I certainly hope that my posts help each of you with ideas and suggestions for approaching your day to day life.  I know that often just the process of writing the blog post helps me to think through the day to day situations that we face as a family. 

In a previous post I wrote about ADHD and anger.  I explored how anger management is a challenge for those with ADHD because, like behavior regulation challenges – a hallmark of ADHD, anger management is a regulation of the emotions.  Because of the impaired nature of the Executive Functioning in those with ADHD, emotions are often more intense and more challenging to regulate.  As a result, I look at how our son handles frustration and anger as not a discipline issue but an opportunity to teach him how to handle frustration and anger constructively.

Hand in hand with the anger and frustration is often hitting.  To tell the truth, I have had concerns about our son’s hitting and have tried to teach him to use his words instead of his hands/body in expressing his anger and frustration.  His hitting kind of remained a fuzzy situation that has bothered me in the back of my head but it is not something I had really spent a great deal of time focusing on.  As I prepared to write this post, I thought through the reason for that.

First of all, we do not have any troubles with him hitting other kids. Well, except for his sister, which I really attribute to the typical sibling interaction.  I fondly remember my brother and I beating the c—p out of each other through high school!!  Secondly, we have no discipline challenges with him at school whatsoever.  So what I realize bothers me is that he does lash out at his father and myself from time to time.

So I have done some research on the topic and have discovered that aggressive behavior is common in young children.  Until a child reaches something like the age of six or so, he is not developmentally mature enough to curb his or her impulse to hit.  Our son is older than six but his ability to handle frustration maturely is still in development and the fact that he largely directs it at his father and I is okay for me for now. 

Why do I think it is okay, for now?  I think that developmentally he is not able to fully control his emotions yet. In addition, we are a safe place for him to direct his anger and frustration – he is working so hard that I think he needs a safe place to express his frustrations.  Finally, he often is least able to handle his frustration or anger when he is tired or when he has spent too much time in front of the tv or video games.   It is up to my husband and I to make sure that he is getting enough sleep and exercise and that we help guide him when he is in overtired situations.  I often verbalize that you are angry and frustrated because you are tired and dad and I need to make sure that you get enough sleep tonight.

What have we done to help him address those situations when he wants to hit?

•  Figure out another outlet for his anger.  We have chosen an “anger” pillow that he can take out his frustrations on.

•  Teaching him words to associate with a situation.  We literally practice the phrases, “you are making me angry”, “I am really frustrated right now” or “I need the anger pillow.”  I am also careful to make sure that I use the phrases myself – “I am really frustrated because I can follow your crumb trail from the kitchen to the living room.

• Recognizing his feelings and verbalizing them.  “I know that you are upset because I am not allowing you to play your DS.  In order for you to be healthy, you need to play and get fresh air. 

• Reinforce verbally that hitting is wrong.  It is as simple as saying over and over again, “you are not allowed to hit.”  I also have our son look at the person that was hit and apologize sincerely. 

• Reinforce when you see frustration and anger handled appropriately.  “I am so proud of you for using the anger pillow instead of hitting me.”  I have, with fits and starts in the past, tried to do reward charts but I have found that our son reacts most positively when rewarded immediately.  So I often praise immediately, offer a treat or say let’s do this together as a reward for your great behavior.

So after writing this blog post, I have found that I am less concerned about his hitting than I used to be at the back of my mind and I have resolved with renewed vigor to keep doing the steps outlined above.

Let me know your thoughts and what works for you.

Until next time …… take care.

The outbursts, the tantrums, the eruptions … day in and day out. It is so stressful. Is it ODD? What is it? Should I be concerned?

The answer to the “should I be concerned question” is both yes and no. Yes, because any child needs to be taught how to handle situations and frustrations with a healthy response. No, because if you look at the problem through the lens of ADHD, it is another symptom of the disorder.

Believe me, I often stress over the angry outbursts and tantrums. They raise my stress level and there are days that they make me exhausted beyond belief. I have found, however, that a shift in my mental framework towards the angry outbursts help. Let me explain.

I thoroughly believe at this point that ADHD is a neurological disorder that impacts the executive functioning within the frontal lobe of the brain. I have written on numerous occasions that this can manifest itself in many different ways. Most associated with ADHD is either hyperactivity or inattention. Both are forms of behavior regulation. Hyperactivity is the inability to control or limit one’s activity and inattention is the inability to maintain attention when there is no interest in an activity or the activity is too challenging (i.e. too frustrating).

So why have I consistently put anger in a different category?

I have even done research into ODD, being concerned that his anger is an indication of ODD. (About 1/3^rd of kids with ADHD do develop some form of ODD) Well, duh, it dawned on me that really anger or lack of handling anger is just another form of regulation. It is emotional regulation versus behavioral regulation but it is really just another form of regulation.

So I have another one of those enlightened moments that seems so stupid after the fact. Gee why did I not realize that anger is just another regulation/management issue that is so challenging for someone with ADHD?

I have noticed that when our son spends more time watching TV or playing video games that he seems to be an angrier child. Exercise is important for any child but can be the difference between a reasonable child and a tantrum child for someone with ADHD. I even say to my son, “Wow, you have watched too much TV/played too many video games – you are angry boy. “ This helps him to identify what is going on and helps him to stop and think.

We still need to teach our son how to handle situations that make him upset or frustrated. It helps me, though, to think of it as a situation that needs to be managed (exercise and fresh air) and taught and not as a discipline problem.

I hope this approach helps you too.

Until next time …. Take care.

One of the things I struggle with as a parent of a child with neurological issues is really grasping everything.  There are times when I feel that I have a handle on things and there are times that I worry about all kinds of issues.  Does he have other psychological and behavioral issues?  Is he suffering from clinical anxiety, does he have ODD, what is immaturity, bad behavior and what is executive functioning deficits?  Sometimes I think I might go mad with all of the questions running around my head!

One term that I have heard fairly often and frequently worry about is ODD, Oppositional Defiant Disorder.  Many parents have not heard about this disorder but it apparently is one of the most common psychiatric problems in children affecting around 5% of the child population.  It also affects a high percentage of children with ADHD … around 30 to 40% of those with ADHD also have ODD. In fact it is exceptionally rare for a child to only have ODD; ODD is commonly associated with ADHD and depression/anxiety.  Oh that lovely comorbidity thing again!!

So what is ODD?  One of the best descriptions I have heard of ODD is by Jim Chandler, MD, FRCPC.  (http://jamesdauntchandler.tripod.com/).  According to Chandler, “ODD is a psychiatric disorder that is really just the far end of the stubbornness spectrum.  The line that divides being just difficult and stubborn from ODD is a set of diagnostic criteria.”

The criteria for ODD are:

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 adults’ 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 and vindictive

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

Now why do I worry about this so much and why am I confused?  I think any parent of child with ADHD probably struggles with getting their child to cooperate with homework, chores and the other necessities of life.  Our son often throws fits and refuses to cooperate.  This is pretty much a daily occurrence.  Are they outrageous, knock down fits?  No.  He occasionally has an outrageous fit but not often.  But why does he throw these everyday fits:

• Is it because some times he gets his way?
• Is it because of executive functioning deficits which cause a low threshold for frustration?
• Is it a side effect of the medication?
• Is it a transition issue?
• Is it because he is exhausted from school?
• Is it signs of ODD?

I think this is the most difficult part of our son’s neurological challenges – not knowing the answers to everyday occurrences.  Am I doing something wrong?  Am I doing something right?  What should I be doing?  And the internal battle of questions rages on and on in my head non-stop.

I decided to do some research into ODD for today’s blog post because it is an area I have been concerned about but have not really had the time to research.  What I found to be the key criteria for ODD is spitefulness and vindictiveness.  This coupled with a blaming others for his or her mistakes or misbehavior are key signs of ODD.  According to Chandler, “the destructiveness and disagreeableness are purposeful.  They like to see you get mad.”  It is this description that turned on the lightbulb for me.  Our son often refuses to cooperate but he is not spiteful or vindictive. He is “oppositional” mostly because he does not want to do what I am asking not because he wants to see me get mad.

To read Jim Chandler full pamphlet on Oppositional Defiant Disorder, please go to http://jamesdauntchandler.tripod.com/ODD_CD/oddcdpamphlet.pdf.  It is a straightforward description with examples that I found to be tremendously enlightening.  Most other sources of information that I found online stuck with the Diagnostic and Statistical Manual of Mental Disorders definition as an ongoing pattern of disobedient, hostile and defiant behavior toward authority figures which goes beyond the bounds of normal childhood behavior.  Most sources of information are very clinical with very few examples.

So I am happy to say that our son’s stubbornness does not seem to fit within the range of Oppositional Defiant Disorder.  Yeah!  Cross that off the list, for now (J).  So now I need to worry if it is a side effect of the medication ….. sigh.