Treating ADHD and ODD in Children

Attention-deficit hyperactive disorder (ADHD) and oppositional defiant disorder (ODD) are commonly linked mental health disorders that children exhibit. This paper examines some of the challenges that both children and parents face as a result of living with these disorders. It suggests some positive approaches to parenting that parents may find useful and offers recommendations in terms of how parents can most positively help a child with ADHD or ODD. The most important conclusion that this paper provides is the notion that parents must be able to demonstrate patience over the long term while facilitating their love and support for the child with guidance, reinforcement, and education. Eliminating stress from the child’s environment can be especially helpful in allowing the child to deal in a healthy manner with the impulses he or she feels, and parents, for their part, may benefit from parental training so that they can learn what to avoid and what to do when a child with ADHD or ODD acts in a certain way. This paper also notes that while medications are available for treatment of children with ADHD and ODD, they should not be relied upon as a cure-all but rather as a support as the parent and the child both attempt to cope with the disorder and learn to interpret and respond appropriately to impulses.

I. Introduction
a. ADHD and ODD are commonly linked (Harvey, Breaux & Lugo-Candelas, 2016)
b. Opposition can stem from feelings of rejection on the part of the child with ADHD
c. Parents who are stressed can compound these negative feelings (Hutchison et al., 2016)
d. Parenting children with ADHD and/or ODD requires patience and training.
II. Body
a. The issue
b. Challenges
i. For children
ii. For parents
c. Positive Methods that can Help
i. One-to-One Time
ii. Knowing the History of the Disorder
iii. Receiving Parental Training (Daley et al., 2017)
iv. Reducing Stress
v. Medication
III. Conclusion
a. Parents must be supportive
b. There is no overnight fix, and patience and skill are required.

As Harvey, Breaux and Lugo-Candelas (2016) point out, attention-deficit hyperactive disorder (ADHD) and oppositional defiant disorder (ODD) are “among the most common childhood disorders and frequently co-occur” (p. 154). Parents who must cope with raising a child who suffers from ADHD are fairly likely to also have to address the issue of ODD as well. Many researchers have examined various methods of parenting children with ADHD and/or ODD. Hutchison, Feder, Abar and Winsler (2016) have noted, for instance, that there is a distinct relationship between stress factors, parenting style and child executive functioning for children with ADHD. Indeed, one of the major findings of Hutchison et al. (2016) is that “in general, increased parenting stress [is] associated with greater use of authoritarian and permissive parenting styles, as well as more problems with behavior regulation for children” (p. 3644). What this means is that the challenge of parenting a child with ADHD or ODD can be very stressful for parents who are not effectively trained to handle the situation, which creates a negative feedback loop for the children, with the parents’ stress increasing the child’s inability to cope or function with his or her own ADHD/ODD symptoms. As Hutchison et al. (2016) state: “Authoritarian and permissive parenting styles [are] associated with poorer child executive functioning” (p. 3644). This paper will discuss the issue of parenting children with ADHD or ODD, identify some of the main challenges, and propose some positive methods that researchers have shown can be effective ways to help parents better cope with their child’s special needs.

Parenting a child with ADHD or ODD requires a special set of knowledge on the parents’ part to ensure that the child receives the support and structure needed to navigate the challenges posed by the disorders. ADHD or ODD can be treated via a number of different methods in which pharmacological intervention or behavioral therapy may be introduced to assist with the child’s development and/or coping with the disorders.

In any event, parents are tasked with creating a loving and stable environment that can easily be disrupted by what they perceive to be the uncaring actions of an unconcerned and undisciplined child. Parents can experience feelings of guilt (sensing that they have done something wrong to make their child this way), anger and frustration (feeling that their child is simply bad and cannot be fixed), and despair (giving up all hope that the situation can be solved). Children with ADHD and/or ODD, however, still require love and attention, care and consideration, so that they can grow and develop into functioning adults. It is critical, therefore, that parents be aware of the challenges that are to be faced by both children with ADHD and parents who must raise them.

It is important to realize that ADHD or ODD can be particularly challenging for the children themselves, not just for the adults who must parent the children. A child who has ADHD experiences a range of emotions and impulses that often prevent the child from limiting his or her train of thought to a single idea or subject. In many cases, a child with ADHD will see numerous corollaries to a single idea and feel compelled to explore them. At the same time, the child may experience the underlying problem of engaging in so many tangential sequences, but—feeling frustrated by his or her inability to prevent the mind from exploring these tangents—the child can easily become upset, distracted, and annoyed. These feelings may be directed inward or outward, and can be manifested in what amounts over a period of time to ODD. The child’s eventual oppositional attitude is a reflection of the inner self being at odds with itself. At one and the same time, the child may want to focus on a single activity while wanting to do several others too. This produces tension and conflict within the body, mind and will of the child. The challenge for the child is to understand these conflicting impulses and develop the ability to control them, which can in all fairness be at times beyond the child’s grasp (Caye, Swanson, Thapar et al., 2016).

Children are also faced with the challenge of developing relationships with peers, which is a task that can be quite difficult for children with ADHD and/or ODD (McQuade & Hoza, 2015). Misbehavior often stems from the child’s inability to control impulses, which can upset other children and cause the child with ADHD or ODD to be isolated, feel cut off, disliked, unloved and even despised. It is difficult for children with ADHD to comprehend why they marginalized and their responses to feelings of marginalization can increase the distance between them and their peers even more—especially if those feelings are represented confrontationally. This can easily carry over into school performance. Czamara et al. (2013) show that ADHD is one of the most common neuro-behavioral childhood disorders, noting that 5% of all school children are affected by ADHD and that half of all children with ADHD present to teachers as students with a learning disability.

Children who suffer from ADHD require special, individualized attention and education that engages them in a one-on-one format. Siegel and Bryson (2012) state that “our brain has many different parts with different jobs” and because the brains of children are still developing, their environment and the people they interact with can have a very formative impact on how they perceive themselves and their world. That is why it is critical that they not feel abandoned, neglected, or marginalized during this difficult time in which they are learning to cope with their own ADHD and the struggles that go along with it (p. 6). A child who experiences undue stress because of a tense environment or because of tense relationships with peers and parents will undoubtedly feel the consequences in terms of psychosocial development (Sandstrom, Huerta, 2013). Providing children with a consistently loving, positive and supportive environment in which the child receives one-on-one attention from the parent can be one of the most supportive and helpful ways of helping the child to cope with his or her impulses and show the child that he or she is still loved by the parent. This approach admittedly requires a seemingly infinite amount of patience on the part of the parent, but the parent cannot give to the child what the parent does not possess. If the parent seeks to instill in the child a habit of patience, that must be demonstrated by the parent towards the child. The less patient a parent is with a child with ADHD, the less patient the child will be with him or herself (Johnston & Chronis-Tuscano, 2015).

This demonstration of patience can of course be challenged by the expression of ODD which is likely to accompany a child’s ADHD in many cases. The symptoms of oppositional defiant disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM) were, until recent years (prior to the publication of the DSM-V), characterized by:

· a demonstrated pattern (6 months or more) of negative and defiant behavior, including at least 4 of the following activities
· frequent loss of temper, arguing with parents or persons of authority, and refusal to conform to rules set by either
· deliberate acts to annoy or irritate
· placing blame or fault on others
· demonstrations of revenge

The DSM-IV also noted that ODD should not be classified as such until it impairs the person’s ability to function socially, academically or occupationally (American Psychiatric Association, 2000). A parent should be aware of the DSM’s previous characterizations, especially since the latest edition—the DSM-V—has adapted the definition and simplified it to consist of: “angry/irritable mood, argumentative/defiant behavior, and vindictiveness” (American Psychiatric Association, 2013, p. 15). Many children can display this type of behavior without a parent needing to worry that the child has ODD. Since the “exclusion criterion” used in DSM-IV is not included in DSM-V criteria, diagnosing ODD may occur more frequently than in days past. There is also no severity rating used to determine how pervasive the symptoms are. Instead, ODD is grouped with conduct disorder and intermittent explosive disorder under the heading Disruptive, Impulse-Control, and Conduct Disorders. In DSM-V, Oppositional Defiant Disorder, Conduct Disorder, Antisocial Personality Disorder, Kleptomania, and Pyromania are all gathered together into a chapter entitled “Disruptive, Impulse-Control, and Conduct Disorders.”

A parent who is informed on the ways in which the medical community is approaching mental health disorders is a parent who can confidently take ownership of making decisions about his or her child’s well-being. In many cases, parents feel helpless and rely on the professional expertise of health care providers. This type of reliance can actually undermine the parent’s own privilege and duty towards the child in the sense that the parent looks for a third-party intervention team to “solve” the problem instead of taking ownership of it him or herself. Joshi, Connelly and Rosenberg (2014) emphasize the point that families are a social structure and in order for that structure to hold, it must have consistency, stability, and principled foundations on which development and growth can be based. A parent seeking to provide the support for that structure must be informed and self-reliant and self-actualizing rather than wholly dependent upon third-party intervention. Ultimately, it is the parent who must raise the child and must interact and guide the child on a daily basis—not the medical practitioner. Seeing and knowing how even the medical experts are continually revising their own understanding of mental disorders should give the parent confidence to engage with a child’s disorder: the reality is that everyone—from parents to health care providers to the children themselves—are working to understand the way the mind, body and will interact, and no one has a monopoly on that knowledge. This understanding should empower parents to engage with and devote themselves to their child.

Parent training is recommended as another helpful method for parents of children with ADHD. As Daley, Van Der Oord, Ferrin et al. (2017) state, “initial positive results have been found in relation to parental knowledge, children’s emotional, social and academic functioning.” Parent training, including “specialised ADHD parent training approaches – delivered either individually or in groups – have reported beneficial effects” (Daley et al., 2017). This finding has been supported by Pryor-Kowalski (2013) who showed that the relationship between “intensive parenting” and child development was very critical. Pryor-Kowalski found that when parents create empathetic environments for their children, the children tend to develop more positively and overcome struggles associated with mental health issues. On the other hand, parents who do not engage in intensive parenting or lack any training whatsoever tend to facilitate only a negative process of development that can lead the child with ADHD or ODD to tend down a path toward delinquency.

One of the methods taught by family therapists to parents raising children with ADHD or ODD is the carrot/stick approach: parents are taught to reward good behavior, such as listening and cooperating, while punishing inappropriate behavior so that children know that there are consequences for following bad impulses. Punishment should never be abusive but should be equal to a time-out or the taking away of an incentive for an appropriate period of time. The loss of freedom or of the opportunity for reward will help to get the child to think about what he or she has done to warrant the punishment and the desire to be back in “good graces” can stimulate the child to take ownership of his or her own feelings. It is important for the parent to remember, however, that this is not an overnight solution or one that can be expected to work in the same way that light comes on when a light switch is flipped. Children of all ages, whether they have ADHD or not, must work through their emotions and learn to respond to stimuli and impulses in an appropriate way. Childhood lasts many years because this is a process that is not accomplished in days or weeks or even months. It is a process that is refined over time and that the child only learns to appreciate as specific developmental milestones have been reached. Just as potty training is an event that will suddenly “click” with a child after months of practice or even after a period of regression, so too does the method of impulse control and the recognition that there are patterns of behavior that are acceptable and patterns of behavior that are unacceptable come to the child after a substantial period of reflection, growth and development. The parent must be willing to maintain a posture of dignity, patience, attentiveness and guidance throughout.

Because the child with ADHD or ODD is responding to impulses within the child’s mind or body, these impulses can actually be both negative and positive. For parents who want to help the child adjust to the struggle of coping with so many impulses at once, one of the best things the parent can do is simply to reduce the amount of stress that the child feels in his or her environment. Stressful environments can breed negative impulses—feelings and/or compulsions within the child to exercise his or her own “fight or flight” instinct. If stress is reduced, the child’s impulses can reflect healthier feelings, ideas, and desires that are not informed or produced by stressful, tense encounters. A parent who is capable of keeping an environment relaxed and supportive is one who, while not always able to dictate control over a child’s impulses, can at least help to ensure that those impulses come from a positive place rather than from a negatively reactive place within the child.

While medication is an option for children with ADHD or ODD, it should not be viewed as a cure-all or as a substitute for any of the above-mentioned practices. Instead, medication should be viewed as a patch, sometimes temporary and sometimes needed for longer periods of time. It can help to moderate the mood, impulses, and attention-span of the child but in terms of teaching the child about how to interpret decisions, actions, impulses and behaviors, medication cannot be relied upon. It is often prescribed in a supportive role to help parents while they undergo parent training or behavioral therapy. It should never be used solely as an end in itself or believed by parents to be the solution that children with ADHD or ODD need. What such children need more than anything is a supportive environment in which stress is minimal and patience is seemingly infinite. This type of atmosphere will help, along with direction and guidance from a parent who has received training, the child to better develop, gain ownership of, and respond to the impulses generated as a result of the disorder.

In conclusion, attention-deficit hyperactive disorder and oppositional defiant disorder are two disorders that typically coincide with one another. A child who suffers from ADHD is one who is subject to a prolonged stretch of impulses that can appear to distract the child from following a single line of thought to conclusion or from staying focused on a single task for any reasonable period of time. ODD can stem from feelings of aggression, agitation, and isolation that the child feels as a result of his or her own lack of impulse control. In these cases, it is important for the parent to understand the child’s challenges as well as his or her own as a parent. Knowing how these disorders have been viewed and treated in the past can provide the parent with a sense of empowerment so that he or she can with confidence take ownership of the situation and respond to it like one ready to assume responsibility. However, in many cases, parents of children with ADHD or ODD should be willing to receive special training to facilitate their approach to the struggles that their child will encounter. Children who have these disorders need patience and stress-free environments along with positive reinforcement and correction when necessary. The goal is not to express dictatorial or authoritarian control over a child’s impulses, but rather to help the child develop an understanding of how to respond to an array of impulses in a manner that is beneficial to all. This can only come with time, guidance, patience and love. Both parents and children may become frustrated at times, but this is a natural part of the process of growth.