What Is the Best Medication for Children With ADHD and ODD?

Does your child struggle with ADHD and ODD? They might need more support. Learn how to find the medication that will best support their needs.

Raising a child with both attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) can be emotionally and mentally exhausting, but the right treatment plan, including medication, can make a world of difference. When the two conditions overlap, effective care becomes more complex but also more critical, making finding the right medication important. Here’s a further explanation of what childhood ADHD and ODD are and the different treatment methods, helping to make informed decisions.

What is childhood attention-deficit/hyperactivity disorder?

ADHD is a common neurodevelopmental disorder that typically begins in childhood and affects a child’s ability to focus, control impulses, and manage hyperactive behavior. Children with ADHD may struggle with inattention, such as difficulty following instructions or staying on task, as well as impulsivity and excessive movement that seems inappropriate for the setting. 

These ADHD symptoms can interfere with school performance, social interactions, and daily routines, often requiring structured treatment plans involving stimulant medication, behavioral therapy, or a combination of both. Early diagnosis and intervention can significantly improve outcomes for children with ADHD.

What is childhood oppositional defiant disorder?

ODD is a childhood disruptive behavior disorder characterized by a consistent pattern of defiant, hostile, and uncooperative behavior toward authority figures. Children with ODD often display frequent temper tantrums, argue with adults, deliberately refuse to follow rules, and may seem easily annoyed or vindictive. These oppositional symptoms go beyond typical childhood misbehavior and can significantly impact a child’s home, school, and social life. 

Early intervention, often involving behavioral therapy, family therapy, and sometimes medication, is important to reduce conflict, improve emotional regulation, and prevent escalation into more severe conditions like conduct disorder.

Why is medication recommended for children with ADHD and ODD?

In most cases of childhood ADHD and ODD, medication is recommended because it can significantly reduce the core symptoms of ADHD and help manage oppositional symptoms. When used as part of a comprehensive treatment plan, ADHD medication can improve attention span, reduce impulsive behavior, and support emotional regulation, making therapy more effective.

In children with both disorders, medication alone is rarely enough. However, it’s often the first step in stabilizing behavior so that the child can benefit from therapies like cognitive behavioral therapy or family therapy. According to the American Psychiatric Association, early medication intervention can help improve school performance, reduce family stress, and prevent the development of more serious disorders like conduct disorder or bipolar disorder.

How do stimulant medications help children with ADHD and ODD?

Stimulant medications are typically the first-line ADHD treatment because they improve focus and reduce hyperactivity by increasing dopamine and norepinephrine levels in the brain. These medications can help children regulate attention and behavior, and in some cases, also reduce ODD symptoms like aggression or irritability, especially when combined with therapy. However, stimulants may not be suitable for every child, especially those with coexisting conditions like anxiety disorder, mood disorder, or poor heart health (as they can raise blood pressure).

What is the difference between stimulants and non-stimulants? 

Here’s an overview of the two kinds of medication:

1. Stimulants

Stimulant medications are the most commonly prescribed treatment for childhood ADHD and are known for their fast-acting effects, typically within 30 to 60 minutes. Examples include methylphenidate and amphetamines. These medications are especially effective in reducing classic ADHD symptoms, such as inattention, impulsivity, and hyperactivity. 

However, stimulants are classified as controlled substances due to their potential for misuse and ability to cause side effects like insomnia, reduced appetite, and elevated heart rate or blood pressure.

2. Non-stimulants

In contrast, non-stimulant medications, such as atomoxetine and alpha-2 agonists, work more gradually, often taking several days or weeks to show benefits. While they may be less effective for improving focus in some children, they are better suited for those with coexisting conditions like anxiety disorder or oppositional symptoms, and they carry a lower risk of side effects or abuse. 

Choosing between these options depends on a child’s unique needs, medical history, and how they respond to each type of medication.

How can therapy support medication in ADHD and ODD treatment?

Therapy is often used in conjunction with medication, as it teaches children coping skills and helps families manage their behavior. Cognitive behavioral therapy (CBT), for example, is a structured, evidence-based intervention that teaches children how to recognize and manage emotions, reduce aggression, and make better choices.

Additionally, family therapy plays a crucial role in addressing parent-child conflict and building consistent routines. Weekly sessions with a mental health professional, especially one trained in adolescent psychiatry, can help address the behavioral challenges common to ODD.

What are the pros and cons of medication for ADHD and ODD?

1. Pros

Medication has many benefits for treating ADHD and ODD in children. It improves focus and attention, helping children stay on task and follow through with instructions, especially in academic settings. Medications can also reduce impulsive and aggressive behaviors, making it easier for children to manage emotions and interact more positively with peers and adults. 

Additionally, by stabilizing core symptoms, medication may enhance a child’s ability to engage in and benefit from behavioral therapy or other interventions. Over time, effective ADHD and ODD treatment can lead to better school performance, improved social relationships, and a more harmonious home environment.

2. Cons

While medication is an important part of treatment for ADHD and ODD, it comes with potential drawbacks. One of the most common concerns is the risk of side effects, which may include sleep disturbances, appetite suppression, or increased blood pressure, especially with stimulant medications. Additionally, medication alone may not address deeper emotional issues or family-related stressors that contribute to a child’s behavior. 

In some cases, the wrong medication or dosage can even worsen symptoms, underscoring the need for accurate diagnosis and ongoing supervision. Because stimulant medications are classified as controlled substances, they require careful monitoring by healthcare providers to ensure safe and appropriate use.

How to know if medication is working

It is important to carefully monitor medication use in a child, looking for improvements in behavior as well as potential side effects. Here are some signs that medication is working: 

• Fewer tantrums or arguments
• Improved attention span
• Reduced hyperactivity
• Better performance at school
• Less conflict with peers or adults

However, if new symptoms appear, like mood swings, social withdrawal, or increased defiance, it is important to speak with the child’s doctor. Medications may need adjustment or switching. Additionally, tracking progress with a behavior chart, therapy feedback, or teacher reports can help ensure the child’s treatment remains on track.

What other conditions affect medication choice?

Sometimes, children may have another co-occurring mental health disorder that can significantly impact medication decisions. Here are some of the main ones. 

1. Bipolar disorder

When a child has both ADHD and bipolar disorder, doctors often recommend starting with mood stabilizers before introducing any ADHD medication. This is because stimulant medications, while effective for attention deficit hyperactivity disorder, can sometimes trigger or worsen mood swings, irritability, or manic episodes in children with bipolar disorder. Stabilizing mood first helps ensure that ADHD treatments do not intensify symptoms of the underlying mood disorder. A careful, step-by-step approach led by an experienced adolescent psychiatrist is essential to balance symptom management and minimize risks.

2. Anxiety disorder

Children with co-occurring ADHD and anxiety disorder typically respond better to non-stimulant medications rather than traditional stimulant treatments. This is because stimulants can sometimes increase feelings of nervousness or exacerbate anxiety symptoms in sensitive children. Non-stimulant options tend to have a gentler effect on the nervous system and may help improve both attention and anxiety symptoms simultaneously.

3. Conduct disorder or another severe behavior disorder

When a child displays aggressive behaviors or property destruction, suggesting possible conduct disorder or a severe behavior disorder, medication selection must be carefully considered. These children often require more intensive treatment, and medications may focus not only on managing ADHD symptoms but also on reducing aggression and impulsivity. In some cases, mood stabilizers or antipsychotic medications might be considered alongside or instead of traditional ADHD medication. 

Because conduct disorder involves more serious behavioral challenges than oppositional defiant disorder, healthcare providers typically take a comprehensive approach, combining medication with behavioral therapy and family interventions to address both neurological and environmental factors effectively.

How Charlie Health can help

If you or a loved one is struggling with a mental health disorder, Charlie Health is here to help. Charlie Health’s virtual Intensive Outpatient Program (IOP) provides more than once-weekly mental health treatment for dealing with serious mental health conditions. Our expert clinicians incorporate evidence-based therapies into individual counseling, family therapy, and group sessions. With treatment, managing your mental health is possible. Fill out the form below or give us a call to start healing today.