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.

Candace McLane combines her practical experience as a mom with ADHD children with her professional experience as an occupational therapist to present clear, well thought out ideas for managing life. She has many great suggestions that not only are good for kids with ADHD but for family life in general. Power Moms Unite is definitely a great resource!
 
 
Candace McLane, MA

I am the Mom CEO of a large family (1 spouse, 5 kids), whose many members struggle to manage their ADHD. A retired occupational therapist, I am a tenacious advocate for families living with ADHD, ODD, and other co-morbid diagnoses. I am a frequent speaker for schools, churches, and various civic organizations on topics about ADHD and large families with special needs. If you are in the Philadelphia/NJ/DC area I would love to share my experiences with you.

I hope the site provides laughter, encouragement, insights, and conversation… as well as a link to accurate, reputable information. I look forward to swapping stories with you.

Thanks for participating, Candace McLane, MA
 

 
Sample of a Blog Entry

http://www.powermomsunite.com/2009/04/13/striking-a-balance-summer-survival-tips-for-families-managing-adhd/

Striking a Balance: Summer Survival Tips for Families Managing ADHD

One major issue with ADHD and summer vacations is the bored factor. Once the novelty of having all that free-time-to-do-anything wears away, what to do with all that free time becomes a problem. On the other hand, over-scheduling and over-planning the summer can lead to burn-out and irritability for both parents and children. The art of managing ADHD during the summer is really about the art of finding balance. Several strategies can help strike this balance.

Keep a calendar: Use a monthly or weekly calendar and write down vacation, camp and community trip dates. Kids need routine to feel secure, but be sure to leave some dates empty to allow for free time to simple create and imagine in the back yard.

Prescript your day: Early in the day, sit with your child and review what they want to accomplish and what you need to accomplish. Negotiate how each of you will spend your time so as not to conflict. Explicitly state how you expect your child to behave for any important activities (like that very important conference call at 1PM) and be sure to reward them for following the “script.”

Make a summer contract: Use the summer as an opportunity to help your child explore their interests, reinforce their academic skills, and find their passions. Write out a contract with your child, in which they list their goals for the summer. Goals could include places they would like to visit, books they would like to read, cub scout activities they would like to complete, models they would like to build- the list of possibilities is endless. Include goals you and the teacher identify as well. If you have a therapist, consult them regarding activities to persue over the summer break. Activities can be focused on building a friendship with a particular friend, trying new foods with dinner, volunteering at a local soup kitchen, or learning the steps to complimenting a sibling. Set a due date and reward for completing each goal. Consider rewarding the child with a bonus for completing all their goals for the summer.

Loosen up but keep a routine: Part of the brillance of summer is the long days and lazy nights without a tight schedule to keep. The occasional later bedtime and relaxation of the rules are part of the inherent beauty of summer vacation. That being said, basic family rules, chores, and routines still need to be followed. Be mindful that a little sleep deprivation can lead to meltdowns for both parent and child any time of year. Rules about not playing on the computer all day, still need to be followed, even during the summer. Too much screen time robs kids of opportunities to build social skills and develop interests as well as leads to irritability.

Manage medicine: Some parents take a medication vacation over the summer, in an effort to allow their children to gain some weight and height. There is little evidence however, that ADHD medications permanently impact a child’s height. Kids often grow slower than their non-medicated peers, but do eventually catch-up.

Before taking a medication vacation, consider all the aspects of your child’s summer. Will you be taking a long trip, during which time your child will need to sit still? How will you all survive the trip? Will your child be in camp, where she will need to follow directions? Will ADHD behavior make it hard for her to participate in group activities or attend to social cues from new friends? Will your child have lots of unscheduled time with neighborhood kids, in which impulsive behavior could result in unsafe decisions or poor peer interactions? Before taking a medication vacation, consider all these potential situations.

ADHD is a chronic lifelong condition that needs to managed- will your child’s self-esteem, self-image, and social skill acquisition benefit from a medication vacation? Consider your goals for your child’s summer and how a medication vacation could affect your child’s success in their summer activities.

In lieu of a complete ADHD medication vacation, consider the use of shorter acting medications for the most challenging activities of your child’s summer- like a long car ride or plane trip. Shorter acting medications can cause fewer appetite- suppressing effects. Speak with your child’s physician, and collaborate with your child, as you make these decisions. Remember that as you are modeling healthy management of a condition that will likely be a lifelong journey for your child. Fuel their passions, provide opportunities to build skills, and model a healthy approach to symptom management.

Relax: Use the summer to reconnect and play. Just as your kids schedule time to do homework during the school year, schedule regular time to play with your kids every day after work. Play catch, go for a swim, bike down to the ice cream shop- do activities together to build your relationship and create a healthy self- image. Enjoy your summer together!