Dr. Alan Greene on Oppositional Defiant Disorder

My 9-year-old was diagnosed as borderline ADHD and has been exhibiting some signs of defiance. Last week he had a complete meltdown. He just didn't listen to anything or anybody. What are the best ways to determine whether this is Oppositional Defiant Disorder (ODD) or if this is just a stage? He never takes responsibility for his actions.

What a great question. Oppositional Defiant Disorder (ODD) is pretty common among kids, especially those with ADHD. It's so common, in fact, that the newest AAP guidelines for the diagnosis of ADHD said that every evaluation for ADHD should include evaluation for other additional disorders such as ODD.

The diagnosis of ODD is made by evaluating a child's behavior. The definition of ODD is pretty simple. It's a pattern of negative, hostile, and defiant behavior that includes at least four different symptoms (such as losing his temper, deliberately annoying people, anger, resentment, spitefulness, vindictiveness, etc.) for more than six months, to a degree that causes significant impairment of social or school functioning.

There may be other reasons for his behavior, but I'm glad when ODD is considered as a possibility. Then, either way, the behavior is usually addressed and the parents supported. Behavior modification is often key to treatment, but when there is also ADHD in the same child, finding the right medication may be the way to go.

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