Every parent of a child with attention deficit disorder knows what it's like to deal with ADHD behavior problems — sometimes even the most well-behaved child lashes out, or refuses to comply with even the most benign request. But almost half of all parents who have children with ADHD live with severe behavior problems and discipline challenges on an almost daily basis.
That's because 40 percent of children with ADHD also develop oppositional defiant disorder, a condition marked by chronic aggression, frequent outbursts, and a tendency to argue, ignore requests, and engage in intentionally annoying behavior.
How bad can it get? Consider these real-life children diagnosed with both ADHD and ODD:
- A 4-year-old who gleefully annoys her parents by blasting the TV at top volume as soon she wakes up.
- A 7-year-old who shouts "No" to every request and who showers his parents with verbal abuse.
- An 11-year-old who punches a hole in the wall and then physically assaults his mother.
"I call them tiny terrors," says Douglas Riley, Ph.D., author of The Defiant Child and a child psychologist in Newport News, Virginia. "These children are most comfortable when they're in the middle of a conflict. As soon as you begin arguing with them, you're on their turf. They keep throwing out the bait, and their parents keep taking it — until finally the parents end up with the kid in family therapy, wondering where they've gone wrong."
The strain of dealing with an oppositional child affects the entire family. The toll on the marital relationship can be especially severe. In part, this is because friends and relatives tend to blame the behavior on 'bad parenting.' Inconsistent discipline may play a role in the development of ODD, but is rarely the sole cause. The unfortunate reality is that discipline strategies that work with normal children simply don't work with ODD kids.
Fortunately, psychologists have developed effective behavior therapy for reining in even the most defiant child. It's not always easy, but it can be done — typically with the help of specialized psychotherapy.
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No one knows why so many kids with ADHD exhibit oppositional behavior. In many cases, however, oppositional behavior seems to be a manifestation of ADHD-related impulsivity.
"Many ADHD kids who are diagnosed with ODD are really showing oppositional characteristics by default," says Houston-based child psychologist Carol Brady, Ph.D. "They misbehave not because they're intentionally oppositional, but because they can't control their impulses."
Another view is that oppositional behavior is simply a way for kids to cope with the frustration and emotional pain associated with having ADHD.
"When under stress — whether it's because they have ADHD or their parents are getting divorced — a certain percentage of kids externalize the anxiety and depression they're feeling," says Larry Silver, M.D., a psychiatrist at Georgetown University Medical School in Washington, D.C. "Everything becomes everyone else's fault, and the child doesn't take responsibility for anything that goes wrong."
Riley agrees. "Children with ADHD know from a young age that they're different from other kids," he says. "They see themselves as getting in more trouble, and in some cases may have more difficulty mastering academic work — often despite an above-average intellect. So instead of feeling stupid, their defense is to feel cool. They hone their oppositional attitude."
About half of all preschoolers diagnosed with ODD outgrow the problem by age 8. Older kids with ODD are less likely to outgrow it. And left untreated, oppositional behavior can evolve into conduct disorder, an even more serious behavioral problem marked by physical violence, stealing, running away from home, fire-setting, and other highly destructive and often illegal behaviors.
Any child with ADHD who exhibits signs of oppositional behavior needs appropriate treatment. The first step is to make sure that the child's ADHD is under control. "Since oppositional behavior is often related to stress," says Silver, "you have to address the source of the stress — the ADHD symptoms — before turning to behavioral issues."
Says Riley, "If a kid is so impulsive or distracted that he can't focus on the therapies we use to treat oppositional behavior," he says, "he isn't going to get very far. And for many ADHD kids with oppositional behavior, the stimulant medications are a kind of miracle. A lot of the bad behavior simply drops off."
But ADHD medication is seldom all that's needed to control oppositional behavior. If a child exhibits only mild or infrequent oppositional behavior, do-it-yourself behavior-modification techniques (see Getting Your Child to Behave) may well do the trick. But if the oppositional behavior is severe enough to disrupt life at home or school, it's best to consult a family therapist trained in childhood behavioral problems.
To share parenting tips, visit the Parents of ADHD Children support group on ADDConnect.