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Diagnosing and Treatment of Oppositional
Defiant Disorder in Children with ADHD
If you have an ADHD child, there is a 40 to 50
percent chance of his doctor also diagnosing Oppositional Defiant
Disorder. Children and adolescents with both Oppositional Defiant
Disorder and ADHD are extremely difficult to live with and are
always in trouble. Their impulsiveness,
hyperactivity, aggression
and willful defiance often lead to fights and huge temper
tantrums.
Oppositional behavior is a normal part of development during the
“Terrible Twos” and “Terrible Teens.” For children with
Oppositional Defiant Disorder, this behavior is not reserved for
toddler and teen years or an occasional bad mood. It is their
day-in and day-out conduct.
These are the children who question and resist authority at every
opportunity, and truly seem to enjoy getting a strong reaction out
of the people they oppose. They become frustrated at slight
events, are prone to temper outbursts, acts of aggression and
destructiveness. Oppositional Defiant Disorder children frequently
lie and are rarely willing to take responsibility for their
actions.
The American Psychiatric Association defines Oppositional Defiant
Disorder as “a recurrent pattern of negativistic, defiant,
disobedient, and hostile behavior toward authority figures that
persists for at least 6 months.”
Diagnosing Oppositional Defiant Disorder is difficult
because of a high rate of comorbid conditions. Comorbid
combinations like ADHD, learning disabilities, depression, bipolar
disorder, anxiety disorders, Tourette’s and other neuropsychiatric
disorders are very common. It is important when diagnosing
Oppositional Defiant Disorder to look for other disorders which
may be present.
Some
symptoms of ADHD overlap with Oppositional Defiant Disorder
but there are distinct differences between the two. These
differences need to be taken into consideration when diagnosing
Oppositional Defiant Disorder. First and foremost, Oppositional
Defiant Disorder is aggressive and purposeful. ADHD is
characterized by impulsivity. People with ADHD will act without
thinking of the consequences and will likely show remorse over a
negative action afterward. An Oppositional Defiant Disorder person
will act purposely, lie about and later laugh and brag about it.
Oppositional Defiant Disorder Symptoms:
_ Frequent temper tantrums
_ Excessive arguing with adults
_ Actively defies requests and refuses to comply with rules
_ Deliberate attempts to annoy or upset people
_ Often blames others for his or her mistakes or misbehavior
_ Is easily annoyed by others
_ Frequently angry and resentful
_ Is spiteful and hateful when upset and seeks revenge
As stated before, all children will exhibit the list of behaviors
at some point in their lives. The key is in frequency.
Oppositional Defiant Disorder children display these
characteristics more frequently than children of comparable age
and development levels. These behaviors are also long-term,
lasting more than six months, instead of a being part of a
developmental stage.
For most children, Oppositional Defiant Disorder signs appear
between the ages of one to three but for these children, the
Terrible Twos never go away. Children with strong-willed or
difficult-child temperaments are often grow into a diagnosing of
Oppositional Defiant Disorder. Rarely do signs of Oppositional
Defiant Disorder appear later than adolescence.
Treatment of Oppositional Defiant Disorder:
Pharmaceutical treatment for Oppositional Defiant Disorder in
children has poor outcomes. Training parents to manage the
behavior is a major focus of treatment of Oppositional Defiant
Disorder and the treatment that promises the most benefit.
One highly recommended book is
"Transforming the Difficult
Child: The Nurturing Heart Approach." This phenomenal book
provides a simple yet effective parenting format that removes
fighting and power struggles.
Parent management training (PMT) for the treatment of Oppositional
Defiant Disorder helps parents change their own behaviors, thereby
altering their child's behavior. Parent management training alters
parent-child interaction patterns by encouraging the parent to pay
attention to positive behavior and using brief, consistent and
effective punishments. Parent management training is the only
treatment for Oppositional Defiant Disorder thus far that has
shown to positively affect negative parent/child interactions.
The health care provider might prescribe antihypertensive
medications (Clonidine, Tenet) or antidepressant medications
(Zoloft, Prozac, Paxil) for the treatment of Oppositional Defiant
Disorder. There is no research currently available on the use of
other psychiatric drugs in the treatment of Oppositional Defiant
Disorder.
Treatment of Oppositional Defiant Disorder might also include
individual psychotherapy, family psychotherapy,
cognitive-behavioral therapy and social skills training. However,
parent management training remains the best treatment for
Oppositional Defiant Disorder.
Parents Can Help Their Child with Oppositional Defiant Disorder
by:
_ Participating in parent management training.
_ Focusing on the positives instead of the negatives.
_ Giving ample praise and positive reinforcement when the child
exhibits positive behavior.
_ Learning conflict resolution skills.
_ Choosing and prioritizing battles. Walk away from the small
battles and stand ground on the major battles.
_ Setting reasonable, age appropriate limits with consistent
consequences.
_ Learning to manage own stress.
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