ADHD & ODD: Confronting the Challenges of Disruptive Behavior

[buddy]

Overall, I think it is a hopeful article. Focuses on what might cause these symptoms, important factors to assess and then what to focus on for treatment. It does give opinions about when medication may be called for (for the neurobiological co-morbid issues, for underlying issues, for resulting depression/anxiety/aggression issues).
I of course read it with a bend toward our home situation (adoption, neurological trauma, autism) so the things that jumped out at me will be different than others but here are some of the things I found interesting:

The clear overlap of symptoms blurs somewhat the lines of distinction between the 2 disorders and raises a number of questions for the clinician. Where does one disorder begin and the other end? Is it possible that ODD is a by-product of severe ADHD? Is there a common pathway to the evolution of disruptive behavior diagnoses? Is it possible to improve ODD symptoms simply by treating a child's ADHD?

The symptoms should not be better accounted for by another mental illness (eg, psychotic disorder in a paranoid child who refuses to eat, or separation anxiety disorder in a child who refuses to attend school)—nor should oppositionality and defiance be symptoms of a biologically mediated illness (eg, autism, schizophrenia)

They discuss whether ADHD and ODD have a common pathway or are separate issues and discuss some of the ideas that support both ideas. They say the benefit of identifying ODD early is what we all know now, that early appropriate intervention is better than waiting. One way it is described evloving is when a 2 yr old goes through the normal oppositional stage, it continues without their developing the ability to self regulate whether due to internal factors, environmental factors and/or adhd.

After the interview process, a physical examination is indicated to rule out medical causes of disruptive behavior, however rare these may be (Table 4).

Be especially careful not to blame the families dealing with the disruptive behaviors. Focusing on the interventions instead may improve the likelihood of their following through with a referral. To achieve this nonblaming attitude, it is helpful to keep in mind that the problematic behaviors are interactional in nature: "problematic parenting can be elicited by a 'difficult' child and, at the same time, can create problems for a child." Given this interactional model, it is not surprising that the 2 types of evidence-based treatments for patients with ODD are individual therapy with a cognitive behavioral focus on problem-solving skills and parental intervention in the form of parent management training (PMT).

The goal of PMT is to help parents establish a more focused approach to consistency and predictability, which promotes pro- social behavior in their child. Without a positive relationship with or attachment to the child, it becomes very difficult to establish lasting change in negative behavior.

As I read some of this I agreed certainly, but thought of my son's frequent-at times nearly constant- negative interactions from adults in his life and thought it should say parents AND teachers. I know he wears them down and that is why even when I am frustrated with them for being so grumpy with him, then expecting him to cooperate, I stay their cheerleader and remind them that they have the opportunity to make a life long difference in this kid if they can just hang in there.

children who feel a sense of security regarding the limits of their environment have less need to constantly test it

This is huge for my difficult child and I hate it (the process that is) It is so hard to establish a new rule or routine in our house but once it is established, even if he hates it, he always does so much better. I am sure that is just common sense for neuro-typical households, but for me I have to consciously think about it because the process of establishing limits can be so physically demanding that it is tempting to just let things slide. I always pay for it if I do that though, so it is really rare I change a pattern once established.

 

[buddy]

#1 that has actually been a long standing theory. HOWEVER several members on this board have stated that medications did not work for their young children, but once passing puberty, medications DID work. So, while the "medication test theory may be valid, it's not an instant diagnostic "tool" medications would have to be ineffective over a lifetime to "prove" that it's not ADHD and that is only helpful for research purposes, not treatment purposes.

This is interesting. All kids are so different, and so far for mine even in puberty it is clear the stimulant. medications are working to keep him safe and to have a chance of focusing. In working on our medication situation, our new psychiatrist (who has 3 difficult child's of her own! and just purchased the partial hospital/outpatient program she manages) said they have found that the stimulant. medications that act calming and help a child to focus actually can become much more stimulating and can cause irritation and opposition as a child goes through puberty-and the neurons and chemical changes in the frontal lobe finish developing -thru the mid twenties-. She has been part of lots of research including at Mayo Clinics and specializes in kiddos with multiple diagnosis. She only takes these kids as patients now.

 

[DS3]

Be especially careful not to blame the families dealing with the disruptive behaviors. Focusing on the interventions instead may improve the likelihood of their following through with a referral. To achieve this nonblaming attitude, it is helpful to keep in mind that the problematic behaviors are interactional in nature: "problematic parenting can be elicited by a 'difficult' child and, at the same time, can create problems for a child." Given this interactional model, it is not surprising that the 2 types of evidence-based treatments for patients with ODD are individual therapy with a cognitive behavioral focus on problem-solving skills and parental intervention in the form of parent management training (PMT).

I found this part to be the most inspirational. We are NOT bad parents. Yes we do need help, but as the quote states, we're often drawn into bad parenting styles because of our children. Heck we could even be drawn into it because parenting today isn't the same as parenting when we grew up. With more technology also means more isolation for new parents and parents of problematic children. As the saying goes, "It takes a village to raise a child" but in todays day and age, you just don't see that. You see new mothers basically being handed a new-born with no real coping skills on how to handle that said child. Often, we are so distracted by what is going on all around us that no one takes the time to help those who need it most. ~sigh~ Sorry, just been reading this book which really explains a lot to me and has helped me cope with some feelings that I have. It's titled "I'm Okay, You're a Brat!" (And yes, the author has children.) Great read for anyone interested.

SO back on topic (That's my ADHD talking there as I get off topic ) In today's day and age, the parents are often blamed. (going back to my book again) The truth is that parents have very little if any influence as to how their children grow up. Most influences come from the people they meet at school or outside of the house, their choices in decisions, etc., and at the very bottom of the totem pole ranks the parents. So we cannot blame the parents. Not if their involvement (no matter how much it may be) is ranked at the bottom of the list. I hate that the parents are blamed. Well we can influence some stuff, we cannot be accountable for their actions if they can comprehend the repercussions of their actions. It's not like they are robots. We can't program them to be such and such or to be have in a certain way. They are responsible for their own actions.

Ok. Think I'm done for now. Perhaps I can stay a little more focused later.

 

[InsaneCdn]

The truth is that parents have very little if any influence as to how their children grow up. Most influences come from the people they meet at school or outside of the house, their choices in decisions, etc., and at the very bottom of the totem pole ranks the parents

With all due respect... I disagree.

This is how the outside influences want you to believe, because it maximizes THEIR impact.
YOU don't have to go that way.
The answer is... to build really strong family bonds, if you can. (there's kids where that doesn't work... I know).
It means putting high priority on relationship building - rather than on fire-fighting. And yes, when we're presented with several dozen fires a day, how to get out of fire-fighting mode?

There is significant research out there that kids with strong family attachment do better in all aspects of life.
To do that, requires things that are not available to all families.
As a society, we have not made child-raising a priority - the adults get on with their lives, and the kids take what they get.
We have... absent dads (some moms), shared custody, shift-work, "away" work, two-parents-working, and so on... and no way to prevent any of this.

But the things that build the bond take TIME. It means family meals together - twice a day, most days, if possible (breakfast and supper). It means family activities, family interests. It means spending specific time with each child, just feeding the relationship.

Doing those things is really tough even if you have an intact nuclear family with some work flexibility and two kids that are not extremely hard to handle. (yes, two... it really helps. Each parent can take one... ). How on earth you do these things in other scenarios, I do not know.

What I CAN tell you is, it works.
Relationship building was one of the key things (medications adjustment and additional dxes and accommodations for school was another) that turned our difficult child around.

 

[DS3]

I'm going to start a new thread on this in the general parenting and do some quoting from my book to tell you why I believe you are wrong Insane. I think it gets way off topic if we continue it here. Look for it in a little bit.


Yeah... Not going to post anymore since we sorted it out in PM. Well, unless my curiosity about what others think on the topic gets the better of me...

 

[InsaneCdn]

DS - sent you a PM.