen or not happening soon enough according to the child’s understanding or expectation.”

“My kid seems to be frequently irritable and grouchy and has angry outbursts.”

“I’ve noticed a big increase in irritability for my 13-year-old son with ADHD.”

“My 12-year-old wants to buy things or have things bought for her. Telling her ‘no’ results in irritability and a major tantrum.”

Extreme Irritability: Next Steps

• Download: 10 Ways to Neutralize Your Child’s Anger
• Read: New Insights Into Emotional Dysregulation and Treatment Considerations
• Read: “My Child’s In a Bad Mood Every Morning!”

Emotion Regulation Manifestation #4: Lack of Flexibility

“My granddaughter is often agitated and gets things stuck in her head, and there is no working around it. Screen time is about all that keeps her focused and calm. Everything is a challenge — routines, grooming, sitting down to dinner. Everything”

“My son is very rigid and has no ability to cope when he doesn’t get his way.”

“I struggle with my daughter’s need to be in control of everything and everyone. So much so, even making doctor’s appointments are hard to do.”

Lack of Flexibility: Next Steps

• Download: Why Is My Child so Defiant?
• Read: What’s Really Behind Your Child’s Bad Behavior?
• Read: Exaggerated Emotions: How and Why ADHD Triggers Intense Feelings

[Self-Test: Does My Child Have ADHD? Symptom Test for ADHD]

Emotion Regulation Manifestation #5: Self-Harm

“I have an 11-year-old daughter who has had explosive outbursts and big highs and lows since age 4. She began expressing suicidal ideation and was self-harming and experiencing intrusive thoughts.”

“During fits, my child makes comments about ‘not wanting to live,’ and ‘can’t take it anymore.'”

Self-Harm: Next Steps

• Download: Easy Mindfulness Exercises for Kids with ADHD
• Read: ADHD & Self-Harm: How to Help the Girls Who Suffer Most
• Read: How Is Your Emotional Resilience? Learning to Cope with Intense ADHD Feelings

Emotion Regulation Manifestation #6: Overly Emotional

“We’re struggling with my son because he’s not combative, just EXTREMELY emotional. He has crying episodes or extended periods of being upset where he cannot regroup for up to an hour.”

“My son does OK in most environments, but at home, he displays a lot more irritability and dysregulation, anger, frustration, and sadness.”

“My son is explosive at times. I remain calm with few words spoken, but he escalates quickly by yelling and running out of the house. This creates a very stressful environment for everyone in the house. I don’t know how to get him out of his terrible moods, where he fixates on ‘small’ things that bother him.”

Overly Emotional: Next Steps

• Download: Evaluate Your Teen’s Emotional Control
• Read: Q: How Do I Teach My Teen to Manage Emotions?
• Read: Calm Starts at Home: How to Teach Emotional Regulation Skills

Emotion Regulation Manifestation #7: Physical Aggression

“My 8-year-old son with ADHD cannot focus or keep still long enough to finish his schoolwork. Then he gets frustrated, which ends with him hitting his peers or teachers.”

“My daughter has a very hard time with aggressive behavior and has had to have the ‘room cleared’ twice this month, along with three in-school suspensions.”

“So often parenting advice recommends setting firm boundaries with kids, such as saying, ‘you can be mad, but I won’t let you throw things/ damage furniture/ etc.” However, with my kid with ADHD, when his lid is flipped, and he’s having a rage outburst, any attempt to say those things seem to ‘feed the fire.’ He just escalates more, often becoming physically aggressive with us.”

Physical Aggression: Next Step

• Download: Free Guide to Ending Confrontations and Defiance
• Read: Anger Is Important — But Only When It’s Managed
• Read: When “Keep Your Hands to Yourself” Doesn’t Work: Fixes for Hitting

More on Emotion Regulation and ADHD

• Free Download: 15 Ways to Disarm (and Understand) Explosive ADHD Emotions
• Read: How Dysregulated Emotions Hijack the Teen ADHD Brain
• Read: ADHD and Emotional Regulation: A Parent’s Guide

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

October 7, 2022

Mood swings. Sleep disturbances. Deteriorating relationships. Worsening grades. Total lack of interest in recreational activities. These are among the troubling behaviors observed by more than half of caregivers since the start of the pandemic, according to a new ADDitude survey on the mental health of youth with ADHD.

Our 1,187 survey responses mirror reports by the U.S. Surgeon General with one important caveat: The mental health crisis plaguing today’s youth appears even more severe for adolescents with ADHD.

The mother of a 14-year-old in Michigan put it this way: “My daughter has developed social anxiety and sometimes has difficulty going to school or to stores where other teens might be present. She is overly obsessed with her looks, so much so that she covers our mirrors. She went from an honor roll student to Ds and Es.”

[ADDitude Special Project: Mental Health Out Loud]

Many high school students, as we now know, weren’t doing well before the pandemic: One in three reported a persistent feeling of sadness or hopelessness between 2009 and 2019, according to U.S. Surgeon General Vivek Murthy. And one in five children aged 3 to 17 reportedly had a mental, emotional, developmental, or behavior disorder during that time period.

But in the last two to three years, mental health challenges grew even more troublesome for high school students with ADHD, according to the caregivers who responded to the ADDitude survey: An astounding 67% of teens have now been diagnosed with anxiety and 46% with depression. Among children ages 3 to 17 with ADHD, the survey also revealed above-average levels of oppositional defiant disorder (11%), sleep disorders (6.75%), and eating disorders (5.32%), not to mention the learning differences that impact more than one in five students with ADHD.

The Social Media Effect

Less than 6% of parents surveyed said their adolescents with ADHD have “very good” mental health today. On a 4-point scale, this group’s average mental health rating was 2.27.

The most alarming signs of a mental health crisis revealed by the survey data involved adolescent girls with ADHD who use social media. The rate of anxiety among this group is a startling 75%, and the rate of depression is 54%, according to the survey. More than 14% have a sleep disorder, and nearly 12% report an eating disorder—more than three times the national average for neurotypical women. Though the survey cannot demonstrate causality with social media use, it does reveal that this demographic has the most severe mental health challenges.

The most “pervasive and troubling” emotions impacting all adolescents with ADHD today include anxiousness (66%), irritability (60%), apathy (59%), withdrawal (47%), and anger or aggression (45%).

[Free Resource: Too Much Screen Time? How to Regulate Your Teen’s Devices]

Among adolescent girls with ADHD, the most common sources of anxiety were school (76%); COVID-19 (54%); finances (31%); gun violence in schools and social media use (28% each). Among teens with ADHD who are not cisgender, 38% report feeling anxiety over political violence.

“Sometimes my son goes through acute depression,” said a caregiver of a transgender adolescent with ADHD, anxiety, and depression. “When this happens, the entire world goes dark for him, and we just do what we can to get him through.”

If your child is experiencing troubling symptoms of anxiety, depression, or self-harm, call or text 9-8-8 to access mental health services in the United States.

How to Protect Your Teen’s Mental Health

Talk to your child’s pediatrician if you are concerned about your child’s mental health. Learn about the signs of anxiety and depression (and other signs of distress) and ask your child’s doctor if screenings for these conditions are warranted. If your child has been diagnosed with anxiety, depression, and/or other conditions, ensure that they are adhering to treatment plans.

1. Model emotional regulation at home.

Practice self-care and prioritize your well being. Even if it doesn’t seem like it, your behaviors serve as a guide for your teen.  Keeping calm will help your teen do the same – or at least prevent emotions from escalating. Make sure you aren’t enabling your child’s anxiety.

2. Try to minimize exposure to negative news.

Avoiding discussing potentially stressful subjects – finances, marital problems, etc. – around your child, as these topics could undermine your child’s sense of safety and stability. Limit your family’s exposure to distressing news events. Learn more about navigating conversations around gun violence and school shootings here.

3. Encourage healthy social media use.

Have ongoing conversations about online experiences, and watch for warning signs of problematic Internet use. Listen to our conversation with Linda Charmaraman, Ph.D., on social media and youth mental health for more strategies. If unhealthy social comparison over social media is a problem for your teen, read this article.

4. Encourage healthy habits.

Consistency and routine ground us, as do sufficient sleep, nutritious meals, and physical activity. Social connection is also vital for teens. Take steps to ensure that your child’s life has all these elements.

5. Prioritize a good relationship with your child above all else.

A stable, supportive environment does wonders for fostering resiliency and confidence. Bond with your child over things they enjoy (don’t come in with an agenda), and really listen to your child’s concerns without judgment. (Check your immediate reactions and unsolicited advice at the door.)

ADHD & the Mental Health Crisis: Next Steps

• Join Us! Mental Health Out Loud Event on Eating Disorders in Teens
• Read: Special 2022 Mental Health Report from ADDitude
• Read: Compare & Despair: Social Media & Mental Health Concerns in Teens with ADHD
• Listen: “Mental Health Out Loud – The Mental Health Fall Out from Social Media Use”
• Free Resource: Social Anxiety Facts & Falsehoods
• Read: A Clinicians’ Guide to Serving and Protecting LGBTQIA+ Youth  

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Adolescents with ADHD and high conduct problems are more likely to develop substance-related problems (SRPs) — including “seven-fold increased odds for illicit drug use” and increased odds for frequent alcohol intoxication, says a new report. Teens with ADHD and high conduct problems who also experienced negative life events such as the death of a loved one or trauma from violence face the highest risk for SRPs, according to a study published recently in the Journal of Attention Disorders. ¹

The study assessed the severity of self-reported conduct problems and its association with SRPs in 9,411 Norwegian adolescents aged 16 to 19. Researchers linked data from a large population-based study conducted in 2012 with registry-based data gathered between 2008 and 2018.

Adolescents with ADHD were grouped into three categories: ADHD only, ADHD plus low conduct problems, and ADHD plus high conduct problems. SRPs were measured on five variables: illicit drug use, high-level alcohol consumption, frequent alcohol intoxication, a positive CRAFFT score (potential drug or alcohol related problems), and level of total symptoms as measured by the first four variables.

Of the 170 adolescents with ADHD, 29% screened positive for conduct disorder compared to 10% of the full survey sample. Adolescents with ADHD plus high conduct problems were more often boys (65.3%) and they experienced higher rates of SRPs. Nearly 29% of adolescents had three or more indicators of SRPs compared to the survey sample (4.7%) and ADHD only subgroup (3.9%).

Previous research suggests that children with ADHD face an increased risk for comorbid disorders, including disruptive behavior diagnoses like conduct disorders and oppositional-defiant disorders.^{2, 3} An estimated 44% to 90% of children and adolescents with ADHD have at least one comorbid disorder.^4–8

“Our findings thus lend support to the notion that the risk of SRPs among ADHD-diagnosed adolescents can largely be attributed to co-existing conduct problems and that ADHD in itself does not increase the risk of adolescent illicit drug use beyond the effect of conduct-related disorders,” the researchers wrote.¹

Of the adolescents that indicated conduct disorders in the ADHD plus high conduct problems subgroup, only about 10% had received a formal diagnosis.

“The results underline the need for CAMHS and other relevant health services to enhance identification of adolescents with ADHD and severe conduct problems, and by this ensure access to interventions that may contribute to break negative cycles related to substance abuse,” the researchers wrote.

Sources

¹Heradstveit, O., Askeland, K. G., Bøe, T., Lundervold, A. J., Elgen, I. B., Skogen, J. C., Pedersen, M. U., & Hysing, M. (2022). Substance-Related Problems in Adolescents with ADHD-Diagnoses: The Importance of Self-Reported Conduct Problems. Journal of Attention Disorders. https://doi.org/10.1177/10870547221105063

²Elia, J., Ambrosini, P., Berrettini, W. (2008). ADHD characteristics: I. Concurrent co-morbidity patterns in children & adolescents. Child and Adolescent Psychiatry and Mental Health, 2(1), 15–19.

³Pfiffner, L. J., McBurnett, K., Rathouz, P. J., Judice, S. (2005). Family correlates of oppositional and conduct disorders in children with attention deficit/hyperactivity disorder. Journal of Abnormal Child Psychology, 33(5), 551–563.

⁴Barkley, R. A. (1998). Attention-deficit hyperactivity disorder. Scientific American, 279(3), 66–71.

⁵Biederman, J., Newcorn, J., Sprich, S. (1991). Comorbidity of attention deficit hyperactivity disorder with conduct, depressive, anxiety, and other disorders. American Journal of Psychiatry, 148(5), 564–577.

⁶Mitchison, G. M., Njardvik, U. (2019). Prevalence and gender differences of ODD, anxiety, and depression in a sample of children with ADHD. Journal of Attention Disorders, 23(11), 1339–1345.

⁷Szatmari, P., Offord, D. R., Boyle, M. H. (1989). Ontario Child Health Study: Prevalence of attention deficit disorder with hyperactivity. Journal of child psychology and psychiatry, 30(2), 219–230.

⁸Willcutt, E. G., Pennington, B. F., Chhabildas, N. A., Friedman, M. C., Alexander, J. (1999). Psychiatric comorbidity associated with DSM-IV ADHD in a nonreferred sample of twins. Journal of the American Academy of Child and Adolescent Psychiatry, 38(11), 1355–1362.

ODD is characterized by persistent hostility, aggression, and defiance. What’s more, it often co-occurs with ADHD. So, how can parents manage their kids’ ODD symptoms and not exacerbate negative behaviors?

Here, ADDitude readers share their tips for managing oppositional defiance. Read about their experiences below and share yours in the Comments section below.

“My son’s ODD tends to flare when he becomes frustrated by seeing something as ‘wrong.’ The infraction could be serious, or something as small as a different pronunciation of a word. He becomes so disturbed and obsessed with that ‘wrong’ that he tries to right it whatever the cost. But, often, his solution becomes a much bigger ‘wrong’ than the original issue. It could mean interrupting an event, shaming someone, or just discouraging them. It can really hurt others he cares about. My main strategy for dealing with this opposition and negativity is a light-hearted, humorous distraction. When I’m feeling patient and light-hearted, it’s easier to do. And when my rapport with my son is pretty good, it’s easier for him to receive it.” — Nathan

“My 10-year-old son with ADHD exhibits ODD symptoms only at home. He questions everything he is told to do, argues for the sake of argument, and responds aggressively if told to do something he doesn’t like. We try to give him room to share his feelings with us, good or bad, but we often intervene when the aggression is aimed at his younger sister, who is neurotypical. We send him to his room, not as a traditional timeout, but as a physical pause button to stop the aggression. We usually talk through the scenario after he calms down, and we have sought outside counseling to help our family deal with the conflict.” — Anonymous

[Get This Free Download: Why Is My Child So Defiant?]

“My son exhibits characteristics of ODD, however, it is more prevalent when he deals with adults who are inflexible in their own thinking.” — Anonymous

“Both of my teens have ADHD, which manifests in different ways. The defiance increases with parental demands to pick up dirty dishes or do homework, etc. This is not only frustrating for me as a parent, but it causes my overwhelmed ADHD brain to fixate on them completing the task. My daughter ignores the request, and my son burrows into his blanket or becomes overwhelmed and yells at me to leave him alone.” — Anonymous

“I’ve learned not to push them. It only results in a battle of wills, which I know I won’t win. Instead, I try to lead them to make good decisions. I give them options or offer information to get them thinking on the right track.” — Dee

“A very aggressive ‘No!’ is my daughter’s first response to most requests. I calmly repeat whatever it is I expect her to do or stop doing and then walk away to give her the space to calm down and digest what she needs to do.” — Anonymous

[Read This: Why Is My Child So Angry and Defiant? An Overview of ODD]

“I see ODD in my 7-year-old son when he’s unmedicated. If I ask him to do something, the answer is immediately ‘No!’ or ‘Never!’ It seems like an automatic reaction. I just wait and give him a chance to think about what he’s said. He then toddles off to do what he’s told (with all the usual distractions along the way). He’s not like that when he’s medicated. It took me a long time to work out that he can’t help it, and I need to deal with it calmly.” — Nikki

“I never tell them directly what to do, except in an emergency. I make them think that it’s their idea, give choices, or I even tell them to do the opposite. I don’t react if they do something odd. I just raise an eyebrow and carry on. I am never angry with tantrums or oppositional verbal naysaying. It’s best to laugh it off as it’s often funny. Most of these things take the sting out.” — Paul

“Mine are still young (6-year-old twins). One twin has ADHD and ODD, and I’m sure they feed off each other. I make corrections using redirection. We are trying behavioral charts with short-term and long-term rewards.” — LC

“My son has both ADHD and ODD. The ODD is only directed at home to us. Other authority figures like teachers or doctors are questioned but not defied. We are constantly re-establishing order in the house. It’s exhausting to plan for him to defy a new boundary. We are consistent and very careful with our words. We maintain control by repeating and disengaging. It’s isn’t pretty, but we are doing our best.” — Anonymous

“My teenage son has ADHD with ODD with symptoms of CD (conduct disorder). Anybody with authority is treated with disdain. It makes it difficult for him to get an education, keep a job, hold on to his driver’s license, the list goes on. In between bouts of lawlessness, he is a fantastic kid. We all have professional support; it helps us more than him. He will be 18 soon, and we worry about his future.” — Chris

“There is nothing we can ask our 10-year-old to do that is not met with some level of resistance. Initially he gets angry. Then he complains. Often, he cries. Depending on how tired or overwhelmed he is, he may go into full meltdown mode. We are finally learning to pick our battles, but it’s never easy when so much of his behavior requires correction. He figured out that reading calms him and hugs help (once he’s over his meltdown). I know he doesn’t want to make our lives difficult on purpose and he wishes he could be different. It inspires me to show empathy and continue to educate myself about ADHD and ODD to do better for him.” — Anonymous

ODD Parenting Advice: Next Steps

• Self-Test: Oppositional Defiant Disorder (ODD) in Children
• Read This: How to Discipline a Child with Oppositional Defiant Disorder (ODD)
• Learn: Oppositional Defiant Disorder Strategies — 8 Discipline Rules

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