Treatment for odd and adhd

What to Do When ADHD and ODD Co-Occur

 ADHD Weekly August 9, 2018

You ask your daughter to come to the family dinner table and she launches into an angry outburst. It’s the same routine every evening. You set her curfew for 11 p.m., but she has never gotten home before 1 a.m. In response, you move her curfew to an earlier time, but she continues to ignore it and blows up when you try to talk with her about house rules.

You end up feeling like you’re walking on eggshells around her because you never know how she will respond to even the smallest comment. Your daughter’s behavior upsets the entire family, because no one really knows what will set her off.

Sound familiar? That’s what it can be like to live with a child who has oppositional defiant disorder.

What is ODD?

Oppositional defiant disorder is fairly common among children and adolescents, and often co-occurs with ADHD. It is classified as a disruptive behavior disorder. That means young people who have ODD are often stubborn to an extreme, can be easily angered, argue with their parents and teachers for seemingly no reason, and go out of their way to avoid doing whatever is asked of them. Though most teens certainly act out and test boundaries from time to time as part of their normal development, ODD symptoms usually start much earlier—often around the time a child enters preschool. In addition, ODD behavior is consistently defiant, in contrast to average adolescent rebellion, which comes and goes.

“Parents of kids with noncompliant ODD problems get into these very coercive exchanges,” says Steve Lee, PhD, a professor of psychology at UCLA, a clinical child psychologist, and a member of CHADD’s professional advisory board.

Dr. Lee compares ODD to a border war between two countries, using the political science term “brinksmanship” to describe the conflicts that often arise between children with ODD and their parents, guardians, or other authority figures.

“I move 10,000 troops closer to the border and then what do you do, you move 8,000 troops and some tanks closer,” he says. “It’s sort of like going up to the brink. That’s often what happens with ODD. You have this escalation, this tit for tat, and it can explode, essentially, into a really negative interaction."

That kind of interaction is even more likely when ADHD is added to the mix, he says. ADHD and ODD commonly co-occur, though estimates of how many children in the United States have been diagnosed with both vary. Some sources show figures as high as 40 or 50 percent of all children with ADHD will also have an ODD diagnosis, but Dr. Lee says that number isn’t really accurate because it includes only those children who have been seen by a mental health professional.

Diagnosed with both ADHD and ODD?

As to why ADHD and ODD so often co-occur, Dr. Lee says it’s likely the conditions share some genetic factors. There may also be risk factors for ODD related to home life or environment, or psychological factors. But what’s really important, he says, is the effect of the two diagnoses combined. ADHD tends to make the symptoms of ODD more noticeable, and vice versa.

“When you have the oppositional irritability, noncompliance associated with ODD, that tends to be a very sort of flammable mix with the inattention, and of course with the hyperactivity and impulsivity,” he says. In other words, they build on each other. At the same time, each affects the treatment plan of the other.

“When ADHD is accompanied by ODD, what that tends to predict is a much more treatment-resistant pattern of ADHD,” says Dr. Lee. “It tends to decrease the responsiveness of kids to standard ADHD treatments when it’s accompanied by ODD.” He likens it to treating a cough. If you have a cough but you also have a fever because of an infection, for example, that will make treating the cough more complicated—you’re no longer just treating one problem.

Treatment for co-occurring ADHD and ODD

If your child has been diagnosed with both ADHD and ODD, the best treatment plan is one with a multimodal approach, says Dr. Lee. That means it shouldn’t rely on just one approach, such as medication or behavioral therapy, but find a balance. Though that is true for many people with ADHD, it’s even more important when ODD is also part of the picture.

“When a child has both ADHD and ODD, there may be a couple of other treatment elements that ought to be prioritized more so than if it was just ADHD only,” he says. That will depend on your child and your family situation.

Parent training is often the starting point for ODD treatment. Knowing how to respond to outbursts and bad behavior, as well as how to effectively discipline your child, is essential to helping her learn to manage herself. Individual and family therapy that may include social skills training or cognitive problem-solving skills training is another important tool. Medication is not usually effective in treating ODD alone, but when ODD co-occurs with ADHD, stimulants are still an effective ADHD treatment option.

Looking for more?

  • Oppositional Defiant Disorder Resource Center

  • Coexisting Conditions in Children

  • Disruptive Behavior Disorders

  • Psychosocial Treatments for Children & Adolescents with ADHD

  • Parenting Teens with ADHD

Do you know someone who has been diagnosed with both ADHD and ODD?

ODD Treatment for Children & Adults

How to Help a Child with ODD

Step one to treating oppositional defiant disorder (ODD) is detecting and controlling the symptoms of attention deficit disorder (ADHD or ADD) if they are present. Treatment for ADHD symptoms may include taking a daily stimulant or non-stimulant medication which can sometimes help with oppositional defiant symptoms as well.

Step two is receiving a formal evaluation for other related psychological conditions that can cause oppositional behavior.

Step three is devising a strategy to treat ODD. The preferred ODD treatment is a combination of individual and family behavioral therapy. When therapy alone does not resolve symptoms, medication for ODD can sometimes help. In addition, lifestyle changes can help some people with mild symptoms to control their explosions.

Oppositional Defiant Disorder Treatment Options

Oppositional Defiant Disorder treatment may include:

  • Cognitive-behavioral therapy
  • Parent-child interaction therapy
  • Collaborative problem solving
  • Medication in the form of a low dose, atypical neuroleptic
  • Lifestyle changes

Oppositional Defiant Disorder Treatment: Therapy

Counseling for ODD should include both the patient and his or her family members, and it should emphasize strategies that the family can use to cope with defiant behaviors.

Remember, people with ODD are neurologically hard-wired to defeat and thwart people in roles of authority. They have no intention of cooperating in any therapeutic process.

[Self-Test: Oppositional Defiant Disorder in Adults]
[Self-Test: Oppositional Defiant Disorder in Children]

Individual Cognitive-Behavioral Therapy for ODD

Individual therapy teaches people with ODD a series of techniques for managing anger, controlling emotions, and solving problems. It can provide positive alternative behaviors to replace defiant ones. This type of therapy works best when it begins early in life, when family and social interactions aren’t ingrained and difficult to change.

Family and Parent Training Programs for ODD

Parent- and family-training programs are built on the premise that children behave badly when they realize that doing so gets them what they want. Say your child throws a fit when you ask him to turn off a video game; if you give in even once, he learns that he will sometimes succeed. Parent training teaches caregivers what to do in these stressful, exhausting moments to avoid setting a precedent that will encourage more bad behavior.

Parents learn to change their reactions to a child’s behavior – good and bad. They learn to demonstrate and define their expectations, and then give well-defined rewards and praise when their child behaves accordingly – or consistent consequences when the child doesn’t. Most effective parenting programs are built around these four core principles:

1. Reinforce good behavior with a reward system – like stars on a chart, or extending a special privilege.

2. Discourage negative behavior by ignoring it. Kids often use bad behavior to get attention.

3. Take away a privilege if negative behavior is too serious to ignore.

4. Remove common triggers of bad behavior.

[Free Download: 4 Parent-Child Therapies for Better Behavior]

A therapist will also work with a parent and child together to solve specific challenges. The plan should start with a key, narrow behavior – like no swearing. Parents learn how to give instructions in an authoritative way, use time-outs effectively, praise children, and create rewards systems.

The goal is to incrementally teach a child new ways of behaving and to break the cycle of defiance. By focusing on and rewarding desired behaviors, a parent can help their child experience success, which encourages the child to behave that way again.

The three most common types of parent- and family-training programs are:

1. Parent-Child Interaction Therapy (PCIT) – PCIT is a program that looks beyond bad behavior to examine troubled relationships – and how changing them can improve daily life. It helps parents become better at managing their child’s behavior with real-time coaching. It is most effective for children ages two to seven, and is offered in university-based centers and by individual therapists.

Participating family members interact while listening to advice from therapists behind a one-way mirror, so the child associates the parenting skills with her parent, not the therapist.

2. Collaborative Problem Solving (CPS) – CPS is a program created by Ross W. Green, Ph.D., for defiant teens who have outgrown time-outs. The program focuses on giving kids the problem-solving skills they lack rather than using a reward-and-punishment system.

The first step in CPS is to identify and understand the child’s concern about a problem (completion of homework or chores), and reassure him that the problem will be resolved by the child and the adult together. The second step is to identify the adult’s concerns about the same problem. The third step invites the child to brainstorm solutions with the adult, and to find a plan that is mutually satisfactory.

3. Vive – This is an intensive family therapy program for parents of older kids with behavioral problems. It uses the principles of parent management training, but involves two separate therapists: a “mentor” for the struggling teen, and a “coach” for the parents. The program can help kids become more reflective about problems, and help families recognize patterns in the ways they react to each other. This technique is geared toward families in crisis who can devote a substantial amount of time and money. Fees can be up to $3,000 a month.

Oppositional Defiant Disorder Treatment: Medication

If therapies prove ineffective, medication can sometimes help to “re-wire” oppositional behaviors. No medications are FDA-approved for the treatment of ODD in the U.S. Nonetheless, clinical experience has shown that the majority of children and adolescents with ODD do show signs of improvement with a low dose of atypical neuroleptics – arippirazole (Abilify) and risperidone (Risperidal), for example.

Oppositional Defiant Disorder Treatment: Lifestyle Changes

Families can use many of the techniques taught in behavioral therapy to improve everyday life with defiant behavior while working to diminish it. These techniques include the following:

  • Always build on positives: Praise your child and offer positive reinforcement when he shows flexibility or cooperation. Recognize the “little victories” with enthusiasm.
  • Learn to control yourself: Take a time-out or break if you suspect you are about to make the conflict with your child worse, not better.
  • Pick your battles: Since a child with ODD has trouble avoiding power struggles, prioritize the demands you put on your child.
  • Provide structure: Bad behavior tends to escalate when a child has unsupervised free time and unclear expectations. A daily routine, on the other hand, lets a child know what to expect.
  • Position behavioral issues as problems she can solve: Explain to your child that ignoring an alarm clock doesn’t help her get to school on time, and ask what she can do to avoid being tardy again.
  • Set up reasonable, age-appropriate limits and enforce consequences consistently: Resist the temptation to rescue the child from naturally occurring consequences.
  • Don’t go it alone: Work with and get support from the other adults (teachers, coaches, and spouse) who interact with your child. Look for local support groups and/or parenting classes for parents of difficult children.
  • Avoid burnout: Maintain interests other than your child so that managing her behavior doesn’t sap all of your time and energy. Manage your own stress with exercise and relaxation. Use respite care as needed.

Additionally, supplements may improve certain symptoms of ODD. Be sure to consult with a physician before trying any of the alternative therapies below.

  • Omega-3 Fatty Acids to regulate mood and emotions
  • Vitamin E to help absorb Omega-3s
  • Melatonin to help normalize sleep patterns
  • Zinc to help neutralize brain chemicals that can lead to hyperactivity and impulsivity

For adults, reading about ODD can be an asset. Taking Charge of Anger, a book by W. Robert Nay, Ph.D., gives practical advice that may benefit an adult with the condition.

[Back From the Brink: Two Families’ Stories of Oppositional Defiant Disorder]

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Diagnosis of ADHD in a Child: Symptoms and Treatment with Diet

Alternative Opinion

At the time I started my studies at the New York Institute of Integrative Nutrition, I had already heard the term “human microbiome” and learned that bacteria can play a crucial role in neurological diseases. And at that very moment, one of my subscribers recommended the book Brain and Gut by David Perlmutter to me. When I read it, I thought: there is hope. I immediately sent an e-mail to David, and during the first holidays I flew to Naples, USA, to his clinic. It was difficult to call what Perlmutter prescribed to Vanya a treatment: a carbohydrate-free diet, probiotics, enzymes and vitamins. There was nowhere to retreat, and the whole family plunged headlong into a new life. Adjusting the diet was difficult at first. The son adored pastries and had a sweet tooth, the basis of his diet, like most modern children, was carbohydrates. To support him, the whole family had to switch to a low-carb diet. Frankly, he constantly complained about the new diet, but I tried to find dishes from the ketogenic diet that he would like. If at home everything was simple - there were only allowed products in the refrigerator and on the kitchen shelves - then it was more difficult with the school cafeteria. Therefore, Vanya always had a delicious snack with him. The change in my son's behavior happened so smoothly that I did not immediately realize it. And when the effect became noticeable not only to me, I began to study the effect of the ketogenic diet on the brain with redoubled energy. And I found another doctor, but already in Moscow, who adheres to a similar system for treating similar diseases - MD, head of the center for the diagnosis and treatment of epilepsy, epileptologist Vasily Generalov. nine0005

“ONE PERFECT DAY I SAID TO HUSBAND: “Look, our son has stopped chewing his sleeves and constantly fidgeting in his chair.”

Eat to live

As the doctors explained to me, neurologists believe that the causes of behavioral disorders in ADHD are changes in the biochemistry of neurons and neurotransmitters. At the biochemical level, our behavior depends on the balance of excitatory and inhibitory mediators, the sensitivity of brain receptors, and the stability of neuronal membranes. For example, on some days of the month, a woman may be unreasonably irritable because her hormones are changing. And a child with ADHD has a constantly altered biochemistry - this is his underlying disease. Food and its components can lead to such an imbalance in the functioning of the brain. Substances such as gluten (wheat gluten) or casein (cow's milk protein) in the metabolic chains can have a strong stimulating effect. The result is overexcitation, aggression, unmotivated tantrums. For some children with ADHD, it is enough to remove flour from the diet so that they become calmer and more assiduous. Therefore, if there are symptoms of ADHD, it is recommended to completely eliminate gluten-containing foods, replace cow's milk with goat's milk dairy products, forget about confectionery, honey, jam, factory and freshly squeezed juices, and limit fruit consumption. Congenital and acquired features of vitamin and microelement metabolism will also be manifested by a violation of the child's behavior and learning ability. Particular attention should be paid to iodine and B vitamins; if they are deficient, vitamin complexes should be used. nine0005

Victory Day

Briefly, the main principle of syndrome therapy can be formulated as follows: filling the body with the necessary substances and reducing inflammation. The second direction is the replenishment of deficits. What is lacking in the body for biochemical processes to proceed normally. My son's behavioral problems, which seemed to have to be solved by a psychologist, were dealt with by the diet. One day I said to my husband: “Look, he stopped chewing his sleeves, stopped fidgeting in his chair.” Of course, I'm not saying that this is the only way to treat ADHD, but we've tried everything and diet is the only method that really worked. Although it is too early to say that the problem is completely gone! As soon as the relaxation of the diet on vacation begins, I immediately see a deterioration in diction, a decrease in the ability to focus. Only six months have passed since the day when the school principal told me that my son was not coping with the program and was staying for the second year: I sat in front of my son's teachers and recalled what he had gone through during this time. He has achieved impressive results, I am proud of him and want to share this experience with all mothers who are faced with the same problem as our family. Don't give up: we can help our beloved children. The main thing is to find the right doctor. nine0005

What is ADHD and why the diagnosis is not a sentence

Attention deficit hyperactivity disorder occurs in every tenth child. However, not all doctors can diagnose it. Without treatment, it progresses, worsening the quality of life. So how can you help ADHD patients?

What is ADHD

Attention deficit and/or hyperactivity disorder (ADHD) is a neurological-behavioral developmental disorder that occurs in childhood. Pathology has more than a dozen symptoms. The most common are the inability to concentrate for a long time, absent-mindedness, inattention, restlessness, irascibility, poor memory. From the side it seems that such a person seems to be “flying in the clouds”. nine0005

Doctors distinguish three subtypes of mental disorders.

  • The first - with a predominance of attention deficit. The person cannot concentrate, is distracted, forgetful.
  • The second is hyperactive and impulsive. When it is difficult to stay in one position for a long time and restrain emotional impulses.
  • Third - mixed. Combines the features of the first and second. Occurs most often.

The listed symptoms are attributed to character traits, accusing a person or oneself of laziness, procrastination and conflict. In fact, it is not the individual who is “guilty”, but his brain and nervous system. According to the International Classification of Diseases, ADHD is classified as a hyperkinetic disorder. nine0005

In Russia, the syndrome is not well understood. Not all specialists are aware of it and know the evaluation criteria. Many do not understand how to diagnose and treat a disease, Olga Demyanenko, a family and child psychologist of the highest category, told RBC. This leads to the fact that sometimes healthy children are given this diagnosis erroneously. And those who really suffer from ADHD do not get the help they need.

How to recognize ADHD in children

Some specialists can diagnose ADHD even in children under one year old. The main symptoms are severe excitability and hyperactivity. Babies often cry, scream, twitch their arms and legs, says Olga Demyanenko. In older children (4-5 years), attention deficit hyperactivity disorder is more pronounced. nine0005

“The child is constantly on the move, it is difficult for him to sit still. And this is not connected with some kind of game - he needs movement in itself. He switches very quickly. He took one toy, played, then another. Also, he cannot keep his attention on something for a long time. He needs a switch, he gets tired quickly. Plus, it’s hard to calm down, he can’t fall asleep for a long time, ”says Demyanenko.

A child with ADHD finds it difficult to follow instructions and often does not even hear what is being said to him. Also, a small person cannot behave quietly and with restraint, even when there is no reason for concern. He talks loudly, laughs loudly, screams. nine0005

How common is ADHD

The disorder affects approximately 2-10% of children. Research data on this matter vary. In boys, pathology is diagnosed several times more often than in girls.

Some children outgrow this syndrome. That is, mental functions are restored as they grow older. But this is not always the case. In adulthood, the syndrome is present in 2-4% of people, French researchers report in their work. More than half of the people who were diagnosed with ADHD in childhood have symptoms of the disease that persist into adulthood, Anna Portnova, head of the Department of Child and Adolescent Psychiatry at the Moscow Research Institute of Psychiatry, a branch of the National Medical Research Center for Psychiatry and narcology named after V.P. Serbsky" of the Ministry of Health of Russia. nine0005

Adults show the same symptoms, including inattention, hyperactivity and impulsivity, and emotional dysregulation. If left untreated, in adulthood ADHD is superimposed in 80% of cases by other psychiatric disorders - anxiety disorders, neurodevelopmental disorders associated with the use of psychoactive substances, sleep disorders, restless legs syndrome. It's hard for people like that. All spheres of life "suffer" from this disease.

The degree of influence of ADHD on a person depends on his personal characteristics. One will be able to adapt and live normally, the other will go downhill. According to a recent study, among youth and adult offenders in police custody, prisons, probation and forensic psychiatric institutions, about 25% suffer from ADHD. They are at a disadvantage in the system because their symptoms are not recognized or misunderstood. Instead of providing psychiatric care, disciplinary sanctions are applied to them, which does not help. nine0005

Causes of ADHD

The work of the brain in children with ADHD and in healthy children is different, scientists from the Northern (Arctic) Federal University named after. M.V. Lomonosov. With a mental disorder, the energy metabolism in the frontal sections of the brain changes. They are the key links in the regulation of behavior and emotions, and are also responsible for the function of programming and control. There is a decrease in metabolism and a decrease in the functional connections of the frontal regions with other brain structures. With ADHD, the left and right hemispheres do not “get along” well with each other, the connections between them are broken. “Imbalances in the relations of regulatory subcortical-stem structures” are noted. nine0005

Doctors have not yet determined the exact cause of these disorders. It is believed that a significant role is played by hereditary predisposition. Also, ADHD in a child may develop due to the fact that his mother smoked during pregnancy, drank alcohol or drugs. The disorder may occur due to complications in childbirth or chronic illnesses of the mother.

Researchers from the Rostov State Medical University conducted a study and found that the uncontrolled use of digital technologies in childhood increases the symptoms of ADHD. And also leads to increased aggression and irritability, isolation, inability to control emotions, increased feelings of anxiety, anxiety and fear. nine0005

How to treat ADHD

Attention Deficit Hyperactivity Disorder needs to be diagnosed by several specialists. This is a neurologist or neuropathologist, as well as a neuropsychologist or clinical psychologist and psychiatrist. Only after making sure that the diagnosis is correct, you need to take action.

Not only drugs are important for a child, but also the right psychological and pedagogical approach, warns Anna Portnova. According to her, a good teacher will put such a student on the first desk and will try to keep his attention. And the bad one will send him to the last one and will constantly make comments, thereby aggravating the child’s condition. nine0005

Cognitive behavioral therapy performed by a psychologist or psychiatrist is also effective in the diagnosis of ADHD.

There are drugs that improve brain function and activate attention function. But in Russia there are few registered. We simply do not have many drugs that have proven effectiveness, says Portnova. And this is a big problem.

Therapy with a psychologist is a more affordable option for correcting ADHD symptoms for Russians. And it is quite effective in most cases. nine0005

Still from the TV series The Good Doctor. Caption: The character on the show, Salen Morrison, has ADHD. She uses original methods for concentration: meditation, playing the ukulele, as well as many gadgets - fitness bracelets, tablets, etc.

How to live with ADHD as an adult

Attention deficit and/or hyperactivity disorder persists into adulthood. Experts say it is possible to adapt to this condition, even without the use of medication. A person with ADHD can be successful both in his personal life and in his profession. This can be achieved by controlling your habits, learning to recognize and use your strengths, and controlling your behavior. nine0005

Psychologists advise a person with ADHD to properly organize their workspace by removing unnecessary items from the table. For example, a stack of unnecessary papers or books. In order not to forget anything, you can make a to-do list every day. A great help for a person with this disorder can be a day planner, a calendar on a smartphone or computer. People with ADHD like to procrastinate. To avoid this, follow the principle: if a task can be completed in two minutes or less, do it now. nine0005

People with ADHD find it difficult to properly manage their time. To avoid this, psychologists advise using a watch. When you start doing work, write down the time and say it out loud. For each task, it is necessary to allocate a certain time period. This is easy to do using a timer or an alarm clock. Let it fire at regular intervals. This makes it harder to lose track of time, a common problem for people with ADHD.

Adults with Attention Deficit and/or Hyperactivity Disorder are often overly impulsive. They jump from one task to another. This may interfere with work. Experts recommend always starting with the most important task. The main mistake is to take on too much work.

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