So, you have just had your diagnosis of ADHD for your child and then the Specialist starts throwing other initials at you, e.g., ADHD and ODD! As if ADHD does not have enough concerns for you to address, you will often find that it rarely exists by itself. ADHD (Attention Deficit Hyperactive Disorder) and ODD (Oppositional Defiant Disorder) often exist simultaneously. About 60 % of people who are diagnosed with ADHD also suffer from one or more other conditions.
Certain conditions are considered secondary, i.e., triggered by ADHD. For example, many children who are constantly given negative feedback due to their ADHD will likely suffer from depression and anxiety. Hopefully, once the ADHD is addressed in whatever form, the depression will subside. However, if the ‘secondary’ condition does not become resolved by the effective ADHD treatment then it is termed a comorbid condition. A comorbid condition will require its very own, specific treatment. It is thought that more than half of children diagnosed with the combined form of ADHD will develop a behaviour disorder. ODD is just one such behavioural comorbid condition. One that my daughter has.
What is ODD?
Oppositional Defiant Disorder is exactly as the name sounds. The child will be extremely defiant and hostile, particularly towards a figure of authority. It is deemed a childhood behaviour disorder. For a diagnosis to occur, you must have seen this pattern of particularly hostile, vindictive and defiant behaviour for six months consecutively.
I remember everyone telling me it was the terrible twos. As I have mentioned before, I have twins, so it was hard not to compare how self-soothing my boy twin was to my girl. I always noticed how defiant she was at such a young age, maybe 18 months, there was just a difference. Hey, but what did I know? Everyone had told me that the terrible twos were terrible. I thought maybe she had just got there quicker. Then people laughed and said, that’s girls for you.
I remember as she grew older, still only young, another mum friend had to say no to her. She looked them straight in the eye and kept doing it. The epitome of defiant. As a kid, I would have died of shame if my mums’ friend had had to tell me off. Nothing phased her. She was ballsy alright. I remember my mum and dad, two of the loveliest grandparents you could ask for tried to appease her once. They gave up! She appeared to have no fear or respect for anyone!
As usual, my gut was telling me this was not quite right. There was something about her behaviour that was so argumentative and disobedient, for such a young age. She would lose her temper so quickly and actually argue back to adults when she could barely speak, actively defy rules, becoming so angry, disruptive and damn right violent. And this only got worse as she got older… It has been an exhausting journey.
On a holiday to Turkey one year, she had a meltdown. To be honest, I was close to one myself as baggage reclaim was taking an exceedingly long time. She lost it. Tried to walk back the way we had come announcing she was going to get back on the plane. She was stopped by a Turkish policeman with a large machine gun. It may as well of been a water pistol. She continued to rant at him! I think at this point I sat on the conveyor belt and bobbed along with the suitcases.
Girls and boys can present differently with ODD as with ADHD. Boys are generally more physically aggressive whereas girls will be more likely to refuse to cooperate. I read a while back that ODD is diagnosed in childhood and that many patients grow out of it before ten. My daughter is twelve and still going strong!
Symptoms of ODD
Whilst it is so common that kids will lash out and say hurtful things to their parents, with ODD it is a constant. I will not lie. My daughter’s ADHD and ODD have been a complete challenge. She has displayed all the following behaviours at some point or another and far too frequently:
Defiance against most rules
Frequently argumentative; must have the last word
Argumentative and irritable
Deliberately annoying others
Sudden explosions of anger
Yup, these are some of the delights that ODD brings.
Whilst approximately 5% of the population has ODD, approximately 40 per cent of children with ADHD live with ODD also. That is a high statistic. Then, just to make matters worse about 40% of these children will develop Conduct Disorder. This is a more serious disorder that can lead to stealing, hurting and other anti-social behaviour. The message is clear, try to sort ODD as early as you can, but how?!
What Causes ODD?
Like with most of these neurological, and behavioural disorders, there never seems to be one simple answer but more a combination of possibilities: biological; social and psychological. Here are a few theories put forward:
Inherited Genetics, although no one gene has been found to be responsible
Poverty and Socio-economic factors e.g., poor nutrition
Harsh parenting and insecure attachment
Smoking or drug use during pregnancy
Traumatic Life events e.g., divorce in the family, child abuse
Co-occurrence with ADHD
A parent with depression and/or other mental illness
My daughter was diagnosed with ODD at the same time as ADHD. Sometimes the medication for ADHD can help. I have noticed nothing.
Ideas to help with ADHD and ODD
I have no magic wand, no magic pill, no life-changing words. I just have certain things I have learnt over the years, that have helped my daughter and me.
1. Attend Positive Parenting courses. I have done so many parenting courses over the years. Some have been insightful, some patronisingly boring. The Triple P one I found to be good. Whatever works for you and your family. If you take away one or two tips, and maybe meet and chat with a few parents in the same position as you, what can be the harm?
2. Keep reminding yourself that this is a real disorder and that they are not just being awkward and nasty to you on purpose. Try to keep this in mind and try to stay calm. Believe me, I know it is not easy, but it really helps. If you join in with the ranting, it’s just going to escalate further. And if you cannot control your temper, how are they supposed to control theirs? You are sending a truly clear message that you are in control and there for them. Really try to keep your tone as calm as possible.
3. Literally keep a notebook of things that have caused a trigger. I know sometimes it may appear that there was no trigger at all but generally there will be some common thread. Once you know what that is you can try to understand why it is happening. My daughter always had a meltdown in supermarkets. I would let her have a treat if we completed the shop in relative peace or let her pick what she would like for dinner whilst there, including dessert!
4. Talk to your kids about emotions. I will let my kids if I am tired or sad, or if something has made me cross. It is ok to have emotions! It’s how we deal with them that is the issue. If you have a moment yourself, show them how you are sorry for what you did. They will so appreciate you owning it!
5. If a meltdown occurs find something to calm it, and have this in place. I try to get my daughter to come and sit and have a cuddle on my bed and talk to her. The other day I read something on ADDITUDEMAG.com that said to ask them to grab a snack and meet you in the lounge/garden/bedroom etc. I thought that was a cute idea.
6. Another great point I picked up on a parenting course a couple of nights ago, which I am planning on using. It was saying how to use your language to let them believe they are in control. That way, any consequence that follows is due to them, not you are being mean.
For example, let your kids know that video/electronic time is a privilege, not a given. Then when you need them to do something you can say I need you to unload the dishwasher and set a time limit, if it is not done then obviously there will not be electronic time tonight. If it has not been done you can say, I am sorry you chose to lose your electronic time tonight. Hopefully tomorrow you will make better choices and get it back. AND ALWAYS FOLLOW THIS THROUGH. You have now worded it in a way, where they had the control to have their time on electronics, but they made poor choices.
7. When my daughter is getting the RED MIST and arguing for no point other than to be angry and argumentative, I call her Scary Mary. Sometimes, this makes her realise where she has gone. I am not saying this works every time. Obviously have a chat before they get to that heightened stage, but Scary Mary can sometimes make her see what is happening. You could use any word, nothing technical, nothing negative, I always use humour where possible.
7. Consistency. Always be consistent with whatever approach you take. Clear expectations, consequences and rewards.
Believe me, I honestly know how tough this is. Sometimes I am at my wit’s end and I am trying to stay so calm as she hurls abuse at me that is so hurtful. I just keep saying in my head that she does not mean any of it.
My daughter became so aggressive to her younger brother, verbally and even physically, that I ended up calling a social worker in. They came and sat and talked to us all, then to me and my daughter. They were amazing. I think having someone else tell her that it was unacceptable to treat her brother this way really hit home.
At the end of the day, we are only human, you can only do your best. Some days will be tougher than others and if you do rage back, give yourself a break. Tomorrow is another day. As with many issues with ADHD, it can be so complex and so individual to your child. Things I have suggested may not work for you at all. I would love any other suggestions myself! As parents/carers of children with ADHD, we are all still learning what strategies help. If anyone wants to join my small parenting group on FB please do click here, we’d love to have you x
Above all take care of yourself.