Many children with ADHD display oppositional behaviors at times. Oppositional defiant disorder is defined in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) as including persistent symptoms of “negativistic, defiant, disobedient, and hostile behaviors toward authority figures.” A child with ODD may argue frequently with adults; lose his temper easily; refuse to follow rules; blame others for his own mistakes; deliberately annoy others; and otherwise behave in angry, resentful, and vindictive ways. He is likely to encounter frequent social conflicts and disciplinary situations at school. In many cases, particularly without early diagnosis and treatment, these symptoms worsen over time—sometimes becoming severe enough to eventually lead to a diagnosis of conduct disorder.

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Acoording to the American Academy of Child and Adolescent Psychiatry, symptoms of ODD may include:

Frequent temper tantrums

Excessive arguing with adults

Often questioning rules

Active defiance and refusal to comply with adult requests and rules

Deliberate attempts to annoy or upset people

Blaming others for his or her mistakes or misbehavior

Often being touchy or easily annoyed by others

Frequent anger and resentment

Mean and hateful talking when upset

Spiteful attitude and revenge seeking

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The symptoms are usually seen in multiple settings but may be more noticeable at home or at school. One to sixteen percent of all school-age children and adolescents have ODD. The causes of ODD are unknown, but many parents report that their child with ODD was more rigid and demanding than the child's siblings from an early age. Biological, psychological, and social factors may have a role.