"My 8 y.o. has been diagnosed with autism (high functioning) recently, and before that was diagnosed with ODD. When we have behavior problems with him, it's hard to know if the particular 'misbehavior' is driven by autism or by ODD. How do we tell the difference, and how do we approach the multitude of behavior issues we are having with him?"
It may be tough at times to recognize the difference between a strong-willed or emotional autistic youngster and one with oppositional defiant behavior. Clearly, there's a range between the usual independence-seeking behavior of kids and defiant behavior. It's normal to exhibit oppositional behaviors at certain stages of development. However, your youngster's issue may be more serious if his behaviors:
- Are clearly disruptive to the family and home or school environment
- Are persistent
- Have lasted at least six months
The following are behaviors associated with oppositional defiance:
- Academic problems
- Acting touchy and easily annoyed
- Aggressiveness toward peers
- Anger and resentment
- Argumentativeness with grown-ups
- Blaming others for mistakes or misbehavior
- Deliberate annoyance of other people
- Difficulty maintaining friendships
- Refusal to comply with adult requests or rules
- Spiteful or vindictive behavior
- Temper tantrums
Oppositional defiant behavior often occurs along with other behavioral or mental health problems such as:
- Anxiety
- Aspergers or High-Functioning Autism (HFA)
- Attention-deficit/hyperactivity disorder
- Depression
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 ASD youngster'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.
Many kids with oppositional defiant behavior have other treatable conditions, such as:
- Learning and communication disorders
- Developmental disorders
- Depression
- Attention-deficit/hyperactivity disorder
- Anxiety
If these conditions are left untreated, managing defiant behavior can be very difficult for moms and dads – and frustrating for the affected youngster. Young people on the autism spectrum with oppositional defiant behavior may have trouble in school with teachers and other authority figures and may struggle to make and keep friends.
If your autistic youngster has signs and symptoms common to oppositional defiant behavior, make an appointment with your youngster's physician. After an initial evaluation, your physician may refer you to a mental health professional, who can help make a diagnosis and create the right treatment plan for your youngster.
Here's some information to help you prepare for your appointment, and what to expect from your physician:
• Make a list of your youngster's key medical information, including other physical or mental health conditions with which your youngster has been diagnosed. Also write down the names of any medications, including over-the-counter medications, your youngster is taking.
• Take a trusted family member or friend along, if possible. Sometimes it can be difficult to soak up all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your physician in advance so that you can make the most of your appointment.
• Write down the signs and symptoms your youngster has been experiencing, and for how long.
• Write down your family's key personal information, including factors that you suspect may have contributed to changes in your youngster's behavior. Make a list of stressors that your youngster or close family members have recently experienced and share it with the physician.
Questions to ask the physician at your youngster's initial appointment include:
- Are there any other possible causes?
- How will you determine the diagnosis?
- Should my son/daughter see a mental health provider?
- What do you believe is causing my son/daughter's symptoms?
Questions to ask if your youngster is referred to a mental health provider include:
- Do you recommend any changes at home or school to encourage my son/daughter's recovery?
- Do you recommend family therapy?
- Does my son/daughter have oppositional defiant behavior?
- Is my son/daughter at increased risk of any long-term complications from this condition?
- Is this condition likely temporary or chronic?
- Should I tell my son/daughter's teachers about this diagnosis?
- Should my son/daughter be screened for any other mental health problems?
- What else can I and my family do to help my son/daughter?
- What factors do you think might be contributing to my son/daughter's problem?
- What treatment approach do you recommend?
What to expect from your physician:
Being ready to answer your 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:
- Do any particular situations seem to trigger negative or defiant behavior in your youngster?
- Has your youngster been diagnosed with any other medical conditions, including mental health conditions?
- Have your youngster's teachers or other caregivers reported similar symptoms in your youngster?
- How do you typically discipline your youngster?
- How have you been handling your youngster's disruptive behavior?
- How often over the last six months has your youngster argued with grown-ups or defied or refused grown-ups' requests?
- How often over the last six months has your youngster been angry or lost his or her temper?
- How often over the last six months has your youngster been spiteful or vindictive, or blamed others for his or her own mistakes?
- How often over the last six months has your youngster been touchy, easily annoyed or deliberately annoying to others?
- How would you describe your youngster's home and family life?
- What are your youngster's symptoms?
- When did you first notice these symptoms?
Treating oppositional defiant behavior generally involves several types of psychotherapy and training for your youngster — as well as for you and your co-parent. If your youngster has co-existing conditions, medications may help significantly improve symptoms.
The cornerstones of treatment for oppositional defiance usually include:
• Cognitive problem solving training. This type of therapy is aimed at helping your youngster 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 youngster work together to come up with solutions that work for both of you — is highly effective at improving oppositional-related problems.
• Individual and family therapy. Individual counseling for your youngster may help him or her learn to manage anger and express his or her feelings more healthfully. Family counseling may help improve your communication and relationships, and help members of your family learn how to work together.
• 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 youngster. In some cases, your youngster may participate in this type of training with you, so that everyone in your family develops shared goals for how to handle problems.
• Parent-child interaction therapy (PCIT). During PCIT, therapists coach moms and dads while they interact with their kids. In one approach, the therapist sits behind a one-way mirror and, using an "ear bug" audio device, guides moms and dads through strategies that reinforce their kid's positive behavior. Research has shown that as a result of PCIT, moms and dads learn more-effective parenting techniques, the behavior problems of kids decrease, and the quality of the parent-youngster relationship improves.
• Social skills training. Your youngster also might benefit from therapy that will help him or her learn how to interact more positively and effectively with peers.
As part of parent training, you may learn how to:
- Avoid power struggles.
- Establish a schedule for the family that includes specific meals that will be eaten at home together, and specific activities one or both moms and dads will do with the youngster.
- Give effective timeouts.
- Limit consequences to those that can be consistently reinforced and if possible, last for a limited amount of time.
- Offer acceptable choices to your youngster, giving him or her a certain amount of control.
- Recognize and praise your youngster's good behaviors and positive characteristics.
- Remain calm and unemotional in the face of opposition.
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 youngster — even during difficult and disruptive situations. Don't be too hard on yourself. This process can be tough for even the most patient moms and dads.
At home, you can begin chipping away at problem behaviors by practicing the following:
• Assign your youngster a household chore that's essential and that won't get done unless the youngster does it. Initially, it's important to set your youngster up for success with tasks that are relatively easy to achieve and gradually blend in more important and challenging expectations.
• Build in time together. Develop a consistent weekly schedule that involves moms and dads and youngster being together.
• Model the behavior you want your youngster to have.
• Pick your battles. Avoid power struggles. Almost everything can turn into a power struggle — if you let it.
• Recognize and praise your youngster's positive behaviors. Be as specific as possible, such as, "I really liked the way you helped pick up your toys tonight."
• Set limits and enforce consistent reasonable consequences.
• Set up a routine. Develop a consistent daily schedule for your youngster. Asking your youngster to help develop that routine may be beneficial.
• Work with your partner or others in your household to ensure consistent and appropriate discipline procedures.
At first, your youngster is not likely to be cooperative or to appreciate your changed response to his or her behavior. Expect that you'll have setbacks and relapses, and be prepared with a plan to manage those times. In fact, behavior often temporarily worsens when new limits and expectations are set. However, with perseverance and consistency, the initial hard work often pays off with improved behavior and relationships.
For yourself, counseling can provide an outlet for your own mental health concerns that could interfere with the successful treatment of your youngster's symptoms. If you're depressed or anxious, that could lead to disengagement from your youngster — and that can trigger or worsen oppositional behaviors. Here are some tips:
- Be forgiving. Let go of things that you or your youngster did in the past. Start each day with a fresh outlook and a clean slate.
- Learn ways to calm yourself. Keeping your own cool models the behavior you want from your youngster.
- Take time for yourself. Develop outside interests, get some exercise and spend some time away from your youngster to restore your energy.
Resources for parents of children and teens on the autism spectrum:
==> Videos for Parents of Children and Teens with ASD
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