What Is the Difference Between ADHD and Oppositional Defiant Disorder?

At some point, when they are young, most children will act up and have trouble behaving, focusing, and paying attention in general. This is especially true for children in preschool and elementary school as they begin to experience the day to day distractions if interacting with friends and all of the other stimuli associated with the new environment school offers. For most children, this is a passing phase, and before long, they integrate into their new environment and learn to understand the expectations. However, for some, it is more than just being young or experiencing something new and exciting. For some, their behavior begins to have a negative impact on their daily life, social interactions, and growth. This could point to something called a neurodevelopmental disorder, or a problem with how their brain is growing and developing. Two of the most common neurodevelopmental disorders in kids are attention-deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD). If your child is experiencing one of these disorders, it is likely they are having trouble controlling their impulses, paying attention, listening, and getting along with their peers, among other issues. But what are the differences between these two disorders? Below we explore each including similarities, differentiation, and treatment options.

Attention Deficit Hyperactivity Disorder (ADHD)

It is important to note that ADHD is not an illness solely attributable to children; however, symptoms begin to present during the early years of life. For most children, the hyperactivity element tends to improve as the child ages, but the problems with attention, organization, and impulse control often persist throughout teen years and into adulthood.

Causes of ADHD

As diagnosis of ADHD has become more prevalent in recent years, a significant amount of research and study has gone into better understand the illness, its causes, signs and symptoms, and treatment options. Current research studies conducted by the researchers at the National Institute of Mental Health and the National Institutes of Health, this disorder may be caused by interactions between genes and environmental or non-genetic factors. Some of the factors that could potentially contribute to attention deficit hyperactivity disorder are:

• Genetics
• Maternal smoking or alcohol use during pregnancy
• Exposure to environmental toxins such as lead at a young age
• Low birth weight
• Brain injuries

This list is by no means exhaustive; however, it provides a few ideas as to how attention deficit hyperactivity order may develop.

Signs and Symptoms

Individuals who are diagnosed with or could be showing symptoms of attention deficit hyperactivity disorder often show an ongoing pattern of three different symptom patterns. These include difficulty paying attention (inattention), being overactive (hyperactivity), and acting without thinking (impulsivity). For many people, these symptoms on their own may not be an issue; however, for those with attention deficit hyperactivity disorder, the symptoms get in the way of daily functioning or development. Examples of symptoms someone with attention deficit hyperactivity disorder may exhibit include:

• Problems sustaining attention in tasks or play
• Difficulties organizing tasks and activities
• Avoidance or dislike for tasks that require sustained mental effort
• Fidgeting and squirming while seated
• Nonstop talking
• Being constantly in motion
• Inability to play or engage in hobbies quietly
• Difficulty waiting his/her turn
• Consistently interrupting or intruding on others

It is valuable to note that displaying these signs or symptoms is not a guarantee or an accurate indicator that a person has ADHD. There are many other mental health issues such as anxiety, depression, and certain types of learning disabilities that can display similar symptoms.

Oppositional Defiant Disorder (ODD)

Even the most well-behaved child can have challenges from time to time. On occasion, their behavior can be challenging, stressful, and also frustrating. But, if your child or teen has frequent (not merely occasional) and persistent patterns that exhibit anger, irritability, arguing, defiance, or vindictiveness towards authority figures (parents included), they may be exhibiting signs of oppositional defiant disorder.

Causes of oppositional defiant disorder

Oppositional defiant disorder is considered a complex problem, and unfortunately, there is no apparent cause. As with ADHD, there are a variety of potential contributing factors, including genetics and the child’s household environment. Other possible risk factors or behavior patterns that may indicate an increased risk for oppositional defiant disorder include:

• Temperament- a child who has a temperament that includes difficulty regulating emotions or tolerating frustration.
• Parenting issues- a child who experiences abuse, neglect, harsh or inconsistent discipline, or lack of parental supervision.
• Other family issues -parental discord, substance abuse, or other mental health disorders within the family.

Signs and symptoms

Sometimes it’s challenging to recognize the difference between a strong-willed or emotional child and one with oppositional defiant disorder. It’s normal to exhibit oppositional behavior at certain stages of a child’s development. Children and teens with oppositional defiant disorder may display difficulties at home with their parents and siblings as well as challenges at school or at work with supervisors and other authority figures. Signs of oppositional defiant disorder generally begin to show as early as preschool.

Common symptoms of oppositional defiant disorder include:

• Angry and irritable mood- easy and frequent loss of temper, easily annoyed by others, often angry and resentful.
• Argumentative and defiant behavior- often argues with people in authority, deliberately defies or refuses to comply with the requests of adults, deliberately upsets people, blames others for mistakes or misbehavior.
• Vindictiveness- often spiteful or vindictive

The symptoms of oppositional defiant disorder can vary in severity from mild to severe. Mild symptoms occur only in one setting. This means the child will display symptoms at home or at school, but not both. Moderate cases will present symptoms in at least two settings, and severe cases will present in three or more settings.

Treatments

There is no cure for attention deficit hyperactivity disorder, but there are treatments available that can help to reduce the symptoms associated with the illness and help to improve daily functioning. Attention deficit hyperactivity disorder is commonly treated through medication, education or training, therapy, or a combination of several of the above.

Oppositional defiant disorder is more commonly treated with behavioral therapy or a combination of behavioral therapy and medication.

Medication

For many children and teens with attention deficit hyperactivity disorder, medications can help to reduce hyperactivity and impulsivity. This can help improve the persons’ ability to learn, focus, and work effectively. The first line of medications used in the treatment of ADHD.

The idea of treating a hyperactivity disorder with something commonly thought to increase activity may seem counterintuitive, but it is effective. Many researchers believe that stimulants are effective because the medication works to increase the levels of dopamine in the brain. Dopamine is a chemical that plays a vital role in thinking and attention.

Non-stimulant medications are also used. These commonly take longer than stimulants to begin working, but once they do, they can help to improve focus, attention, and impulsivity. Antidepressants are also used, although they are not necessarily explicitly approved for the treatment of attention deficit hyperactivity disorder. In adults, they are sometimes used because, like stimulants, they affect the brain chemicals norepinephrine and dopamine.

There is no FDA-approved medication for oppositional defiant disorder. However, in some cases, antipsychotic medications such as Abilify and Risperdal are prescribed if the behaviors the child is exhibiting are severe enough to risk their removal from school or their home. For children with oppositional defiant disorder, medications are often most successful when they are being used to treat co-occurring disorders such as anxiety, depression, or co-occurring attention deficit hyperactivity disorder.

Education and training

Children and adults with attention deficit hyperactivity disorder need guidance and understanding from those around them (teachers, family, parents, etc.) to help them achieve their full potential. Mental health professionals can help by educating the parents of a child diagnosed with attention deficit hyperactivity disorder about the condition and how it impacts not only the child but the entire family. They can help the child (and their family members) by assisting them in developing new skills, attitudes, and ways of relating to each other that may help reduce the stresses each is experiencing.

Other forms of education and training can include

• Parenting skills training- this training is designed to teach parents new skills (or reinforce existing skills) to encourage and reward positive behaviors in their children.
• Stress management skills- learning how to manage stress properly can help parents by increasing their ability to deal with frustration. This helps them better respond to their child’s behavior in a calm and purposeful manner.
• Support groups- these groups can help parents and complete family units connect with others who have similar problems, experiences and concerns.

Therapy

There are many different therapy models that have been tried for ADHD, but research has shown that therapy alone may not be effective in treating the symptoms of the illness. However, when added to a complete treatment plan, therapy may help the child as well as their families better cope with the challenges the illness presents.

There are a variety of therapies that are utilized for children with oppositional defiant disorder. They include psychotherapeutic and cognitive schools of thought. It is important to recognize when treating a child with oppositional defiant disorder, that repairing the parent-child relationship is a priority. Unfortunately, the actions (symptoms) of a child with oppositional defiant disorder can be trying and often hurtful to those around them, especially parental figures. For this reason, parents play a significant role in the treatment process through the use of parent training programs. Parent training programs may include sessions that involve parents and children working together or just parents on their own. There are a variety of parent training programs that are available, and some may be successful where others may not.

Some children may also benefit from social skills training, which is designed to help improve their peer relationships. It the child or teen is struggling with anxiety or depression. Cognitive-behavioral therapy may be indicated, as well. Cognitive-behavioral therapy is a form of therapy that helps a patient understand how their thoughts and feelings influence their behaviors. Again, this may not be a solution for the symptoms explicitly associated with oppositional defiant disorder, but it may be beneficial for some of the symptoms and issues that arise from a co-occurring disorder.

Therapeutic treatments can take place in a variety of different settings. The appropriate setting isn’t so much decided by the type of treatment, but more so by the needs of the individual or the family who are seeking treatment. Treatment sessions involving parental therapy, psychotherapy, and cognitive behavioral therapy can take place in an outpatient setting or in an inpatient residential setting. This, again, would be determined based on the needs of the individual or family.

For some children or teens who are high dysregulated due to the symptoms of their illness, a residential facility, such as, Hillcrest Adolescent Treatment Center may be the best choice. A setting such as this will allow for the opportunity for the child to take advantage of any number of various treatment programs designed for teens struggling not only with oppositional defiant disorder or ADHD, but the assortment of co-occurring disorders as well.

At Hillcrest, an individualized treatment plan will be created that is designed to work with the specific needs of your child and the needs of the family to ensure success. We also have a highly trained staff on site that is able to assist in all aspects of your child and your family’s needs-not just counseling. Through well balanced and well-rounded therapeutic treatment plans, we aim to offer the highest level of professional care possible both during and after treatment.

If you are considering residential treatment for your child or teen but are confused or concerned, that’s ok. We would like to help guide you on your next steps in the decision-making process. Give us a call and ask why our residential care services may be right for your family.