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High-Functioning Autistic Teens and Oppositional Defiance

“I have a 14-year-old son with high functioning autism who behaves in a way that mystifies me...I cannot do anything right, according to him. I had never heard of Oppositional Defiant Disorder, and after reading the symptoms, I think that he should be seeing a doctor about possibly having this disorder. I have noticed symptoms like the ones mentioned in him since he was very young.  I have tried to talk to him about it and he has told me that he feels out of control at times with his temper, especially when it comes to people of authority. I have learned to not talk about anything he might turn on. I e-mail him across the house and have learned to speak to him in his language. Is it possible for a child to have both disorders? What action should parents take in these cases?”

Many parents have difficulty recognizing the difference between a strong-willed, emotional teen with High-Functioning Autism (HFA) or Aspergers’ (AS) and one with Oppositional Defiant Disorder (ODD). Clearly, there's a range between the usual independence-seeking behavior of teens and out-of-control defiant behavior. It's normal to exhibit oppositional behaviors at certain stages of an adolescent’s development. However, your teen’s issue may be more serious if his behaviors:
  • Have lasted at least six months
  • Are persistent
  • Are clearly disruptive to the family or school environment

The following are behaviors associated with ODD:
  • Tantrums
  • Spiteful or vindictive behavior
  • Refusal to comply with adults’ requests or rules
  • Difficulty maintaining friendships
  • Deliberate annoyance of other people
  • Blaming others for mistakes or misbehavior
  • Argumentativeness with parents, teachers and other authority figures
  • Anger and resentment
  • Aggressiveness toward siblings and peers
  • Acting touchy and easily annoyed
  • Academic problems



Oppositional defiant behavior often occurs along with other behavioral or mental health problems, such as autism spectrum disorders, depression, ADHD, and anxiety. The symptoms of defiant behavior may be difficult to distinguish from those of other behavioral or mental health problems. It's important to diagnose and treat any co-occurring disorders, because they can create or worsen irritability and defiance if left untreated.

Stressful changes that disrupt an HFA or AS teen's sense of consistency increase the risk of disruptive behavior. However, though these changes may help explain disrespectful or oppositional behavior, they don't excuse it.

If your HFA or AS teen has signs and symptoms common to ODD, make an appointment with your physician. After an initial evaluation, the physician may refer you to a mental health professional who can help make a diagnosis and create the right treatment plan for your teen.

==> Discipline for Defiant Aspergers and High-Functioning Autistic Teens

Here's some information to help you prepare for an appointment:
  1. Write down your family's key personal information (e.g., factors that you suspect may have contributed to changes in your teen's behavior).
  2. Make a list of stressors that your teen or close family members have recently experienced.
  3. Write down the signs and symptoms your teen has been experiencing – and for how long.
  4. Take a trusted family member or friend with you to the appointment. Someone who accompanies you may remember something that you missed.
  5. Make a list of your teen's key medical information (e.g., any physical or mental health conditions that he has been diagnosed with).
  6. Write down the names of any medications your teen is taking (include any over-the-counter medications).
  7. Write down questions to ask the physician in advance so that you can make the most of your appointment.

Questions to ask the doctor if your HFA or AS teen is referred to a mental health provider include:
  1. What treatment approach do you recommend?
  2. What factors do you think might be contributing to my teenager’s issues?
  3. What else can I and my family do to help my teenager?
  4. Should he be screened for any other mental health problems?
  5. Should I tell his teachers about this diagnosis?
  6. Is this condition likely temporary or chronic?
  7. Is my teen at increased risk of any long-term complications from this condition?
  8. Do you recommend family therapy?
  9. Do you recommend any changes at home or school to encourage my teen’s recovery?
  10. What do you believe is causing his symptoms?
  11. Are there any other possible causes?

Being ready to answer the physician's questions may reserve time to go over any points you want to talk about in-depth. You should be prepared to answer the following questions from your physician:
  1. What are your teen's symptoms?
  2. When did you first notice these symptoms?
  3. How would you describe your teen's home and family life?
  4. How often over the last six months has your teen been touchy, easily annoyed or deliberately annoying to others?
  5. How often over the last six months has your teen been spiteful or vindictive, or blamed others for his own mistakes?
  6. How often over the last six months has your teen been angry or lost his temper?
  7. How often over the last six months has your teen argued with you or his teachers?
  8. How often has he refused to follow through with your rules or requests?
  9. How have you been handling your teen's disruptive behavior?
  10. How do you typically discipline your teen?
  11. Have your teen's teachers reported similar symptoms?
  12. Has your teen been diagnosed with any other medical conditions?
  13. Do any particular situations seem to trigger defiant behavior in your teen?

Treatment—

Treating oppositional defiant behavior (whether or not your teen has a formal diagnosis of ODD) involves several types of psychotherapy and parent-education training. The cornerstones of treatment for oppositional defiance usually include:

1. Social skills training: Your teen may benefit from therapy that will help him learn how to interact more positively and effectively with peers.

2. Parent training: A mental health provider with experience treating oppositional behavior may help you develop skills that will allow you to parent in a way that's more positive and less frustrating for you and your teen. In some cases, your teen may participate in this type of training with you, so that everyone in your family develops shared goals for how to handle problems. As part of parent training, you may learn how to:
  • Remain calm and unemotional in the face of opposition.
  • Recognize and praise your teen's good behaviors and positive characteristics.
  • Offer acceptable choices to your teen, giving him a certain amount of control.
  • Limit consequences to those that can be consistently reinforced and last for a limited amount of time.
  • 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 teen.
  • Avoid power struggles.
3. Individual and family therapy: Individual counseling for your teen may help him learn to manage anger and express his feelings more healthfully. Family counseling may help improve your communication and relationships, and help members of your family learn how to work together.

4. Cognitive problem solving training: This type of therapy is aimed at helping your teen identify and change through patterns that are leading to behavior problems. Research shows that an approach called collaborative problem solving — in which you and your teen work together to come up with solutions that work for both of you — is highly effective at improving oppositional-related problems.

Although some parent-management techniques may seem like common sense, learning to use them in the face of opposition isn't easy, especially if there are other stressors at home. Learning these skills will require consistent practice and patience. Most important in treatment is for you to show consistent, unconditional love and acceptance of your HFA or AS teen — even during difficult and disruptive situations. Don't be too hard on yourself. This process can be tough for even the most patient mom or dad.

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Parenting Strategies—

At home, you can begin chipping away at problem behaviors in your HFA or AS teen by practicing the following:
  • Develop a united front. Work with your partner/spouse to ensure consistent and appropriate discipline procedures.
  • Set up a routine. Develop a consistent daily schedule for your teen. Asking your teen to help develop that routine can be helpful.
  • Set limits and enforce consistent reasonable consequences.
  • Recognize and praise your teen's positive behaviors. Be as specific as possible (e.g., "I really liked the way you helped pick up your room tonight").
  • Pick your battles carefully. Avoid power struggles. Almost everything can turn into a power struggle — if you let it.
  • Model the behavior you want your teen to exhibit.
  • Build in time together. Develop a consistent weekly schedule that involves you and teen being together.
  • Assign your teen a household chore that's essential and that won't get done unless he does it. Initially, it's important to set your teen up for success with tasks that are relatively easy to achieve, then gradually blend in more important and challenging expectations.
  • Take care of yourself. Counseling can provide an outlet for your own mental health concerns that could interfere with the successful management of your teen's defiant behavior. If you're depressed or anxious, that could lead to disengagement from your teen, which can trigger or worsen oppositional behaviors. Let go of things that you or your teen did in the past. Start each day with a fresh outlook and a clean slate. Learn ways to calm yourself, and take time for yourself. Develop outside interests, get some exercise, and spend some time away from your teen to restore your energy.
  • Remind yourself that your teen’s defiance is most likely a temporary inconvenience rather than a permanent catastrophe.

At first, your teen is not likely to be cooperative or appreciate your changed response to his behavior. Setbacks and relapses are normal, so be prepared with a plan to manage those times. In fact, behavior often temporarily worsens when new limits and expectations are set. However, with persistence and consistency, the initial hard work will pay off with improved behavior.





Resources for parents of children and teens on the autism spectrum:
 

==> Videos for Parents of Children and Teens with ASD
 
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COMMENTS:

 •    Anonymous said… Absolutely possible! My daughter has High Functioning Autism and ODD. We have found that by changing how we approach certain triggers, we can avoid the ODD eruptions. If she does blow up, we've also learned that it is not the time to push her or try to persuade her unless it is a safety issue. she can only have a learning experience once she has calmed down.
•    Anonymous said… Following. Yes please which meds have been given and which worked best in your situations
•    Anonymous said… I am exhausted! What meds have helped? I have a 17 year old with Aspergers and a suspected ODD diagnosis.
•    Anonymous said… I believe it to be under the umbrella... ocd and add/odd are subcharacteristics of HFA and Aspergers. My son was orignianlly diagnosed ODD/OCD/Major Depression (missing the BIGGER picture for a couple of years until finding a doctor who knew what Aspergers looked like). Once medicated (this took time to find right fit), years of counselling and finding something he enjoyed and was good at, much of the ODD symptomology extinguished. It's understandable how one would be oppositional when his/her life is so "out of control"- anger, fear, frustration all leads to a normal brain to want to gain control over his/her environment; couple that with the angst of teenage years for the neurotypical as well and you have a big mess. Most difficult years for me and mine were ages 11 to 16. Again, medication helped tremendously; in addition to, all of the other components to a comprehensive plan (counselling, family support). I point to the medication because if one is crawling out of his/her own skin...behavior modification will not work. My son is 31 today, still medicated and is successful and happy (gainfully employed, lives on his own, is delightful). It's a long hard road, but worth the pain.
•    Anonymous said… I do think it is unfortunate to label a particular behaviour as a disorder. We have had occasions over the years when my son has dug his heels in and refused to do as expected of him. He quite logically explains that he is unable to comply with our expectations at times when he doesn't feel in control of a situation and feels over-anxious. He is 19 now and recently started playing guitar. A family friend helps run a folk club and invited us to go along. I was amazed the first time that Oliver got up when invited and performed in front of everybody. He attended again on the next meeting and again performed. My friend had arranged to pick up us again a couple of weeks later and I was so looking forward to this but Oliver made it clear that he wan't going to go this time. I was disappointed but nothing would persuade him. AFTER the event when I was able to talk to Oliver calmly he explained that he just hadn't felt ready with his new song but would go again in the future when he felt better prepared. We have been a couple of times since. The real problem over the years was always my own frustration with his decisions when they interfered with my own plans but if I stayed objective and calm we could in due course talk things over together. I could help Oliver understand my disappointment when things didn't go as planned and Oliver would help me see how difficult it was for him to do things if he was over-tired, unprepared, stressed or just having a bad day.
•    Anonymous said… I have looked at PDA and although there are similarities with ODD and PDA, our son is definitely ODD and both of these diagnoses can operate in ASD. We have been on our journey for more than five years and with therapy, medication and great support we've made incredible accomplishments with our son. It is as many have said though...very exhausting.
•    Anonymous said… PDA strategies are ery different to strategies for ODD. Reducing demands and providing an anxiety free environment is ideal. Anxiety free isnt possible but a happier calm child has a better chance of learning strategies to deal with demands.
•    Anonymous said… I was that child...tho they did not have a label for it back then. I would recommend to be respectful and ackowledge his feelings but at the same time dont walk on egg shells. Use "i" statements like "i need u to..." and avoid labels like "youre" this and that etc. At the same time clear boundaries and expectations and a consistant reward and consequence system. Another huge thing is the consequence having something to do with the action and not being a punishment. I know this wouldve helped if my parents had known better. but i got a lot of name calling from my parents and was made fun of by kids at school as well as my parents. It cannot have been easy for them and they mustve gotten some relief out of letting off some steam. A psychiatrist even recommended that they slap me (yes a westwood, ma psychiatrist who is still practising). I would say that has been the most detrimental thing to my aspergers and ODD and would not recommend it.
•    Anonymous said… I've never heard of ODD but it sounds like my daughter might have this. Thanks for mentioning it.
•    Anonymous said… My aspie gas O.D.D. & believe, it's a challenge!!!!
•    Anonymous said… My daughter was dx with ODD 10 years ago and it never sat right with me, after researching PDA I believe she has that
•    Anonymous said… My son has Asperger's and O.D.D. We are also questioning P.D.A. but CAMHS aren't keen on giving it as a diagnosis. Worth reading about it though. My son is 15, not hit puberty yet and it's really hard going most of the time x
•    Anonymous said… My son has both its very difficult and trying  😣
•    Anonymous said… My son is 14 and is diagnosed ODD, Aspergers and Mixed Mood/Anxiety. His first diagnosis was ODD aged 9.
•    Anonymous said… My son is on seraquel, Prozac and trazadone ..he's 18 and doing much much better, hang in there!
•    Anonymous said… My son was diagnosed when he was 4 with ASD ADHD and odd its a real challenge to say the least..
•    Anonymous said… My sons defiance seems to come from anxiety. Wanting to gain/regain control because he frequently feels powerless or vulnerable. Not sure if he has ODD but giving him explanations about why things need to be done and helping him find ways to feel more in control and powerful sometimes has really helped. The more I push the more he pushes back. You have to bend and manoeuvre. Tiring and time consuming but works for us.
•    Anonymous said… Not only possible..very likely, Autism always pairs with another disorder from what I have been told through the many hospitals and psychiatrists we have seen, my son who is 18 now was diagnosed with both way back when, it's a long hard struggle and a lot of work, do the testing for diagnosing ..stay strong friend!
•    Anonymous said… ODD and Aspergers combined have been the most challenging diagnoses I have ever encountered! I am worn out as a parent. Meds have helped but it has been a tough journey.
•    Anonymous said… Our 11 year old is on the Spectrum as high functining (aka Aspergers) with multiple diagnoses, one being ODD. We have him in therapy and he's learning how to manage it. It is definitely exhausting, but very treatable. Hang in there...if you can find a support group for yourself...you'll find that helps.
•    Anonymous said… Our son was diagnosed at age12 with high function autism. He is now 15 and I strongly feel he also has ODD.
•    Anonymous said… Please research PDA. People with ASD with Demand avoidance behaviours usually have Pathological Demand Avoidance. If they dont have ASD then they probably have ODD. PDA is part of the Autism spectrum.
•    Anonymous said… Ugh, what do you do when this keeps on into adulthood?
•    Anonymous said… Vincent my 4 yr old seems to have ODD. I'm not sure if it is a symptom of Autism or a standing disorder in him. I was told, I needed to verify if he was indeed not Autistic because ODD can be a symptom of Autism. Not sure how I feel about my developmentally delayed child possibly being diagnosed as Autistic when I am not even sure if I believe he is, and know in my heart that he could be due to how he is AND his delays. I'd hate for him to be misdiagnosed whem he very well may just have ODD. So, If I were you I would research and speak to multiple professionals about weather or not this is a symptom of or an actual disorder for your individual child.
•    Anonymous said… We have tried several meds throughout the years (Clonodine, Intuniv, Prozac etc)! What worked the best for my child was Seroquel.
•    Anonymous said… Yes our son was diagnosed with Aspergers and ODD at 15, although he had these symptoms for years...The medicine Lamictal has really helped!
*   Anonymous said...What do you recommend for my 15yo high-functioning ASD with ODD who absolutely refuses anymore counseling or meds? We’ve done both over the years, with no real success. The meds we’ve tried have all had side effects that make him feel horrible. He also hates how they numbed his appetite, and he said they made him super quiet “like a zombie” (teachers confirm this). They didn’t improve his grades (he also has dyslexia & math LD)The counseling, though good advice from the counselors, had no effect on him outside the counseling room, and now he refuses to go anymore. If we try to force it, with consequences and such, we get the out-of-control, angry, horrible behavior nonstop…it’s unbearable. So we’ve been on no meds & no counseling for 6 months now. Behavior is inconsistent, but grades and motivation at school are still bad. Still rude and illogical when the mood hits, but we avoid power struggles and allow for reasonable compromises when he’s trying to exert control. He has good and bad days. It’s like he’s in that gray gap- not bad enough to force meds or professional treatment, but not on the healthy road to success with his choices and behaviors. Any advice? Again, meds and counseling he refuses at this point. Thanks for any advice.
*   Anonymous said...I have a 10 YO Son ASD, ODD, working with the local health food store on supplements, 5 HTP heavy metal detox etc. To help him to be able to control himself. It has worked for tons of friends, I will keep you posted. Also homeopathic remedies are helping too.
 
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