Managing Disorders of the Externalizing Child: ADHD & ODD


Many children with ADHD are diagnosed and treated by primary care providers. The American Academy of Pediatrics first published clinical recommendations for the diagnosis and evaluation of ADHD in children in 2000 and followed in 2001 with recommendations for treatment. The primary care provider should initiate an evaluation for ADHD for any child 4 to 18 years of age who presents with academic, behavioral problems and symptoms of hyperactivity, impulsivity, inattention. To make a diagnosis of ADHD, the primary care provider should determine that the DSM V criteria have been met.1 As listed in the DSM-V, the symptoms must be present in two or more environments (such as the home and school), and the child’s ability to function academically and socially must have been impaired for at least six months.

Approximately one-third to one-half of all children with ADHD may have Oppositional Defiant Disorder. A child with ODD is often persistently defiant, disobedient, and hostile to adults and others in authority for at least six months; they frequently display alt least four of the following behaviors: getting angry, arguing, disobeying orders, breaking rules, blaming others, spiteful and vindictive attitudes. A child can progress from having ODD to Conduct Disorder (CD) as he or she gets older. Symptoms of CD include aggression towards people, animals, destruction of property, stealing, skipping school (behaviors often described as delinquency).

Untreated ODD or CD along with ADHD can make the management of ADHD symptoms more challenging and lead to severe consequences later on in life for the child. The primary care provider evaluating the child can determine whether the child’s symptoms are either due to ADHD itself, due to ODD or CD, or both.

This training will highlight the importance of addressing externalizing behaviors in a pediatric primary care setting. You will gain a better understanding of ADHD and identify symptoms related to externalizing disorders. You will also learn about strategies for assessing symptoms of ADHD, in-office interventions, as well as the role of different primary care team members for helping children and families through a stepped up care model. You will also learn about strategies for assessing, diagnosis, and developing appropriate evidence-based interventions. A case will be used to demonstrate some of the concepts.

  1. ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. Subcommittee on Attention-Deficit/Hyperactivity Disorder, Steering Committee on Quality Improvement and Management. Pediatrics November 2011, 128 (5) 1007-1022; DOI:

Learning Objectives

After completing this training, you will be able to:

  • To identify symptoms related to externalizing disorders
  • To understand how to screen and assess in the primary care setting
  • To understand the evidence-based intervention using stepped up and collaborative care model
  • To discuss diagnosis, assessment, and appropriate evidence-based interventions

Course Information

Estimated Time: 1 hour


Course Instructors

  • Tamkeenat Syed headshotTamkeenat Syed
    MD, MPH
  • Michelle Durham headshotMichelle P. Durham
    MD, MPH


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