Children with ADHD and disruptive behavior disorders often benefit from special behavioral techniques that can be implemented at home and at school. These approaches typically include methods for training your child to become more aware of his own anger cues, use these cues as signals to initiate various coping strategies ("Take five deep breaths and think about the three best choices for how to respond before lashing out at a teacher."), and provide himself with positive reinforcement (telling himself, "Good job, you caught the signal and used your strategies!") for successful self-control. You and your child’s teachers, meanwhile, can learn to better manage ODD or CD-type behavior through negotiating, compromising, problem-solving with your child, anticipating and avoiding potentially explosive situations, and prioritizing goals so that less important problems are ignored until more pressing issues have been successfully addressed. These highly specific techniques can be taught by professional behavior therapists or other mental health professionals recommended by your child’s pediatrician or school psychologist, or other professionals involved with your family.

If your child has a diagnosis of coexisting ODD or CD, and well-planned classroom behavioral techniques in his mainstream classroom have been ineffective, this may lead to a decision to place him in a special classroom at school that is set up for more intensive behavior management. However, schools are mandated to educate your child in a mainstream classroom if possible, and to regularly review your child’s education plan and reassess the appropriateness of his placement.

There is growing evidence that the same stimulant medications that improve the core ADHD symptoms may also help coexisting ODD and CD. Stimulants have been shown to help decrease verbal and physical aggression, negative peer interactions, stealing, and vandalism. Although stimulant medications do not teach children new skills, such as helping them identify and respond appropriately to others’ social signals, they may decrease the aggression that stands in the way of forming relationships with others their age. For this reason, stimulants are usually the first choice in a medication treatment approach for children with ADHD and a coexisting disruptive behavior disorder.

The earlier stimulants are introduced to treat coexisting ODD or CD, the better. A child with a disruptive behavior disorder whose aggressive behavior continues untreated may start to identify with others who experience discipline problems. By adolescence, he may resist treatment that could help him change his behavior and make him less popular among these friends. He will have grown accustomed to his defiant "self" and feel uncomfortable and "unreal" when stimulants help check his reckless, authority-flaunting style. By treating these behaviors in elementary school or even earlier, you may have a better chance of preventing your child from creating a negative self-identity.

If your child has been treated with 2 or more types of stimulants and his aggressive symptoms are the same or worse, his pediatrician may choose to reevaluate the situation and replace the stimulant with other medications. If stimulant medication alone led to some but not enough improvement, his pediatrician may continue to prescribe stimulants in combination with one of these other agents.