Oppositional Defiant Disorder

My oldest daughter has always had a mind of her own, ever since she was a toddler. It's like she never got over the "terrible twos" where they say "No!" to everything you ask them. Now she is twelve and wants to think that she is all grown up and doesn't need to listen to anybody, regardless of who they are. I know a lot of teenagers are that way, but she's really extreme, even for a teenager.

At school they have always told me about how she's very smart, even though she has ADHD, but most of the teachers get fed up with her attitude. She is always arguing with whatever they say. They say white and she'll argue, "No, it can't be that way. It's really black." They call her "the lawyer" because she's always going on and on with her arguments. Sometimes she can be funny, but she doesn't know when to stop. The principal has suspended her three times this year for being disrespectful to teachers. They say this isn't part of her ADHD.

She seems to get along all right with other kids. She's one of the ringleaders of a group of girls at school. They play sports together. She's actually pretty good at soccer, and swimming and lacrosse. Coaches get frustrated though because anytime she makes a mistake, she always blames somebody else. She won't take responsibility for what is her own fault. She does the same thing at home. It's always somebody else who didn't do what they were supposed to. Nothing is ever her fault.

When her father and I set limits and won't let her go someplace she wants or won't buy her something she has decided she needs, she has a tantrum that can go on for a couple of hours, with lots of swearing and throwing things and repeated slamming of doors. We just don't know what to do with her! She's not a bad kid. She gets herself to school and practice every day and usually gets pretty good grades, but she's got a big-time attitude problem that we haven't found any way to improve much over the past ten years.

This girl's chronic negativistic and oppositional attitude extend beyond impairments usually associated with ADHD. According to her mother's report she has a long history of being defiant toward not only parents, but also teachers and other adults. She is not delinquent, but she reportedly maintains a very oppositional and defiant attitude in her interactions with most adults. This is an example of oppositional defiant disorder (ODD).

Overlap between ODD and ADHD is usually reported as very high, particularly when only the combined type of ADHD is considered. Usual estimates are that about 40 percent of children with ADHD also meet diagnostic criteria for ODD. Characteristics of ODD are mostly variants of excessively negative emotional reactions and their behavioral manifestations. These include frequent angry outbursts, arguing with or defying adults, annoyance with or blaming of others, touchiness, resentfulness, spitefulness, and vindictiveness. Most children who meet criteria for ODD do not have the more severe problems of conduct disorder (CD), a chronic pattern of more delinquent behavior that is discussed later.

I explained in Chapter 2 that problems in managing frustration and regulating emotion are one aspect of ADD syndrome. This is consistent with my earlier work (1996, 2001) as well as reports of other researchers such as Russell Barkley (1997), Keith Conners (1997), Conners and colleagues (1999), and Paul Wender (1995); all of us have reported problems in regulating emotion as an important aspect of the impairments of individuals with ADHD. But current diagnostic criteria for ADHD include no mention of problems with regulation of emotion. The very high incidence of the ODD cluster of negative emotional reactions among children with ADHD raises the question of whether chronic problems in managing emotions, especially frustration, may be an aspect of ADHD that was mistakenly excluded from the DSM-IV description of the disorder.

Ross Greene and others (2002) reported on large samples ofboys and girls, average age about ten years, who met diagnostic criteria for ODD alone or ODD with conduct disorder. He compared these children with others who had other psychiatric problems, but not ODD or CD. Comparisons showed that socioeconomic status was significantly lower for families of children with ODD alone, and for ODD with conduct disorder, than for families of children with other psychiatric disorders not including ODD or CD. These findings suggest that children with ODD and/or CD are more likely to come from relatively disadvantaged families.

Greene found that schoolchildren with ODD and/or CD had higher rates of placement in special education classes, though his three groups did not differ in rates of repeated grades or need for tutorial assistance. This suggests that children with ODD or CD were seen as needing more intensive supervision in school. But problems of children with ODD were not limited to school settings. Social impairments of those with ODD, with or without CD, cut across all domains of social functioning, including relationships with parents, siblings, and peers. Individuals with this combination of executive function impairments (from ADHD) and chronic problems in managing negative attitudes and emotions (which characterize ODD) tend to make significant difficulties for themselves and others in virtually every social setting.

Greene and colleagues (2002), as well as others, have reported that families of children diagnosed with ODD, with or without CD, tend to show significantly poorer family cohesion and significantly higher levels of family conflict. One possibility is that ADHD impairments with ODD symptoms of the child tend to create more conflict with parents. Another is that parents of these children may be more harsh and more likely to provoke the child, thus establishing a pattern of intensified reciprocal anger and chronic conflict that the child carries to other situations. It is likely that socioeconomic disadvantage also contributes substantially to chronic stress in many of these families.

ADHD Helping Your Anxious Child Audio

ADHD Helping Your Anxious Child Audio

Has Your Child Been Diagnosed With ADHD Is Coping With Your Child's Behavior Wearing You Out Are You Tired of Searching For Answers An ADHD child does not have to have a dark cloud over his or her head. If You've Got Burning Questions About ADHD, I've Got Answers.

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