ADHD and ODD – what’s the treatment?

It is imperative that a child with ADHD and Oppositional Defiant Disorder (ODD) receives the treatment they need as soon as possible, as ODD in particular has a deleterious effect on their relationships and future development. But how can these children be supported most effectively? And why does a timely approach matter? Dr. James Wiley explains.

The risks of ODD being left untreated

A child’s level of aggression can escalate. Certainly, when you have a child who is frustrated and angry and you add the hormones of adolescence – this can lead to more aggression and more acting out. The more that young person is punished, whether that’s exclusion, or restricted or physically punished, the more anger rises. At some point, the young person asks themselves, “What do I have to lose”? This is where their behavior can escalate.

I often tell parents in these situations that it’s as though you’ve given them a prison sentence – they have nothing else to lose; they might as well act out in any way that they wish and they probably don’t feel like they can succeed. The pendulum swings to one extreme and they become more protective, perhaps more aggressive, or they shut down more. Instead of just not doing their homework, they don’t show up at school and become truant because they feel like they can’t be successful anyway, so why bother going. Those are just examples of the natural consequences of us not getting a handle on ODD.

Treating ODD

As of now, there’s no medication for ODD. Although I’m not a therapist myself, my understanding is that the aim of treatment is to unlock the underlying reason for that oppositional defiant behavior. Many people who were diagnosed with both ADHD and ODD, have been found to reduce oppositional defiant behavior, once the ADHD is treated with stimulant medications. Let me be clear, however, this is not a treatment for ODD. Nevertheless, I think the studies are clear in that when ADHD is treated or when OCD is treated or when a mood disorder is treated, then the ODD symptoms diminish because of the treatment of those comorbid mental health issues. So, in my opinion, treating the co-morbidity and then working with a behavioral therapist can be helpful.

Parent training

This is where parent training really shines. Because parents are up against this opposition behavior and so are teachers, for that matter – and they don’t know where this behavior is coming from. The assumption is, almost always in my experience, to blame the child. To say things like – “they’re being noncompliant, they’re not trying, they’re having a meltdown, they’re becoming disruptive or they’re becoming aggressive”. This is what people would typically describe as naughty behavior.

Whereas, from our clinical perspective, we like to say it’s neurological, it’s not naughty behavior. It looks like naughty behavior but they’re not trying to be bad – there’s something that’s driving that behavior. A great example of that is the kid with ODD who won’t complete a writing exercise because they don’t like the way it looks on the paper and so they tear it out and they won’t start the task because they’re not certain what it is the teacher wants them to do. Pediatricians, parents and teachers aren’t trained to recognize these very important triggers for this behavior and kids are left with the blame as well as being incorrectly labeled.