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It’s normal when a child acts angry or is defiant from time to time. However, if these behaviors happen all the time or are severe, it could be a sign of disruptive behavior disorder. This quick fact will help you: 

1. Recognize symptoms of disruptive behavior disorder in your child with ADHD 
2. Know what to do if you think your child may have disruptive behavior disorder 
3. Learn how your child’s doctor will diagnose and treat both disruptive behavior disorder and ADHD 

What are the signs and symptoms? 

The symptoms of a disruptive behavior disorder can look different depending on the child’s age and can affect a child’s personality, social skills, and coping skills. These symptoms may include: 

• Difficulty managing emotions 
• Irritability 
• Intense meltdowns or tantrums  
• Anger and aggression 
• Arguing with adults and refusing to comply with rules and requests 
• A lack of remorse  
• Damaging property  
• Revenge seeking  
• Disregard for rules 

How common is disruptive behavior disorder in children with ADHD? 

Nearly half of children and teens with ADHD also have a disruptive behavior disorder such as oppositional defiant disorder (ODD) or conduct disorder (CD). Struggling with disruptive behavior can make ADHD symptoms like inattention, hyperactivity, and impulsivity worse. A careful evaluation is needed to develop a comprehensive treatment plan.   

What causes disruptive behavior disorder? 

There is no known cause of disruptive behavior disorder, but experts believe that several things can play a role in how a disruptive behavior disorder develops. Genetics, trauma, mental or physical health problems, lack of sleep, poor nutrition, premature birth, low birth weight, learning disabilities, and poor or inconsistent parenting can affect the development of a disruptive behavior disorder. Children with ADHD may especially feel out of control and may show an extreme avoidance to everyday demands and an extreme need to feel in control, which can trigger disruptive behavior. 

Strategies for helping children with ADHD and disruptive behavior disorder 

You can take the following steps if you think your child has both ADHD and a disruptive behavior disorder. 

• Keep your face, voice, and body calm. Be reassuring and hopeful. Show your child how you cope when things don’t go your way. Children learn by watching the behaviors of those around them.  

• Examine the situations that lead to disruptive behavior and look for triggers like hunger, tiredness, sensory overwhelm, or feeling out of control. 

• Think about possible disruptions to routines and provide support ahead of changes and transitions.   

• Look for opportunities to praise your child for their efforts. 

• Set aside one-on-one time every day without screens or other distractions. 

• Explain rules in a positive way and provide logical consequences for misbehavior. 

• Respond to positive behavior and ignore minor negative behavior. 

• Take classes on parenting children with ADHD. Learning how ADHD can affect your child’s behavior and mood can help you set up your child’s daily life to minimize disruptive behavior 

• Encourage and model a healthy lifestyle by talking about the importance of exercise, a good diet, and good sleep habits. 

Diagnosis 

Your child’s doctor will do an evaluation by looking at both your child’s and family members’ developmental, educational, social, medical, and mental health history.  They will also review any past or ongoing ADHD treatment. All this information will be collected from interviews with parents and the child, teacher behavior ratings, observations, and psychological testing.  

Treatment 

The following treatments can be effective for children with ADHD who have a disruptive behavior disorder:  

• Behavior therapy for both the child and parents to learn social-emotional skills for getting along with others and dealing with aggression.  

• Cognitive behavioral therapy (CBT) for teens to help them change their negative thought patterns into more positive thoughts. 

• Parent training to help improve parent-child relationships and teach parents ways to respond effectively to their child’s behavior.  

• Medication to treat ADHD symptoms may also help decrease disruptive behaviors.  

• Intensive outpatient, residential, or inpatient services may be required for more serious cases. 

It is important to carefully keep an eye on how well your child’s treatment works. Talk with their doctor if adjustments are needed. 

Additional reading, resources and references  

1. CDC. Behavior or Conduct Problems in Children.  
2. AAP. Disruptive Behavior Disorders.  
3. CHADD. ADHD 101 Parenting Class 

Other references

• Understood. The difference between disruptive behavior disorders and ADHD. 
• Childmind. ADHD and Behavior Disorder Center – Intensive Behavior Treatment.   
• Society for Developmental and Behavioral Pediatrics. Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents with Complex Attention Deficit/Hyperactivity Disorder.  
• Society for Developmental and Behavioral Pediatrics. Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents with Complex Attention-Deficit/Hyperactivity Disorder: Process of Care Algorithms. 
• Aman MG et al. What Does Risperidone Add to Parent Training and Stimulant for Severe Aggression in Child Attention-Deficit/Hyperactivity Disorder?  Journal of the American Academy of Child and Adolescent Psychiatry, 2014, 53(1):47–60.  
• Johnstone JM et al. Micronutrients for Attention-Deficit/Hyperactivity Disorder in Youth: A Placebo-Controlled Randomized Clinical Trial. Journal of the American Academy of Child and Adolescent Psychiatry, May 2022, 61(5):647-661.