Published on ADDitudeMag.com
ODD and ADHD: Parenting Your Defiant Child
ADHD behavior issues often partner with oppositional defiant disorder (ODD), making discipline a challenge. Try these strategies for managing and treating an angry, defiant child.
More Than Defiant
parent of a child with attention deficit knows what it’s like to deal with
behavior problems—saying no to requests or blurting words out. Children with
ADHD and ODD take defiant behavior to the extreme. They have a pattern
of angry, violent, and disruptive behaviors toward parents, caretakers, and
other authority figures.
ODD and ADHD: Stats and Facts
percent of children with ADHD also develop ODD. Before puberty, ODD is more
common in boys; after puberty, it is equally common in both genders. About half
of all preschoolers diagnosed with ODD outgrow the problem by age eight. Older
kids with ODD are less likely to outgrow it.
ODD and ADHD: The Links
oppositional behaviors aren’t intentional. Experts think that ODD is linked to intense
impulsivity. Not being able to control impulses, combined with the stress and
frustration of trying to get on top of ADHD symptoms every day, lead some
children to lash out, physically and verbally.
An ODD Diagnosis Is Tricky
child will act out and test his boundaries. It may be hard to know whether a
child is normally defiant or has ODD. Consult a therapist trained in childhood
behavioral problems. He should also screen for anxiety, depression, and bipolar
disorder—each of which may cause oppositional behavior. Left untreated, ODD can
evolve into conduct disorder, a more serious behavioral problem.
Steps to Treating ODD
starts with controlling ADHD symptoms. When a child’s hyperactivity,
impulsiveness, and inattention are reduced, there is usually an improvement in
ODD symptoms. Stimulant medications have been shown to decrease ADHD symptoms,
as well as those of ODD, by up to 50 percent.
Go Beyond Stimulants
If a child
doesn’t respond well to stimulants, some doctors prescribe the non-stimulant
atomoxetine (brand name: Strattera). In one study, researchers found that the medication
significantly reduced ODD and ADHD symptoms. However, higher doses of the
medication were needed to control symptoms.
Change a Child’s Behavior—by Changing Yours
treatment of choice for ODD is parent-management training. Parents are taught
to change their reactions to a child’s behavior—good and bad. Training involves
using carrots and sticks, giving well-defined rewards and praise when your
child cooperates, and consequences for misbehavior. Therapists will also work
with a parent and child together to solve specific challenges.
Discipline in Three Steps
experts find the following strategy effective for parents: Ask
child calmly to do something. If he doesn’t respond to you in two minutes,
gently tell him, “I’m asking you a second time. Do you know what I’m asking you
to do—and the consequences if you don’t? Please make a smart decision.” If you
have to ask a third time, he suffers the pre-arranged consequence’—no TV or
video games for an hour.
Get Everyone on the Same Page
For behavior therapy to work, the child’s caregivers should use
the same discipline strategies that you do. Grandparents, teachers, nannies,
and other adults who spend time alone with your child must understand which
carrots and sticks you use and, above all, to use them consistently. If one of
them gives into your child’s bad behavior, it can undermine your discipline
Do Not Take ODD Personally
It is hard for a parent to remain calm when a child is verbally
abusing her, but don’t overreact. Yelling or spanking may worsen a child’s
oppositional behaviors. Stay calm and emotionally neutral amid your child’s
defiance. Oppositional kids have radar for adult hostility. If they pick up
your anger, they’re going to match it.
Make Room for Praise
Helping parents learn to praise good behavior is one of the
toughest challenges therapists face. Many parents are so focused on bad
behavior that they stop reinforcing positive ones. A few tips: Specify the
praiseworthy behavior, be enthusiastic while not overdoing it, and finish up
with a non-verbal gesture—a kiss on the cheek or a hug.
Be Creative and Be Consistent
The more creatively you tailor your program of rewards and
punishments to your child’s specific abilities and needs, the better. Her needs
change as she grows. Creativity is important, but consistency is vital to
success. Consistency in the way you treat your child—setting rules, conveying
expectations—is the key to cleaning up your child’s ODD act.
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