Aspergers, ADHD, and ODD

Question

My 8 year old Aspie also has ADHD and Oppositional Defiant Disorder [ODD]. I can deal with the ADHD and the Aspergers …it’s the ODD I am having a hard time with. How do deal with it and what works with dealing with this disorder? What do you do as far as discipline? We are at our wits end with this part of his diagnoses and would love some advice.

Answer

Aspergers (high-functioning autism) is often not be the only psychological condition affecting a particular youngster. In fact, it frequently coexists with other problems such as:

• Attention Deficit Hyperactivity Disorder (ADHD)
• Bipolar Disorder
• Depression (Major Depressive Disorder or Adjustment Disorder with Depressed Mood)
• Generalized Anxiety Disorder
• Obsessive Compulsive Disorder
• Oppositional Defiant Disorder (ODD)

Oppositional Defiant Disorder, also known as ODD, is a psychiatric behavior disorder that is characterized by aggressiveness and a tendency to purposefully bother and irritate others.

DSM delineates the criteria for ODD as follows:

A. A pattern of negativistic, hostile, and defiant behavior lasting at least six months during which four or more of the following are present: often loses temper, often argues with adults, often actively defies or refuses to comply with adult requests or rules, often deliberately annoys people, often blames others for his or her mistakes or misbehavior, is often touchy or easily annoyed by others, is often angry and resentful, is often spiteful or vindictive.

B. The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functions.

C. The behaviors do not occur exclusively during the course of psychotic or mood disorder.

D. Criteria are not met for Conduct Disorder, and if the individual is age 18 years or older, criteria are not met for Anti-social Personality Disorder.

Facts on Oppositional Defiant Disorder—

• 15% of ODD kids develop some form of personality disorder
• 20% of kids with ODD have some form of mood disorder, such as Bipolar Disorder or anxiety
• 35% of these kids develop some type of affective disorder
• 50-65% of ODD kids also have ADD or ADHD
• 75% of kids with Oppositional Defiant Disorder above the age of eight will still be defiant later in life
• Kids with CD and ODD are also at high risk for criminality and antisocial personality disorders in adulthood
• Many of these kids have learning disorders
• ODD is more common in boys than in girls before puberty
• ODD is reported to affect between 2 and 16 percent of kids
• Once kids enter adolescence, it is extremely difficult for moms and dads to change the ODD behavior

Symptoms of Oppositional Defiant Disorder—

Kids with ODD show defiant, hostile, and negativistic behaviors lasting at least six months, of which four or more of the following behaviors are present:

• actively defies or refuses to comply with adults' requests or rules
• argues with adults
• blames others for his or her mistakes
• deliberately annoys people
• is angry or resentful
• is spiteful and vindictive
• loses temper
• mean and hateful talking when upset
• often being touchy or easily annoyed by others
• seeking revenge

Causes of Oppositional Defiant Disorder—

There has been no systematic research into the causes of ODD; however, there are two theories as follows:

• Learning Theory: ODD comes as a response to negative interactions. The techniques used by moms and dads and authority figures bring about the oppositional defiant behavior.

• Developmental Theory: ODD is really a result of incomplete development. For some reason, ODD kids don't master the tasks that other kids master during their toddler years. They get stuck in the toddler stage (2-3 years old) and never really grow out of it.

Treatment of Oppositional Defiant Disorder—

• Cognitive-Behavioral Psychotherapy to assist in problem solving and decrease negativity
• Family Psychotherapy to improve communication
• Individual Psychotherapy to develop effective anger management
• Parent Training Programs to help manage behavior
• Social Skills Training to increase flexibility and improve tolerance to frustration with peers
• Stimulant Medication is prescribed only when ODD is accompanied by another disorder such as ADD or ADHD

Treatment is particularly important because kids with ODD are also at high risk for criminality and antisocial personality disorders in adulthood.

What Moms and Dads Can Do—

1. Avoid power struggles.
2. Build on the positives.
3. Establish a schedule for the family that includes specific meals that will be eaten at home together, and specific activities one or both parents will do with the Aspergers child.
4. Exercise and relax. Use respite care as needed.
5. Give effective timeouts.
6. Give the youngster praise and positive reinforcement when he shows flexibility or cooperation.
7. Limit consequences to those that can be consistently reinforced and if possible, last for a limited amount of time.
8. Manage your stress.
9. Offer acceptable choices to your Aspergers child, giving him a certain amount of control.
10. Pick your battles carefully.
11. Prioritize the things you want your youngster to do.
12. Remain calm and unemotional in the face of opposition.
13. Set up reasonable, age-appropriate limits with consequences that can be enforced consistently.
14. Stay involved in things other than your youngster with ODD, so that your youngster doesn't take up all of your time and energy.
15. Take a break if you are about to make the conflict with your youngster worse. This is good modeling, so be sure to support your youngster if he decides to take a time-out to prevent overreacting.
16. Try to work with other adults that are involved with your youngster, such as educators, coaches, and your husband or wife.

What Teachers Can Do—

It is important for educators to be aware of the disorders that their students are suffering from. Educators may or may not see symptoms of ODD at school. Even if the symptoms are not present at school, it is helpful to know what the moms and dads are dealing with at home. The more you communicate with the family and understand the situation, the better you will be able to help.

Click here for a complete parenting-course on how to deal with the Aspergers child who also has Oppositional Defiant Disorder.