ADHD – Co-Existing Disruptive Behavioral Disorders


More than two-thirds of the sufferers of Attention Deficit and Hyperactivity Disorder ADHD have co-existing disorders such as disruptive behavior disorders, mood disorders, anxiety disorders, learning disabilities, tics and Tourette Syndrome. The existence of one of these conditions complicates the treatment plan. Most children with ADHD will manage to adapt, but having one of the associated disorders makes it more likely that they will fail to finish their education. The best line of defense is an early diagnosis because the consequences of an undiagnosed or untreated coexisting condition can be severe.

Most children with ADHD will manage to adapt, but having one of the associated disorders makes it more likely that they will fail to finish their education. The best line of defense is an early diagnosis because the consequences of an undiagnosed or untreated coexisting condition can be severe.




Because ADHD is difficult to diagnose and because of the possibility of co-existing conditions, when presented with a possible case of ADHD, the doctors will conduct various investigations and analyses before determining whether or not the child has ADHD and/or other disorders. The investigation will include interviews with parents, the child, teachers, and caregivers. The doctors will seek to discover if the symptoms are a result of environmental factors such as relationship problems in the home. They will also explore family history to understand whether or not there is a previous history of any of the disorders.

This isn’t to say that every mental health professional you hire is going to consider or review the same things, and most of us know what a doctor is, but here is an interesting article about the difference between a therapist and a psychologist. Just know that whoever medical expert you speak with, the fact remains that any disorder can coexist with ADHD, but some are more common. Over 50% of ADHD sufferers have a disruptive behavior disorder.

Disruptive Behavior Disorders

Disruptive behavior disorders include Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD). The symptoms of these disorders include defiance of authority, temper tantrums and antisocial behavior, which can include lying and cheating. The behavior patterns of children with CD are worse than those with ODD but behavior can progress from ODD to CD as the child becomes older.


Oppositional Defiant Disorder

About 40% of ADHD sufferers are also diagnosed with ODD, which is characterized by antisocial behaviors such as stubbornness, temper tantrums, refusing to follow rules, defiance, anger and resentment. Children with ODD frequently argue with their parents or others in authority. ODD usually starts before the age of eight. Males have a higher incidence of ADHD with ODD. Adverse environmental conditions are believed to add to the likelihood of ODD in children diagnosed with ADHD.



To be diagnosed with ODD the patient must have four or more of the following symptoms:

  • Frequent loss of temper
  • Frequently arguments with adults
  • Refusal to obey rules, or do what is asked
  • Is deliberately annoying
  • Easily annoyed
  • Angry and resentful
  • Spiteful and vindictive
  • Frequently blames others for his own mistakes

This behavior must be recurrent and must be excessive when compared to children of a similar age. It must have caused disruption to the school and home environment and it must have been present for more than six months to warrant this diagnosis.


Conduct Disorder

Conduct disorder is present in 27% of ADHD children, 45% of adolescents and 20-25% of adults. CD is far more serious than ODD and it is thought that untreated ODD will develop into CD. CD is sometimes described as delinquency and involves attempts to break the rules without getting caught.  Children with CD will often be unkind and aggressive to animals and other people. They usually skip school, break the rules, lie and steal. They are also much more likely to abuse substances or get into trouble with the law. Children with ADHD and CD are at risk of getting into trouble with authorities so early intervention is imperative.


Treating Disruptive Behavior Disorders

Studies show that parent training is the most successful way to reduce symptoms of disruptive behavior disorders over the longer term. Parents are trained in positive reinforcements – the use of punishment and reward for desirable and undesirable behavior. The training aims to teach increased positive parenting. It reinforces the need for support and the consistent application of discipline. It seeks to decrease negative parenting, eliminating harsh punishment or constant criticism. Parents are taught the importance of predictable and immediate responses to bad behavior.



Parent child interaction therapy helps parents build stronger relationships with their children and teaches them techniques which can help them manage the child’s behavior. These programs have proven effective over the long term. In addition to this, the parent should consider getting familiar with and educating themselves about different tactics that they can use pretty much immediately to see some improvement, and at the very least cope with whatever they’re facing. One of the most popular and well documented is understanding the difference between nurture vs nature.

Collaborative problem solving is used to train children and adolescents to deal with their frustrations in an acceptable manner. Many families with children that have behavioral problems require family counseling. The child’s disruptive behavior can have a negative effect on the entire family. The parents’ relationship may be strained and the siblings may be resentful as they frequently do not receive as much attention as the child with ADHD. Family therapy seeks to address these problems.

Medication can reduce the severity of the symptoms and is likely to be used in conjunction with the behavioral and training therapies. Where coexisting conditions exist, the medical professional is likely to treat the ADHD symptoms first as this is likely to reduce the symptoms of the coexisting condition.


Education and Disruptive Behavioral Disorders

Many schools now have programs to help deal with the problems of ADHD in the classroom. The goal is to improve both the social interaction and the academic outcomes of the students with ADHD. These programs ensure that rules are consistently applied, and that appropriate behavior is rewarded and poor behavior is punished.

Tutoring may be appropriate for the child with these disorders, as academic outcomes are known to improve when the child is tutored. Classroom management by the teacher is imperative. She must create a classroom environment that is conducive to teaching children with ADHD. There should be few distractions and she must ensure that rules are consistently applied with the appropriate sanction.



The child diagnosed with ADHD and a coexisting disruptive behavioral disorder can present challenges to the family, but with early diagnosis and the correct interventions both medical and behavioral, the family and school can help the child overcome the worst symptoms and prepare the way for a successful future.