Oppositional Teen Behavior: Understanding Pathological Demand Avoidance, ODD, and ADHD

Is your child pushing back against rules? Challenging your authority? Resisting even reasonable requests? It’s common for youth to rebel during adolescence, but it’s important not to dismiss your teen’s oppositionality as just hormones. Saying “no” could be your child’s way of expressing a wide range of emotions they can’t put into words. It may be their way of setting limits, slowing things down, or expressing their feelings of being overwhelmed.

Defiance is frequently associated with attention deficit hyperactivity disorder (ADHD) symptoms like weak impulse control and emotional regulation, but repeated acts of defiance may indicate oppositional defiant disorder (ODD) or pathological demand avoidance (PDA). To determine why a child is acting out, we need to look past their inappropriate behavior and words.

Many teenagers with oppositional behavior have an internal voice that loudly tells them that they’re a failure, can’t do things correctly, no one likes them, they’re stupid, and more. As a parent, you may have noticed that your child experiences pushback stemming from this internal narrative. Defiance is an unskilled and ineffective way of trying to manage these feelings. When things are out of control internally, youth attempt to manage their external surroundings.

Oppositional tweens and teens may do the following:

• Sass adults
• Become easily irritated or angered by others
• Blame others for their mistakes or misbehavior
• Deliberately annoy or upset others, e.g., siblings, classmates, and/or teachers
• Refuse to comply with adult rules
• Indulge in spiteful or vengeful behavior
• Be argumentative and defensive

ODD is classified as a disorder in the DSM-V, but its symptoms often only occur situationally. Children who are overtly resistant with one authority figure or setting may be fully cooperative in other areas of their life. Their behavior might switch between angry and fine in a moment and could confuse their parents. Children with ADHD may exert authority in an area they feel mostly secure in and may direct their defiance towards the parent they think is most likely to take it and/or forgive them. They may push back only because they can.

When defiant behavior always occurs, it may signify PDA. This profile is characterized by an overwhelming and consistent need to resist or avoid demands. PDA is more severe and extensive than ODD, as it isn't restricted to certain individuals or situations.

Children with PDA resist requests they perceive as overly assertive obsessively. They might avoid concessions through manipulative measures and even pull back from activities they enjoy. Parents might observe abrupt mood changes that associate with the necessity to manage or reject a demand.

PDA isn't a standalone diagnosis in the United States, but it is considered part of the autism spectrum diagnoses. It usually occurs among individuals with autism, ADHD, and high levels of anxiety.

The communication style (and substance) of a parent may add to oppositional behavior in children, good or bad. Asking your child to participate, teamwork, collaboration, being a partner, and acknowledging your child’s efforts can lead to more cooperation. Consider how you invite your child to take part in something and what you do when they can’t or don’t.

A teenager might say “no” to a request because they view it as an order instead of a request. For children with PDA, words like “need,” “must,” or “will” may trigger resistance. These limitations make them feel like a decision has already been made.

To reframe your demands, try using phrases such as:
- Could you consider…?
- Would you like to…?
- Do you have any ideas about…?

Using words like “us,” “we,” “let’s,” and “together” could encourage collaboration. Allowing your child to make their decisions and exercise their autonomy and decision-making abilities by involving them in guided free choice could also foster cooperation. This means giving them two or three alternatives in a position so they feel empowered to make the decision, rather than resentful or angry that they’ve been ordered to do something. Youth may also want to play a greater role in the brainstorming process.

Since ODD and PDA are repetitive behavioral patterns, you shouldn’t manage them like isolated incidents. Be prepared for outbursts. What choices are available to your child when they act out? What are the logical outcomes?

For instance, perhaps your teen has one free hour of screen time a day. They could get additional screen time after completing cooperative activities like basic chores and school assignments. If they get angry, reduce the available screen time. This demonstrates that "have to" activities are necessary to gain "want to" incentives.

Lying is a social behavior that occurs between two people due to avoidance, denial, or a desire to avoid punishment. It creates comfort in the present and minimizes conflict based on something that’s happened in the past. Kids with ADHD may lie due to poor impulse control or inattention. They might not realize that they misinterpreted an event until after they’ve said it out loud.

This is when we want to give them an option to take it back. I call this the “take back of the day” or TBD approach. I did it with my kids when they were growing up and I’ve recommended it to hundreds of families as a tool to diffuse tension and bring awareness to disrespectful comments. I think it’s helpful when everyone in the family has a chance to take back something they said without risk of penalty–including adults who can model how it works.

If your child is stuck, it may be that your demands are too difficult to meet. Fatigue or low energy could also be signs of sleep deprivation or depression. Technology addiction, while composed of many things, is often related to an ADHD brain hunting for dopamine. Creating a balance or flow with high dopamine and low dopamine activities helps kids with building their abilities for shifting and flexibility. If your approach is not working, ask some open-ended questions about what’s going on with your child that is interfering with their compliance (e.g. ‘What is making it tough to do this? What would make it more appealing? How can I offer you support to get through this?’), and adjust as needed.

To encourage your child to cooperate or tell the truth, you might also create ground rules that are negotiable in certain situations. Maybe your ground rule is no swearing, and your child broke that rule. Instead of imposing consequences right away, take a pause. Consider the STAR method: stop, think, act, and recover. This process includes taking a pause with a planned, self-soothing activity, coming back together to discuss what each person thinks they could have done differently occurred, what the next right action will be and doing it and then giving time and space for recovery and moving forward.

If you notice that your child’s behavior is improving, acknowledge it. “Efforting” is what I call a full-body experience for outside-the-box thinkers. It’s emotional, it’s social, it’s cognitive, and it’s physical. It’s more than simply trying. It may result in accomplishing something or it may show genuine efforts without completion. It’s the process that contributes to growth mindset. We want to acknowledge, validate, and encourage the progress that we see our kids making.

The content for this article was derived, in part, from the ADDitude ADHD Real-Time Support Group session titled, “Helping Oppositional Teens with ADHD” with Sharon Saline, Psy, D., which was broadcast via Facebook Live on February 10, 2023. Live support group meetings take place on Facebook most Fridays at 4 p.m. ET.

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