ADHD & ODD: Oppositional Defiant Attention Deficit Disorders

Written by Joanne in Uncategorized

(First in a Series of ADHD Comorbidities)

There is an offshoot of Attention Deficit & Hyperactivity Disorder (ADHD) that can be particularly stressful for a family, namely Oppositional Defiant Disorder, or “ODD.” This is a condition defined by constant aggression, outbursts, and – to put it bluntly – being seemingly purposely annoying. This is typified in behaviors such as always saying “no” to any requests.

According to some research, children/teens with ADHD are eleven times more likely to develop ODD behaviors than other children/teens their own age.

The strain on family life can be tremendous. Although I was familiar with this disorder, I had never realized the impact that it made on a family until I experienced it with my grandson. It was a daily battle to get him to do homework, go to church, and clean his room. He argued about everything and anything. Life was not good, to put it mildly. I got to see firsthand the disruption and chaos this disorder can cause. Also, in hindsight, I think his dad may have displayed some of these symptoms during his teen years.

Boys tend to “present with” or manifest this disorder more than girls do. Their “exhibition” also differs. This means that the constellation of symptoms in boys is somewhat different than those displayed by girls. While boys explode with anger and are more aggressive, girls refuse to cooperate and use other more subversive (or, dare I say, “passive-aggressive”[1]) ploys.

Although all children and teens are unruly at times and try to buck authority, this type of behavior is constantly seen in a child/teen that has ODD. It also tends to be more extreme.

ODD Symptoms at a Glance:[2]

  • Anger can be explosive
  • Behavior is often angry or vindictive
  • Annoys others on purpose and is easily annoyed themselves
  • Argues a lot, especially with adults
  • Blames others for their mistakes
  • Can be aggressive
  • Defies rules/laws
  • Does not obey authority figures
  • Loss of temper
  • ODD Severity Varies[3]

Severity of these symptoms can vary.

  • Mild – Symptoms occur in only one setting. For example, at home only
  • Moderate – Symptoms occur in two settings
  • Severe – Symptoms occur in three or more settings

Two Types of ODD

  • Childhood Onset – The symptoms can appear at an early age. Getting treatment early can prevent escalation of the disorder.
  • Adolescent Onset – Appearing in middle school or high school, ODD can be a sudden occurrence. Abruptly, as if overnight, your teen can become driven by anger and conflict.

Adults can be diagnosed with ODD also. Adults can become progressively worse. This usually ends up with a development of antisocial personality disorders causing problems in marriages and relationships. Jobs can also be affected. Divorce and substance abuse can follow in this high-risk population. Therapy and medication can help.

Cause of ODD?

According to many experts at the Mayo Clinic,[4] there isn’t any clear-cut cause of ODD. Possible contributing factors are as follows:

  • Environmental – Parenting problems that may include inconsistency with enforcing the rules and schedules, harsh discipline or neglect issues.
  • Genetic – Inherited temperaments and possibly neurobiological functions in the brain or nerves.

But others[5] believe that many cases of ODD are related to the impulsivity of ADHD. Many kids, they think, are misbehaving not because they want to, but because they can’t control their impulsive outbursts.

Still others see ODD as a way of coping with their ADHD – and all the frustration, inner pain and embarrassment that comes with it.

ODD Risk Factors

  • Highly emotional temperament.
  • Low tolerance level for frustration.
  • Problems in a family – like substance abuse.
  • Receiving reinforcement for the defiant behavior – maybe from peers.

ODD Diagnosis

ODD is usually found by parents and teachers. Official diagnosis has to come from a physician because the symptoms can also be indicative of anxiety, mood disorders, personality disorders, trauma or substance abuse.

Consider also that the symptoms must occur more than is “normal” for others in the same age and development level. Also taken into consideration is whether or not they have problems functioning socially, academically or occupationally.

Physicians should get a complete history of the child/teen and talk to as many people as possible that know the child/teen. This gives the doctor a more complete picture of the child/teen so they can assess how, where and when the behaviors occur and how much of an impact they are making on the child/teen’s life. Evaluations of overall health is also necessary as is any record of behavioral strategies that have been tried.

Sites such as ADDitude have self-tests for ODD that can be helpful to start with. They include questions such as:

(Child-directed:[6])

  • “Is your child unwilling or unable to compromise, give in or negotiate with adults or peers?
  • Does your child get into trouble for being physically aggressive?”

(Adult-directed:[7])

  • Are my friends correct when they tell me that I have bad “road rage”?
  • Do I have – or have I had – problems with substance abuse?

ODD Brain-Imaging

Brain scans are one of the newer methods used for a thorough diagnosis. This so-called SPECT imaging shows highlighted areas of the brain that have too much or too little healthy activity.

People with ODD show increased activity in a section of the brain called the anterior cingulate gyrus (ACG). This part of the brain assists us in changing from one thought to another.

Too much activity in this area may be the cause of thought-fixation. It may lead to getting locked into unhealthy patterns or repetitious and futile problem-solving strategies.

Thus, we see children that always answer you with a “no,” an argument, or a refusal, because they are simply trapped in cycles of futility and obstinance.

Understanding Their Thought Patterns[8]

Dr. Riley believes that to understand the behavior, you must look into the thought behind it.

  • They believe they can defeat all authority figures.
  • They don’t learn from their experiences.
  • They believe that everyone has to be fair to them, even when they are not being fair to others.
  • When angry, they usually try to get revenge.
  • They believe that if they don’t pay any attention to you, then you will “give up” because you believe that there is “nothing you can do” for them.
  • They believe that they are of equal authority with adults.

ODD Treatment

Treatment can consist of psychotherapy and medication although behavior therapy and parent training are favored. The parent training teaches families how to deal with and defuse upsetting behavior. While behavior therapy helps replace defiant behaviors with more positive responses.

 

No medications are currently recommended by the FDA. However, if a child/teen is in danger of being removed from the home or school, low doses of neuroleptics like aripiprazole (Abilify) and risperidone (Risperdal) are helpful if paired with therapy.

If the child also has ADHD or is overly impulsive, then a stimulant may be prescribed. If depression or anxiety are a problem, then an antidepressant may be prescribed.[9] And so on.

ODD Vitamin Deficiencies

Vitamins and other biologically essential chemicals may also be lacking in these individuals. Some families have found the following vitamins and minerals to help improve the symptoms of ADHD and lessen the frustration. (The families incorporate these into a holistic plan with the help of their doctors.)

  • Omega-3 – A fatty acid that helps regulate mood and emotions
  • Vitamin E – Assists in the absorption of omega 3
  • Melatonin – Hormone that helps people sleep better
  • Zinc – Helps to keep hyperactivity and impulsivity under control

ODD Odds and Ends

Finally, don’t neglect treating and controlling the other symptoms of ADHD. This might involve giving affected individuals daily stimulant pills, coffee or Mountain Dew, as well as getting them tutors to facilitate their work at school.

My grandson was greatly helped by having a tutor to keep him on track and helping him with keeping up in the classes where he had trouble.

It’s also vital to correctly and promptly diagnose any comorbidities such as learning disabilities. For example, dyslexia can make reading a nightmare for a child.

Tips for Dealing With Children Who Have ODD[10]

  • Abstain From Arguments – Arguing with a person that has ODD is not a good idea. It’s what they want you to do. So… keep calm.
  • Allow for Options – The element of choice of options on what to do makes it harder to say “no.” In other words, try to lessen the child’s feeling of being under duress, by helping them to feel “empowered.”
  • Be a Model of Control – Like ADHD, ODD is supposed to run in families. So, controlling your own tendency to be argumentative helps to set a good example.
  • Compliment the Positive – I’ve written before about focusing on the positive rather than the negative. (See HERE.[11]) When a child with ODD is finally doing the right thing, provide them with positive reinforcement by simply noticing – and acknowledging – it. You could also follow it up with hugs or high fives, depending on the circumstances, the parameters or your relationship, and the child’s temperament.
  • Introduce Distractions – This may seem odd, especially since ADHD is – if anything – a problem with focus. Why exacerbate the focus issues? But, really, this tip is suggested something like a brief break or, to invoke the video terminology, a “pause.” It helps to disrupt behavioral sequences that march towards negativity. It lets you – and your child or student – come back to the issue later – maybe after everyone is calmer.

In addition to the above, the Mayo Clinic offers a few more suggestions.[12]

  • Be Prepared – At the start, your child will not want to go along with the new program. Behavior may worsen. Remain consistent for success.
  • Give Them a Chore – This should be something that is important but relatively easy so that they can achieve success. Gradually add more responsibility.
  • Pick Your Battles – If you address every little thing, you will battle constantly. So, save it for the most important things.
  • Schedule in Some Time Together – This should be a time for fun and relaxation. Plan fun activities together.
  • Set Limits – Don’t try to do this in the middle of a confrontation. Wait until everyone is calmer. Then discuss. Make sure your directions are clear and concise and that the consequences are reasonable.
  • Set up Routines – There should be a daily schedule that you will all follow.
  • Work Together – Everyone in the house should be on board with the rules and consequences to be make for consistency. Also ask help from teachers and coaches.

Final Thoughts

By giving my grandson praise when he met a goal or finished an assignment – or when he just cooperated or allowed his tutor to help him with his work – I am happy to say that life has been more pleasant.[13]

I hope something in this article can help you to find a little more peace in your home.

Notes:

[1] This is arguably more a term of folk psychology. I use it here merely to help readers get an intuitive “fix” on the condition.

[2]Dr. Douglas A. Riley, Child and Adolescent Psychologist The Defiant Child A Parent’s Guide to Oppositional Defiant Disorder Taylor Trade Publishing 1997 https://www.amazon.com/gp/product/0878339639/ref=as_li_qf_asin_il_tl?ie=UTF8&tag=nhm00-20&creative=9325&linkCode=as2&creativeASIN=0878339639&linkId=f441e1be019cb601ee166e32c796fb6f

[3]Mayo Clinic Staff, Oppositional Defiant Disorder Mayo Clinic https://www.mayoclinic.org/diseases-conditions/oppositional-defiant-disorder/symptoms-causes/syc-20375831

[4]Oppositional Defiant Disorder Overview Mayo Clinic https://www.mayoclinic.org/diseases-conditions/oppositional-defiant-disorder/symptoms-causes/syc-20375831

[5]Royce Flippin, Why is My Child so Angry and Defiant? An Overview of Oppositional Defiant Disorder November21, 2019 ADDitude Inside the ADHD Mind https://www.additudemag.com/parenting-a-defiant-adhd-child/?utm_source=eletter&utm_medium=email&utm_campaign=parent_october_2019&utm_content=101919&goal=0_d9446392d6-49920db87f-292902485

[6]ADHD Editorial Board, Self-Test-Oppositional Defiant Disorder in Children  Additude Inside the ADHD Mindhttps://www.additudemag.com/test-for-oppositional-defiant-disorder-in-children-odd/

[7]ADHD Editorial Board Self-Test- Oppositional Defiant Disorder in Adults ADDitude Inside the ADHD Mind https://www.additudemag.com/screener-oppositional-defiant-disorder-symptoms-test-adults/?src=embed_link

[8]Dr. Douglas A. Riley, Child and Adolescent Psychologist The Defiant Child Taylor Trade Publishing 1997 https://www.google.com/books/edition/The_Defiant_Child/jZLCAAAAQBAJ?hl=en&gbpv=1&printsec=frontcover

[9]Oppositional Defiant Disorder Child Mind Institute https://childmind.org/guide/oppositional-defiant-disorder/

[10]Tips for Parenting Oppositional Children Amen Clinic https://www.amenclinics.com/blog/tips-for-parenting-a-child-with-odd/

[11]Joanne Bell, Stay Positive with ADHD: Tips for Parents, Teachers, and Students November 2019 http://thinkingthroughadhd.com/index.php/2019/10/20/stay-positive-with-adhd-tips-for-parents-students-teachers/

[12]Oppositional Defiant Disorder Mayo Clinic https://www.mayoclinic.org/diseases-conditions/oppositional-defiant-disorder/diagnosis-treatment/drc-20375837

[13] Of course, he is also aging and maturing as well – a not inconsiderable factor.

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